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Policy Snapshot
August 19, 2016

The public has until September 1 to comment on the revised Medicare Outpatient Observation Notice (MOON) under the Paperwork Reduction Act (PRA). The information collection requirements are not effective until approved under a valid Office of Management and Budget (OMB) control number. We expect PRA approval around the time the implementing regulations, part of the FY 2017 Inpatient Prospective Payment System final rule, are effective. Hospitals and critical access hospitals should begin using the MOON no later than 90 calendar days from the date of final PRA approval by OMB. View the...

Policy Snapshot
August 19, 2016

Open Payments 2015 data was published on June 30; however, you can still review and dispute it. Check your data every year, even if you think nothing was reported about you. If drug or device companies submitted new data from previous years, you can dispute it in the Open Payments system until the end of the year. You can also nominate staff to act on your behalf. If you need help or have any questions, contact the CMS Open Payments Help Desk at ...

Policy Snapshot
August 19, 2016

The Programs of All-Inclusive Care for the Elderly (PACE) is a Medicare and Medicaid program that provides comprehensive medical and social services that enable older adults to live in the community instead of a nursing home or other care facility. More than 34,000 older adults are currently enrolled in about 100 PACE organizations in 31 states, and enrollment in PACE has increased by over 60 percent since 2011.

On August 11, the Centers for Medicare & Medicaid Services proposed a rule to update and modernize the PACE program, including:

  • Strengthening protections
  • ...
Policy Snapshot
August 12, 2016

The Department of Health & Human Services (HHS) announced a model that will test the effects of payments that encourage the use of cardiac rehabilitation services. The cardiac rehabilitation incentive payment model would test the impact of providing an incentive payment to hospitals where beneficiaries are hospitalized for a heart attack or bypass surgery, which would be based on beneficiary utilization of cardiac rehabilitation and intensive cardiac rehabilitation services in the 90-day care period following hospital discharge. Increasing the use of cardiac rehabilitation services has...

Policy Snapshot
August 12, 2016

On July 29, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1645-F) outlining FY 2017 Medicare payment policies and rates for the Skilled Nursing Facility (SNF) Prospective Payment System (PPS), the SNF Quality Reporting Program (QRP), and the SNF Value-Based Purchasing (VBP) Program. CMS projects that aggregate payments to SNFs will increase in FY 2017 by $920 million, or 2.4 percent, from payments in FY 2016. This estimated increase is attributable to a 2.7 percent market basket increase reduced by 0.3 percentage points, in accordance with the multifactor...

Policy Snapshot
August 12, 2016

The Centers for Medicare & Medicaid Services (CMS) recently opened the application period for practices to participate in the new nation-wide primary care model, Comprehensive Primary Care Plus (CPC+). CPC+ is a five-year primary care medical home model beginning January 2017 that will enable primary care practices to care for their patients the way they think will deliver the best outcomes and to pay them for achieving results and improving care. CPC+ is an opportunity for practices of diverse sizes, structures, and ownership who are interested in qualifying for the incentive payment...

Policy Snapshot
August 12, 2016

The Health Care Payment Learning & Action Network (LAN) recently released their final White Paper on Clinical Episode Payment (CEP) models. The paper, developed by the Clinical Episode Payment Work Group, provides guidance for the design and implementation of CEP models, specifically focusing on elective joint replacement, maternity care, and coronary artery disease. The LAN’s white paper, entitled, Accelerating and Aligning Clinical Episode...

Policy Snapshot
August 12, 2016

Two new datasets are available through the Physician Compare Downloadable Database:

  • 2014 Physician Quality Report System (PQRS) clinical quality of care performance rates for six measures collected via claims for over 37,000 individual Eligible Professionals (EPs)
  • 2014 PQRS Group Practice Reporting Option (GPRO) performance rates for 14 measures collected via Web Interface, as well as eight CAHPS for PQRS survey of patients’ experiences summary survey measures for approximately 345 group
  • ...
Policy Snapshot
August 5, 2016

Wednesday, August 10 from 1:30 to 3 pm ET

To register or for more information, visit MLN Connects Event Registration. Space may be limited, register early.

Learn about Physician Quality Reporting System (PQRS) negative payment adjustments, feedback reports, and the informal review process for program year 2015 results and 2017 payment adjustment determination.

Policy Snapshot
August 5, 2016

Recordings of the webinars are available FREE for members.

THE ROLE OF QIOS IN NEW PAYMENT MODELS
Confused about MACRA? This webinar is for you and will give you the tools you need to succeed within the changing payment landscape. Click here to access the webinar.

PARAMETERS FOR DISCUSSING AND BILLING FOR THE NEW ADVANCE CARE PLAN CODE
This webinar discusses the value of ACP, the new ACP code, when to consider using it, and how to meet...