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Quality Payment Program: Reporting Patient Relationship Categories

Policy Snapshot
Centers for Medicare and Medicaid (CMS), Payment, Quality Payment Program (QPP), Practice Management, Practitioners
August 8, 2019

Merit-based Incentive Payment System (MIPS)-eligible clinicians: The Centers for Medicare & Medicaid Services (CMS) released an article about reporting Patient Relationship Categories and Codes (PRC) on Medicare claims. Note: Reporting these codes will not affect reimbursement or have an impact on beneficiaries.

Voluntary Reporting Period: As of January 1, 2018, Medicare Part B MIPS-eligible clinicians may report patient relationships on...

CMS Podcast: Beyond the Policy: Nursing Home Strategy Part 1 – Strengthening Oversight

Policy Snapshot
Skilled Nursing Care, Centers for Medicare and Medicaid (CMS), Practitioners
August 8, 2019

The Centers for Medicare & Medicaid Services (CMS) released the latest episode of its podcast, CMS: Beyond the Policy. This edition focuses on the first part of its five-pronged strategy on strengthening oversight in nursing homes. You can also listen to the podcast on Google Play  and ...

CMS Releases 2020 Physician Fee Schedule and Quality Payment Program Proposed Rules

Policy Snapshot
Skilled Nursing Care, Centers for Medicare and Medicaid (CMS), Payment, Alternative Payment Models (APM), Merit-Based Incentive Program Payment System (MIPS), Physician Fee Schedule (PFS), Quality Payment Program (QPP), Practice Management, Practitioners
August 1, 2019

On July 29, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that includes proposals to update payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2020. Also released was CMS’ proposed policies for the 2020 performance year of the Quality Payment Program (QPP). The Society will continue to review the rules and submit comments in September.

Here are some highlights of the PFS:...

Skilled Nursing Facilities Final FY 2020 Payment and Policy Changes Rule Released

Policy Snapshot
Skilled Nursing Care, Centers for Medicare and Medicaid (CMS)
August 1, 2019

On July 30, the Centers for Medicare & Medicaid Services (CMS) issued a final rule for FY 2020 Medicare payment rates and quality programs for Skilled Nursing Facilities (SNFs). CMS projects aggregate payments to SNFs will increase by $851 million, or 2.4%, for FY 2020 compared to FY 2019. This estimated increase is attributable to a 2.8% market basket increase factor with a 0.4 percentage point reduction for the multifactor productivity adjustment.

The final rule also includes:

  • Payment policy
  • Sub-regulatory process for ICD-10 code revisions
  • ...

GAO Report: Improved Oversight Needed to Better Protect Residents from Abuse

Policy Snapshot
Centers for Medicare and Medicaid (CMS), Federal Regulations, Practitioners
July 25, 2019

Last week representatives from the Government Accountability Office (GAO) testified publicly to the Senate Special Committee on Aging about their Improved Oversight Needed to Better Protect Residents from Abuse report. The report noted that “while abuse in nursing homes is often underreported, we found that abuse citations more than doubled from 2013-2017. We also found that gaps in CMS’s [the Centers for Medicare & Medicaid Services] oversight make it harder to protect residents. Oversight is critical in addressing and preventing...

Antipsychotic Drug Use in Nursing Homes: Trend Update from CMS

Policy Snapshot
Centers for Medicare and Medicaid (CMS), Dementia, Antipsychotics, Practitioners
July 25, 2019

The Centers for Medicare & Medicaid Services (CMS) is tracking the progress of the National Partnership to Improve Dementia Care in Nursing Homes by reviewing publicly reported measures. The official measure of the Partnership is the percentage of long-stay nursing home residents who receive antipsychotic medication, excluding residents diagnosed with schizophrenia, Huntington's disease, or Tourette’s syndrome. In...

CMS Hosting Webinar on Quality Payment Program Performance Information Published on Physician Compare

Policy Snapshot
Centers for Medicare and Medicaid (CMS), Payment, Accountable Care Organization (ACO), Merit-Based Incentive Program Payment System (MIPS), Quality Payment Program (QPP), Practitioners
July 25, 2019

The Centers for Medicare & Medicaid Services (CMS) and the Physician Compare support team are hosting two one-hour webinars on the 2017 Quality Payment Program performance information recently published on ...

CMS Releases New ACO Case Studies

Policy Snapshot
Centers for Medicare and Medicaid (CMS), Payment, Accountable Care Organization (ACO), Practice Management, Practitioners
July 25, 2019

The Centers for Medicare & Medicaid Services (CMS) has released three new case studies describing innovative programs from Medicare Accountable Care Organizations (ACOs). The case studies feature ACO initiatives related to:

  • Promoting staff development through leadership academies
  • Conducting home visits
  • Engaging providers

The case studies highlight ACOs participating in the Next Generation ACO Model and the Medicare Shared Savings Program. Each case study includes detailed results and describes lessons learned by the ACO during...

CMS Issues Proposed Rule on Requirements for Long-Term Care Facilities; Finalizes Arbitration Agreements

Policy Snapshot
Skilled Nursing Care, Centers for Medicare and Medicaid (CMS), Federal Regulations, Practitioners, Quality Assurance and Performance Improvement (QAPI), Resident
July 19, 2019

Last week the Centers for Medicare & Medicaid Services (CMS) issued two rules, a proposed rule on requirements for long-term care (LTC) facilities and a final rule for LTC facilities arbitration agreements. The proposed rule for requirements for LTC facilities is aimed at easing some of the requirements for nursing homes to participate in Medicare and Medicaid by giving facilities more flexibility over their...

Quality Payment Program: 2018 MIPS Performance Feedback and Final Score

Policy Snapshot
Centers for Medicare and Medicaid (CMS), Payment, Merit-Based Incentive Program Payment System (MIPS), Quality Payment Program (QPP), Practice Management
July 19, 2019

If you submitted 2018 Merit-based Incentive Payment System (MIPS) data, view your performance feedback and final score on the Quality Payment Program (QPP) website. Performance feedback is also available for eligible clinicians participating in MIPS alternative payment model entities.

The MIPS payment adjustment you will receive in 2020 is based on your final score. If you believe there is an error in your payment adjustment factor calculation, request a targeted review by September 30.

For More Information:

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