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Archive for October, 2016

2017 Home Health Final Rule Released

Monday, October 31st, 2016

On October 31, the Centers for Medicare & Medicaid Services (CMS) released the final rule for the home health prospective payment system (HH PPS) for calendar year (CY) 2017. This rule reduces HH payments by 0.7%. This net cut includes a 2.8% market-basket update and 0.3 percentage point cut for productivity, as mandated by the Affordable Care Act (ACA). It also applies the second of three planned 0.9 percentage point cuts to account for estimated case mix growth from CYs 2012 through 2014 that the agency states was unrelated to increases in patient acuity. In addition, the rule implements the final year of the four-year phase-in of the rebasing of this payment system, a 2.3% cut, as mandated by the ACA.

The final rule can be found at https://federalregister.gov/d/2016-26290

Opportunities for Clinicians to Join APMs Announced

Tuesday, October 25th, 2016

The Centers for Medicare & Medicaid Services (CMS) has announced new opportunities for clinicians to join Advanced Alternative Payment Models (APMs). These models were developed by the CMS Innovation Center to improve care and potentially earn an incentive payment under the Quality Payment Program(QPP) created through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The QPP rewards clinicians with sufficient participation in Advanced APMs that align incentives for high-quality, patient-centered care. By giving more clinicians the opportunity to participate in these models, this announcement will extend the benefits of high-quality, coordinated care to more Medicare beneficiaries.

CMS expects to re-open applications for new practices and payers in the Comprehensive Primary Care Plus (CPC+) model, as well as new participants in the Next Generation Accountable Care Organization (ACO) model for the 2018 performance year. In addition, CMS is announcing that the Innovation Center’s Oncology Care Model with two-sided risk will now qualify the model as an Advanced APM beginning in the 2017 performance year. In 2017, under the Quality Payment Program, clinicians may earn a 5 percent incentive payment through participation in the certain Advanced APMs.

For more information, go to https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-10-25.html

Quality Payment Program Final Rule Issued

Friday, October 14th, 2016

On October 14, the Centers for Medicare & Medicaid Services issued a final rule with comment period implementing key provisions of the new physician payment system required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA, which repealed the Medicare sustainable growth rate (SGR) methodology and required the establishment of a new physician quality and value-based payment program. The new program, the Quality Payment Program (QPP), begins calendar year 2019. The regulation establishes rules for clinician participation in the Merit-Based Incentive Payment System (MIPS). It also details how clinicians can qualify for incentive payments based on participation in Advanced Alternative Payment Models (APMs).  The rule also finalizes policies related to blocking of health information and electronic health record (EHR) surveillance that apply to all hospitals, critical access hospitals, and physicians.

For further details, go to https://qpp.cms.gov/docs/CMS-5517-FC.pdf

CMS Announces New Initiative

Thursday, October 13th, 2016

The Centers for Medicare & Medicaid Services (CMS) has announced a new initiative to improve the clinician experience with the Medicare program. Acting Administrator Andy Slavitt is appointing Dr. Shantanu Agrawal to lead the development of this function and its implementation, which will cover documentation requirements and existing physician interactions with CMS, among other aspects of provider experiences. To ensure CMS is hearing from practicing physicians, each of the ten CMS regional offices will oversee local meetings to take input from physician practices within the next six months, with regular meetings thereafter.

The first action is the launch of an 18-month pilot program to reduce medical review for certain physicians while continuing to protect program integrity. Under the program, providers practicing within specified Advanced Alternative Payment Models (APMs) will be relieved of some scrutiny under certain medical review programs. Advanced APMs were identified as a potential opportunity for this pilot because participating clinicians share financial risk with the Medicare program. Two-sided risk models provide powerful motivation to deliver care in the most efficient manner possible, greatly reducing the risk of improper billing for services. After the results of the pilot are analyzed, CMS will consider expansion along various dimensions including additional Advanced APMs, specialties, and provider types.

For more information, visit https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-10-13.html