Give Us Your Suggestions! Many CMS improvements were suggested by - - PowerPoint PPT Presentation
Give Us Your Suggestions! Many CMS improvements were suggested by providers. Keep the ideas coming! 1 Send suggestions and comments to: How Your ReducingProviderBurden@cms.hhs.gov Voice Can 2 Be Heard 1 E&M Payment Amounts CMS
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https:/ / www.c ms.g o v/ Ab o ut-CMS/ Ag e nc y-I nfo rma tio n/ E me rg e nc y/ Do wnlo a ds/ Opio id-e pide mic -ro a dma p.pdf
4 Months 0-6 Core Sessions Months 7-12 Core Maintenance Sessions Months 13-24 Ongoing Maintenance Sessions
A minimum of 16 sessions offered at least a week apart during the first 6 months A minimum of 6 monthly sessions during the second 6 months of core sessions Monthly sessions for an additional 12 months Eligible beneficiaries have coverage for 3 month intervals of monthly maintenance sessions for 1 year Available to eligible beneficiaries regardless of weight loss and attendance Available to eligible beneficiaries who achieve and maintain weight loss and attendance goals A CDC-approved curriculum is used to guide sessions In-person and virtual make-up sessions are available and must meet specific requirements
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Timelines
2019
2019
patients and record data during the year
submitting data is March 31, 2020
encouraged to submit data early
performance feedback after the data is submitted
receive feedback before the start of the payment year
adjustments are prospectively applied to each claim beginning January 1, 2021
2019
Performance Year
March 31, 2020
Data Submission
Feedback January 1, 2021
Payment Adjustment
Feedback available adjustment submit Performance period
MIPS eligible clinicians include:
Anesthetists
MIPS eligible clinicians include:
Year 2 (2018) AND:
Professionals
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Dollars Beneficiaries Professional Services (New) Eligible for Opt-in?
≤ 90K ≤ 200 ≤ 200 No – excluded ≤ 90K ≤ 200 > 200 Yes (may also voluntarily report or not participate) > 90K ≤ 200 ≤ 200 Yes (may also voluntarily report or not participate) > 90K ≤ 200 >200 Yes (may also voluntarily report or not participate) ≤ 90K > 200 > 200 Yes (may also voluntarily report or not participate) > 90K > 200 > 200 No – required to participate
threshold criteria may choose to participate in MIPS 28
Low V w Volum lume T e Thr hresho hold ld D Det etermin inatio ion P Perio iod: d:
(including 30-day claims run out)
2018 (including a 30-day claims run out) Special S Sta tatus
eligible clinicians with a special status and apply the designation.
Change t e to t the MI he MIPS D Det etermin inatio ion P Perio iod: d:
(including a 30-day claims run out)
2019 (does not include a 30-day claims run out)
the determination period with the fiscal year
eligible clinicians with the following special status:
Note: Rural and HPSA status continue to apply in 2019 9
MIPS Determination Period
Quic uick T Tip: p: MIPS eligible clinicians with a special status are i e includ luded d in MI MIPS and qualify for special rules. Having a special status does n not ex exempt a clinician from MIPS.
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Reporting Options
Individual Group
a) 2 or more clinicians (NPIs) who have reassigned their billing rights to a single TIN* b) As an APM Entity
National Provider Identifier (NPI) number and Taxpayer Identification Number (TIN) where they reassign benefits
Virtual Group
3. As a Virtual Group – made up of solo practitioners and groups of 10 or fewer eligible clinicians who come together “virtually” (no matter what specialty or location) to participate in MIPS for a performance period for a year
Same me reporting options as Year 2. Clinicians can report as an/part of a: What a are m my reporting o
if I am required to p participate i in MIPS?
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 & on
Fee Schedule
+0.5% each year No change +0.25%
0.75%
Participation in Qualifying
4 5 7 9 9 9 Max Adjustment (+/-)
(excludedfromMIPS)
BBA of 2018 reduced the update for 2019 to +0.25%
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For M MIPS: Start by checking your participation status using the National Provider Identifier (NPI) Look-up Tool on qpp.cms.gov.
status.
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CMS has free resources and organizations on the ground to provide help to clinicians who are participating in the Quality Payment Program: Available Resources
Learn more about technical assistance: https://qpp.cms.gov/about/help-and-support#technical-assistance
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Medicare Prescription Drug Coverage and Your Rights Fact Sheet at: https://www.cms.gov/Outreach- and-Education/Outreach/Partnerships/downloads/yourrightsfactsheet.pdf Information regarding the CDC Guideline for Prescribing Opioids for Chronic Pain, please visit https://www.cdc.gov/drugoverdose/prescribing/guideline.html. A Prescriber’s Guide to the New Medicare Part D Opioid Overutilization Policies for 2019 at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network- MLN/MLNMattersArticles/Downloads/SE18016.pdf Additional Guidance on Contract Year 2019 Formulary-Level Opioid Point-of-Sale Safety Edits or Medicare Part D Drug Management Programs at: https://www.cms.gov/Medicare/Prescription-Drug- coverage/PrescriptionDrugCovContra/RxUtilization.html To review the notice of appeal rights that patients receive from pharmacies about their appeal rights when a prescription is not filled as written, please visit https://www.cms.gov/Outreach-and- Education/Outreach/Partnerships/downloads/yourrightsfactsheet.pdf
15 New Medicare Card www.cms.gov/Medicare/New-Medicare-Card/
Medicare Diabetes Prevention Program https://innovation.cms.gov/initiatives/medicare-diabetes-prevention-program/
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