Monday Morning Rounds with CMS

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.

Now Accepting Applications: Primary Care First Model Cohort 2 – CMS released the Request for Applications (RFA) for Cohort 2 of the Primary Care First (PCF) Model. Primary care practices in eligible regions are encouraged to apply. Practices that participate in PCF will have flexibility in terms of care delivery and the opportunity to increase practice revenue through performance-based model payments. The deadline for practice applications is April 30, 2021; the deadline for payer applications is May 28, 2021.

CMS Releases Rural Health Model Resources – The deadline to apply to the Community Health Access and Rural Transformation (CHART) Model Community Transformation Track is May 11, 2021. The CHART Model website has resources to answer questions and help potential Lead Organizations prepare to submit an application.

2022 Qualified Clinical Data Registry (QCDR) Measure Preview Calls – CMS will conduct QCDR measure concept preview calls for the 2022 performance period between February 22, 2021 and June 4, 2021. The last day to request a call is May 21, 2021.

CMS is Now Accepting Proposals for New Measures for the Medicare Promoting Interoperability Program – CMS Annual Call for Measures for eligible hospitals and critical access hospitals participating in the Medicare Promoting Interoperability Program is now open. Submit a measure proposal by Wednesday, June 30, 2021.

Notice of Funding Opportunity (NOFO) Available – CMS is releasing a NOFO for the Emergency Triage, Treat and Transport (ET3) Model. Through the NOFO, CMS will fund state and local governments, their designees, or other entities that operate or have authority over a Public Safety Answering Point (PSAP) to establish or expand Medical Triage Lines aimed at reducing inappropriate use of emergency ambulance services and increasing efficiency in Emergency Medical Services (EMS) systems.

New FAQs Document Posted for the Hospice Benefit Component of the Value-Based Insurance Design Model – CMS Innovation Center announces a new Frequently Asked Questions document as an additional resource for the Value-Based Insurance Design (VBID) Model’s Hospice Benefit Component. This FAQ document can be found on the Model website and provides answers to questions on claims and billing, networks and contracting, appeals and grievances, and other topics related to the Hospice Benefit Component.

Additional Resources Now Available in 2021 Quality Benchmarks Zip File – When you submit measures for the Merit-based Incentive Payment System (MIPS) quality performance category, each measure is assessed against its benchmark to determine how many points the measure earns. The 2021 MIPS Quality Benchmarks (ZIP) lists and explains the 2021 benchmarks used to assess performance in the quality performance category of MIPS. This file is available on the QPP Resource Library.


2021 Quality Payment Program Overview
When: Thursday, April 8, 2021 2:00 – 3:30 pm ET
Register for this event.

CMS is hosting a webinar to provide an overview of the Quality Payment Program (QPP) for the 2021 performance year. This presentation will review requirements for the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).

During the webinar, CMS subject matter experts will provide information on ways to participate in QPP in 2021, including:

  • MIPS requirements
  • Requirements for MIPS APMs
  • Participation through Advanced APMs
  • Help and support

CMS will answer questions from attendees at the end of the webinar as time permits.

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 COVID Provider ToolkitCMS 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.

MLN Matters Articles

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.

Announced: Part D Senior Savings Model
CMS announced a new Model beginning in Calendar Year (CY) 2021, the Part D Senior Savings Model (or the “Model”), and the corresponding Request for Application (RFA) process for participation from eligible pharmaceutical manufacturers and Part D sponsors in all states and territories. The voluntary Model tests the impact of offering beneficiaries an increased choice of enhanced alternative Part D plan options that offer lower out-of-pocket costs for insulin.

Announced: Part D Payment Modernization Model
CMS Innovation Center began the Part D Payment Modernization Model in January 2020 to test how changes in Part D benefit design and incentives would affect overall Part D prescription drug spending and beneficiary out-of-pocket costs. The Model aims to cut Medicare costs while keeping or improving beneficiary quality of care. The Model is open to eligible standalone Prescription Drug Plans (PDPs) and Medicare Advantage-Prescription Drug Plans (MA-PDs) approved to participate.

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.