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Insights to guide your practice. 

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CMS Releases Notice To Address ICD-10 Claims Processing Issues

by Kaitlyn Houseman on December 7, 2015

CMS recently issued an update on the steps it has taken to address isolated problems with processing ICD-10 codes, AHA News reports (AHA News, 11/20). The U.S. health care system transitioned from using ICD-9 codes to the ICD-10 code set on Oct. 1. The switch required health care providers and insurers to change out about 14,000 codes for about 68,000 codes (iHealthBeat, 10/30).

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Topics: CMS, ICD-10

15 Things to Know About the 2016 Medicare Physician Fee Schedule

by Kaitlyn Houseman on November 12, 2015

On Friday, the Obama administration issued its final rule for the 2016 Medicare Physician Fee Schedule that includes several health IT provisions.  The fee schedule – the first since repeal of the Sustainable Growth Rate (SGR) formula and enactment of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) – includes changes to payment policies, modifications to misvalued codes, and updates to quality performance metrics under the PQRS, the Medicare Shared Savings Program, and Physician Compare, among others. (Internal Medicine News, 10/31)
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Topics: Revenue Cycle Management, Medical Business, CMS, PQRS

Bipartisan Budget Act of 2015 Signed Into Law

by Keith Lage on November 10, 2015

On Monday, November 2, President Obama signed into law the Bipartisan Budget Act of 2015. Among its provisions, the two-year budget deal sets 2016 Medicare Part B premium rates, changes Medicaid rebate policy, repeals the ACA auto-enrollment requirement, and provides for a new Medicare payment policy for new outpatient providers.

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Topics: Revenue Cycle Management, Medical Business, CMS, Incentive Programs

CMS and ONC Release Final Rules for EHR Incentive Programs

by Kaitlyn Houseman on October 7, 2015

The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) recently announced the release of final rules for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs and the 2015 Edition Health IT Certification Criteria. The rules will be published on October 16, 2015, and are currently on display in the Federal Register. 

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Topics: CMS, Incentive Programs

Top 4 ICD-10 Frequently Asked Questions with CMS and AMA

by Kaitlyn Houseman on July 7, 2015

Q. What if I run into a problem with the transition to ICD-10 on or after October 1st 2015?
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Topics: CMS, ICD-10

Medicare Eligible Professionals: Take Action by July 1 to Avoid 2016 Medicare Payment Adjustment

by Kaitlyn Houseman on May 15, 2015

Payment adjustments for eligible professionals that did not successfully participate in the Medicare EHR Incentive Program in 2014 will begin on January 1, 2016. Medicare eligible professionals can avoid the 2016 payment adjustment by taking action by July 1 and applying for a 2016 hardship exception.

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Topics: CMS

Updated 2014 Electronic Clinical Quality Measures for 2016 Reporting

by Kaitlyn Houseman on May 4, 2015

On May 1, CMS posted the annual update for the 2014 electronic clinical quality measures(eCQMs) for eligible hospitals and eligible professionals. Providers will use these updated measures to electronically report 2016 quality data for CMS quality reporting programs, including the Physician Quality Reporting System (PQRS), Inpatient Quality Reporting Program (IQR), and the EHR Incentive Programs.

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Topics: CMS, PQRS

CMS Releases 2013 PQRS and eRX Incentive Program Experience Report

by Kaitlyn Houseman on April 30, 2015

The Centers for Medicare & Medicaid Services (CMS) released the 2013 Physician Quality Reporting System (PQRS) and Electronic Prescribing (eRx) Incentive Program Experience Report.
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Topics: CMS, PQRS

CMS Proposed Rule to Shorten Meaningful Use Reporting Period

by Kaitlyn Houseman on April 14, 2015

CMS issued a new proposed rule for the Medicare and Medicaid EHR Incentive Programs  to align Stage 1 and Stage 2 objectives and measures with the long-term proposals for Stage 3.

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Topics: CMS, Incentive Programs

Update on the Status of Provisions Expiring on April 1

by Kaitlyn Houseman on April 1, 2015

The negative 21% payment rate adjustment under current law for the Medicare Physician FeeSchedule is scheduled to take effect on April 1, 2015.  CMS is taking steps to limit the impact on Medicare providers and beneficiaries by holding claims for a short period of time beginning on April 1st.  Holding claims for a short period of time allows CMS to implement any subsequent Congressional action while minimizing claims reprocessing and disruption of physician cash flow in the event of legislation addressing the 21% payment reduction.  Under current law, electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt. CMS will provide more information about next steps by April 11, 2015.

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Topics: Revenue Cycle Management, CMS

2013 Quality and Resource Use Reports Are Available Online

by Kaitlyn Houseman on March 31, 2015

Did you know that CMS provided Quality and Resource Use Reports (QRURs) to  physicians in groups of all sizes and physician solo practitioners in September of 2014? The 2013 QRURs provide clinically meaningful and actionable information that can be used to improve the quality and efficiency of care provided to Medicare beneficiaries and also to understand and improve performance on quality and cost measures. If you are a physician subject to the Value-Based Payment Modifier (VM) Program, the reports also contain information about how your performance is affecting your Medicare payments in 2015.

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Topics: CMS

NPRM for Stage 3 Meaningful Use & 2015 Edition Certification Criteria

by Kaitlyn Houseman on March 25, 2015

On Friday, CMS released a notice of proposed rulemaking (NPRM) for Stage 3, the next step in the implementation of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. Concurrently, ONC also announced the proposed 2015 Edition certification criteria for health IT products. Both proposed rules focus on the interoperability of data across systems, and make the EHR Incentive Programs simpler and more flexible.

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Topics: CMS, Incentive Programs

CMS Announces Extension for EPs Participating in PQRS via EHR and QCDR (QRDA III format)

by Kaitlyn Houseman on February 26, 2015

The Centers for Medicare & Medicaid Services (CMS) announced that the submission deadlines for the PQRS reporting methods below have been extended. All other submission timeframes for other PQRS reporting methods remain the same.
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Topics: CMS, PQRS

CMS Extends EHR Attestation Deadline for Medicare Eligible Professionals

by Kaitlyn Houseman on February 26, 2015

 

Eligible professionals now have until 11:59 pm ET on March 20, 2015to attest to meaningful use for the Medicare Electronic Health Record (EHR) Incentive Program 2014 reporting year. 


CMS extended the deadline to allow providers extra time to submit their meaningful use data. CMS continues to urge providers to begin attesting for 2014 as soon as they can. 

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Topics: CMS, Incentive Programs

Hospitals Must Start Medicare EHR Participation in 2015 to Earn Incentives

by Kaitlyn Houseman on February 17, 2015

Last Year for Eligible Hospitals to Begin EHR Participation and Earn Incentive Payments is 2015

To earn a 2015 incentive payment and avoid a 2016 payment adjustment, first-time participants should:

  • Begin their 90-day reporting period no later than April 1, 2015
  • Attest by July 1, 2015

Eligible hospitals that miss this deadline can still earn a 2015 incentive payment—and avoid the 2017 payment adjustment—if they begin their reporting period by July 1 and attest by November 30. However, they will be subject to the 2016 payment adjustment unless they apply and qualify for a hardship exception.

Hospitals that successfully attest in 2015 will also be eligible to earn a 2016 incentive if they continue to participate.

Eligible hospitals that begin participating after 2015 will not be able to earn incentive payments. They will also be subject to payment adjustments in 2016 and 2017.

Reforms to Medicare regulations identified as unnecessary, obsolete, or excessively burdensome on hospitals and other health care providers will save nearly $660 million annually, and $3.2 billion over five years, through a rule issued today by the Centers for Medicare & Medicaid services (CMS).

 

Additional Resources
The EHR Incentive Programs website offers tools and resources to help eligible hospitals to successfully participate:

News Update from www.CMS.gov

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Topics: CMS, Hospital Networks

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