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SNF PPS Patient Driven Payment Model: Get Ready for Implementation on October 1

Policy Snapshot
Practice Management, Practitioners
April 25, 2019

On October 1, the new Patient Driven Payment Model (PDPM) is replacing Resource Utilization Group, Version IV for the Skilled Nursing Facility (SNF) Prospective Payment System (PPS). The Centers for Medicare & Medicaid Services (CMS) and the Society have a variety of resources to help you prepare:

2019 MIPS Group Participation

Policy Snapshot
Centers for Medicare and Medicaid (CMS), Payment, Medicare Access and CHIP Re-authorization Act (MACRA), Merit-Based Incentive Program Payment System (MIPS), Quality Payment Program (QPP), Practice Management, Practitioners
April 25, 2019

The Centers for Medicare & Medicaid Services (CMS) posted a Merit-based Incentive Payment System (MIPS) 2019 Group Participation Guide covering the following topics:

  • Eligibility and participation
  • Group registration for CMS Web Interface and CAHPS® for MIPS Survey
  • Data collection and submission for each MIPS performance category
  • ...

CMS Administrator Focuses on Safety and Quality in Nursing Homes

Policy Snapshot
Skilled Nursing Care, Centers for Medicare and Medicaid (CMS), Federal Regulations, Practitioners
April 18, 2019

This week, Seema Verma, administrator of the Centers for Medicare & Medicaid Services (CMS), posted a blog about CMS’ efforts to ensure quality and safety in nursing homes. The administrator noted that CMS will be undertaking a comprehensive review of regulations, guidelines, internal structures, and processes related to safety and quality. “We have demonstrated our commitment to this path by developing a five-part plan to ensure the care provided in America’s nursing homes is of the highest...

CMS Releases ACO Care Coordination Toolkit

Policy Snapshot
Centers for Medicare and Medicaid (CMS), Payment, Accountable Care Organization (ACO), Medicare Access and CHIP Re-authorization Act (MACRA), Practice Management, Practitioners
April 18, 2019

The Centers for Medicare & Medicaid Services (CMS) released a public Accountable Care Organization (ACO) Care Coordination Toolkit and a series of case studies that highlight the work of...

CMS to Host MIPS APMs Scoring Standard Webinar on April 24

Policy Snapshot
Centers for Medicare and Medicaid (CMS), Alternative Payment Models (APM), Medicare Access and CHIP Re-authorization Act (MACRA), Merit-Based Incentive Program Payment System (MIPS), Practice Management, Practitioners
April 18, 2019

The Centers for Medicare & Medicaid Services (CMS) is holding a webinar on Wednesday, April 24, from 2 to 3 PM ET. The purpose of the webinar is to provide an overview of the Merit-based Incentive Payment System (MIPS) Alternative Payment Models (APMs) in the Quality Payment Program (QPP), including:

  • MIPS APMs in 2019
  • APM scoring standard and MIPS performance category requirements
  • APM information in the QPP Participation Status Tool
  • Additional resources and how to learn more

...

National Healthcare Decisions Day is April 16

Policy Snapshot
Advance Care Planning, Practitioners
April 11, 2019

National Healthcare Decisions Day educates the public and providers about the importance of Advance Care Planning (ACP). For example, did you know that ACP services can be billed to the Medicare Physician Fee Schedule?

For more information:

Study of First Visits for Patients In SNF

Policy Snapshot
Federal Regulations, Medical Necessity, Practitioners
April 11, 2019

A study, Assessing First Visits By Physicians To Medicare Patients Discharged To Skilled Nursing Facilities, published in the April edition of Health Affairs, examined the timeliness of the first visit after discharge from an acute care facility. The authors from the University of Pennsylvania found that while the majority of patients were seen either by a physician or an advanced practitioner within the first four days, some patients were not seen, which affected outcomes and mortality.

While...

Quality Payment Program: 2018 MIPS Data Submission Preliminary Feedback

Policy Snapshot
Centers for Medicare and Medicaid (CMS), Payment, Medicare Access and CHIP Re-authorization Act (MACRA), Merit-Based Incentive Program Payment System (MIPS), Quality Payment Program (QPP), Practice Management, Practitioners
April 11, 2019

The data submission period for the 2018 Merit-based Incentive Payment System (MIPS) closed on April 2. If you submitted data through the Quality Payment Program (QPP) website, you can review your preliminary performance feedback data. Your final score and feedback will be available in July. Between now and June 30, your score could change based on:

  • Special status scoring considerations
  • All-cause readmission measure for the quality performance category
    • ...

New Part D Policies from CMS Address Opioid Epidemic

Policy Snapshot
Opioids, Practitioners
April 4, 2019

The Centers for Medicare & Medicaid Services (CMS) introduced new Medicare Part D opioid safety policies to reduce prescription opioid misuse while preserving medically necessary access to these medications. It’s important to note that these new policies are not “one size fits all,” and are deliberately tailored to address distinct populations of Medicare Part D prescription opioid users. These interventions do not apply to residents of long-term care facilities; beneficiaries in hospice, palliative, or end-of-life care; and beneficiaries being treated for active cancer-related pain....

AMDA to Host PDPM Webinar on April 18

Policy Snapshot
Centers for Medicare and Medicaid (CMS), Payment, Practice Management, Practitioners
April 4, 2019

AMDA is hosting a webinar, Patient Driven Payment Model (PDPM): An Opportunity for PALTC Clinician, on Thursday, April 18, 2019, 6:00 - 7:30 PM ET. As always, this webinar is free to members.

This session will discuss the details of PDPM, which will take effect on October 1, 2019, and impact the way skilled nursing facilities are reimbursed for the first time in 20 years. In addition to focusing on the regulatory details of the new model, this webinar will provide guidance to post-acute and long-term care clinicians on how they can become an integral resource to their facilities....