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Policy Snapshot
October 10, 2019

This week, the Department of Health and Human Services (HHS) announced proposed changes, by the Centers for Medicare & Medicaid Services (CMS) and the Office of the Inspector General (OIG), to modernize and clarify the regulations that interpret the Physician Self-Referral Law (the “Stark Law”) and the Federal Anti-Kickback Statute.

The proposed rules are aimed at providing greater certainty for health care providers participating in value-based arrangements and providing coordinated care for patients. The proposals would ease the compliance burden for health care providers...

Policy Snapshot
October 10, 2019

On October 7, the Centers for Medicare & Medicaid Services (CMS) announced a major change of the information available to nursing home residents, families, and caregivers on the Nursing Home Compare website. Beginning October 23, CMS will display a consumer alert icon next to nursing homes that have been cited for incidents of abuse, neglect, or exploitation.

The new alert icon will be added for facilities cited on inspection reports for one or both of the following:

  • Abuse that led to harm
  • ...
Policy Snapshot
October 10, 2019

The Centers for Medicare & Medicaid Services (CMS) is hosting a webinar on Wednesday, October 16, from 2 to 3:30 PM ET to provide information about the Eligible Measures Applicability (EMA) process, which checks for additional clinically related quality measures that could have been included in data submission for the Quality Performance Category of the Merit-based Incentive Payment System (MIPS).

The EMA process is applied when submitters are in a small practice and choose Medicare Part B claims as their collection type, or when submitters work with a third-...

Policy Snapshot
October 10, 2019

Important Merit-based Incentive Payment System (MIPS) dates and deadlines:

  • December 31 – 2019 Promoting Interoperability Hardship Exception and Extreme and Uncontrollable Circumstances Applications deadline
  • December 31 – 2020 virtual group election period closes
  • January 2 – 2019 MIPS performance period data submission window opens
  • March 31 – 2019 MIPS performance period data submission window closes

For more information:

  • ...
Policy Snapshot
October 3, 2019

Starting January 1, 2020, under the CY 2020 Physician Fee Schedule proposed rule, the Centers for Medicare & Medicaid Services (CMS) plans to pay Opioid Treatment Programs (OTPs) through bundled payments for opioid use disorder treatment services for people with Medicare Part B, including medication-assisted treatment medications, toxicology testing, and counseling.

Get ready to participate in the...

Policy Snapshot
October 3, 2019

To form a virtual group for the 2020 Merit-based Incentive Payment System (MIPS) performance year, you must follow an election process and submit your election to the Centers for Medicare & Medicaid Services (CMS) via email by December 31.

For more information:

  • ...
Policy Snapshot
October 3, 2019

Starting in September, clinicians who were qualifying Alternative Payment Model (APM) participants based on their 2017 performance will begin receiving 5% APM incentive payments. The Centers for Medicare & Medicaid Services (CMS) posted a new 2019 APM Incentive Payment Fact Sheet to explain:

  • Who is eligible to receive an APM incentive payment in 2019
  • How CMS determines your payment
  • Answers to frequently asked questions
  • ...
Policy Snapshot
October 3, 2019

For the second year in a row, the Centers for Medicare & Medicaid Services (CMS) proposed sweeping changes to evaluation and management (E&M) coding. In its annual release of the physician fee schedule (PFS) proposed rule, CMS proposed to align the previously finalized E/M office visit coding changes with the framework adopted by the American Medical Association’s CPT Editorial Panel. Since last year’s proposal, which

...
Policy Snapshot
September 26, 2019

On October 1, the new Patient Driven Payment Model (PDPM) is replacing the Resource Utilization Group, Version IV (RUG-IV) for the Skilled Nursing Facility (SNF) Prospective Payment System (PPS). PDPM improves the accuracy and appropriateness of payments by classifying patients into payment groups based on specific, data-driven patient characteristics, while simultaneously reducing administrative burden.

Changes to the assessment:

  • Both RUG-IV and PDPM use the Minimum Data Set (MDS) 3.0 as the basis for patient assessment and classification, but the assessment
  • ...
Policy Snapshot
September 26, 2019

Medicare pays Medicare Diabetes Prevention Program (MDPP) suppliers to furnish group-based intervention to at-risk Medicare beneficiaries:

  • Centers for Disease Control and Prevention (CDC)-approved National Diabetes Prevention Program curriculum
  • Up to 2 years of sessions delivered to groups of eligible beneficiaries

Find out how to become a Medicare enrolled MDPP supplier:

  • Obtain CDC preliminary or full recognition: It takes at least 12 months to obtain preliminary recognition and up to 24 additional months to achieve full recognition;
  • ...