ICYMI, here is recent communication from CMS.
CMS Releases 2021 Final Rule for the Quality Payment Program – CMS published the final policies for the 2021 performance year of the Quality Payment Program (QPP) via the Medicare Physician Fee Schedule (PFS) Final Rule.
Reminder: Upcoming MIPS Important Dates and Deadlines
CMS would like to remind clinicians of important upcoming Merit-based Incentive Payment System (MIPS) dates and deadlines:
- February 1, 2021 – 2020 Extreme and Uncontrollable Circumstances Application period closes. Clinicians, groups, and virtual groups who believe they are eligible for this exception may apply, and if approved, will qualify for a re-weighting of one or more MIPS performance categories. CMS will notify applicants via email whether their requests are approved or denied. If approved, the exception will be added to the QPP Participation Status Tool.
- New: CMS has finalized that for the 2020 performance year, Alternative Payment Model (APM) Entities may submit Extreme and Uncontrollable Circumstances applications as a result of COVID-19. For more information about the impact of COVID-19 on Quality Payment Program participation, see the Quality Payment Program COVID-19 Response webpage.
- March 1, 2021 – Deadline for CMS to receive 2020 claims for the Quality performance category. Claims must be received by CMS within 60 days of the end of the performance period. Deadline dates vary to submit claims to the MACs. Check with the MACs for more specific instructions.
- March 31, 2021 – 2020 MIPS performance year data submission window closes.
All Medicare Promoting Interoperability Program participants, the deadline to submit 2020 data is March 1, 2021 at 11:59 PM ET. Medicare Promoting Interoperability Program participants are required to register and attest through the QualityNet Secure Portal.
- Register to Hear Important Updates to CMS Quality Programs on January 26 – CMS Quality Programs Bi-Monthly Forum will be held on Tuesday, January 26, 2:30 – 3:30 pm ET. During this webinar, attendees will learn important updates relevant to CMS’s Quality Measurement and Value-Based Incentives Group (QMVIG). The forum will also provide stakeholders with the opportunity to ask CMS subject matter experts questions on quality reporting programs and initiatives that directly impact their organizations. Register for this event.
- Save The Date! 2021 CMS Quality Conference – March 2-3, 2021. This will be a vitural conference. Learn more.
Claims, Pricers & Codes
- ICD-10 Code Files for FY 2021 – In response to the COVID-19 public health emergency, new ICD-10 codes are effective January 1: 21 procedure codes (ICD-10-PCS): CMS will implement new codes to describe the introduction or infusion of therapeutics, including monoclonal antibodies and vaccines for COVID-19 treatment; 6 diagnosis codes (ICD-10-CM): CDC National Center for Health Statistics.
- COVID-19: PC-ACE Software Vaccine Roster Billing Issue – Part B providers: When you select a roster bill for a COVID-19 vaccine in PC-ACE 4.8.100 software, it inappropriately auto-populates HCPCS code G0008 on the claim for the administration. This code is valid for traditional roster billing vaccines like pneumococcal and flu but not for administering the COVID-19 vaccine. Your Medicare Administrative Contractor will provide updated PC-ACE 4.9 software. Download the update to ensure proper billing of roster-billed COVID-19 vaccines.
CMS adds to ACO, ESCO resources with a care transformation toolkit, case studies, and a tip sheet – CMS releases new resources highlighting strategies that Medicare Accountable Care Organizations (ACOs) and End-Stage Renal Disease Seamless Care Organizations (ESCOs) use to improve quality of care, lower health care costs, and enhance the beneficiary experience. View these resources posted on the ACO General Information web page.
CMS COVID Provider Toolkit – CMS released a set of toolkits for providers, states and insurers to help the health care system prepare to swiftly administer the vaccine. These resources are designed to increase the number of providers that can administer the vaccine and ensure adequate reimbursement for administering the vaccine in Medicare, while making it clear to private insurers and Medicaid programs their responsibility to cover the vaccine at no charge to beneficiaries. In addition, CMS is taking action to increase reimbursement for any new COVID treatments that are approved by the FDA.
CDC COVID-19 Vaccination Communication Toolkit – Medical centers, clinics, and clinicians can use or adapt these ready-made materials to build confidence about COVID-19 vaccination among your healthcare teams and other staff.
CMS Announces New Model to Advance Regional Value-Based Care in Medicare – A new and transformative voluntary payment model that builds on CMS’ focus to deliver Medicare beneficiaries value through better care and improved quality was announced. The Geographic Direct Contracting Model (the Model) will test an approach to improving health outcomes and reducing the cost of care for Medicare beneficiaries in multiple regions and communities across the country. Through the model, participants will take responsibility for beneficiaries’ health outcomes, giving participants a direct incentive to improve care across entire geographic regions.
CQMC Releases Additional Core Measure Sets Aimed at Improving Transition to Value-Based Care – As the nation’s health care system transforms from one that pays for volume to one that pays for value, there is a growing need for useful performance measures to help assess the quality of care being delivered by physicians in a value-based payment (VBP) arrangements. The Core Quality Measures Collaborative (CQMC) released four revised core measure sets as well as two new core sets tailored to specific specialties and designed to improve patient outcomes, reduce the burden on health care providers, and give consumers and payer information on which to assess physician performance.
CMS has added new performance information to the Doctors & Clinicians section of Medicare Care Compare and in the Provider Data Catalog (PDC), the successor websites to Physician Compare and the Physician Compare Downloadable Database. Medicare patients and caregivers can use the Care Compare website to search for and compare doctors, clinicians and groups who are enrolled in Medicare. Publicly reporting 2018 Quality Payment Program performance helps empower patients to select and access the right care from the right provider.
MLN Matters Articles
- FAQs on the 3-Day Payment Window for Services Provided to Outpatients Who Later Are Admitted as Inpatients
- Calendar Year (CY) 2021 Annual Update for Clinical Laboratory Fee Schedule and Services Subject to Reasonable Charge
- 2021 Annual Update of Per-Beneficiary Threshold Amounts
- CY 2021 Update for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule
- Summary of Policies in the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS) Final Rule, Telehealth Originating Site Facility Fee Payment Amount and Telehealth Services List, CT Modifier Reduction List, and Preventive Services List
- International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs)–April 2021 — Revised
From CMS Innovation Center
The Centers for Medicare & Medicaid Services Innovation Center, also known as “CMMI,” develops and tests new healthcare payment and service delivery models.
CHART Model Updated
Through the Community Health Access and Rural Transformation (CHART) Model, CMS aims to continue addressing disparities by providing a way for rural communities to transform their health care delivery systems by leveraging innovative financial arrangements as well as operational and regulatory flexibilities.
Announced: Radiation Oncology Model
The Radiation Oncology (RO) Model aims to improve the quality of care for cancer patients receiving radiotherapy (RT) and move toward a simplified and predictable payment system. The RO Model tests whether bundled, prospective, site neutral, modality agnostic, episode-based payments to physician group practices (PGPs), hospital outpatient departments (HOPD), and freestanding radiation therapy centers for radiotherapy (RT) episodes of care reduces Medicare expenditures while preserving or enhancing the quality of care for Medicare beneficiaries. The Consolidated Appropriations Act, 2021 (H.R. 133) enacted on December 27, 2020 includes a provision that prohibits implementation of the Radiation Oncology Model prior to January 1, 2022, effectively delaying the start date by 6 months. CMS plans to provide additional information on the delayed implementation.
Announced: Comprehensive ESRD Care Model
The Comprehensive ESRD Care (CEC) Model is designed to identify, test, and evaluate new ways to improve care for Medicare beneficiaries with End-Stage Renal Disease (ESRD). Through the CEC Model, CMS will partner with health care providers and suppliers to test the effectiveness of a new payment and service delivery model in providing beneficiaries with person-centered, high-quality care. The Model builds on Accountable Care Organization experience from the Pioneer ACO Model, Next Generation ACO Model, and the Medicare Shared Savings Program to test Accountable Care Organizations for ESRD beneficiaries.