Monday Morning Rounds with CMS

ICYMI, here is what has been happening at CMS.

Register Now for the MIPS 2021 Self-Nomination Application Demonstration Webinar on June 18, 2020. Join CMS to learn more about the 2021 MIPS Performance Period Self-Nomination Process and QCDR Measure Submission Template. Register now.

COVID-19: Using the CR Modifier and DR Condition Code. CMS revised MLN Matters Special Edition Article SE20011 on Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19) to clarify when you must use modifier CR (catastrophe/disaster related) and/or condition code DR (disaster related) when submitting claims to Medicare. The update includes a chart of blanket waivers and flexibilities that require the modifier or condition code.

CMS requires that all eligible hospitals use 2015 Edition certified electronic health record technology (CEHRT) to meet the requirements of the Promoting Interoperability Programs. CMS mandates downward payment adjustments be applied to eligible hospitals that are not meaningful users of CEHRT. Promoting Interoperabiliy Program Hardship Exception Applications for Eligible Hospitals Due Sept 1. Learn more.

Prior Authorization Process and Requirements for Certain Hospital OPD Services: Payment for Related Services – Beginning July 1, certain hospital Outpatient Department (OPD) services require prior authorization as a condition of payment. While only the hospital OPD service requires prior authorization, CMS wants to remind other providers that perform services in the hospital OPD setting that claims related to or associated with these services will not be paid if the service requiring prior authorization is not eligible for payment. These related services include, but are not limited to, anesthesiology services, physician services, and facility services. Only associated services performed in the OPD setting are affected. Depending on the timing of claim submission for any related services, claims may be automatically denied or denied on a postpayment basis.

On May 11, 2020, CMS issued the FY 2021 Inpatient Prospective Payment System (IPPS) for Acute Care Hospitals and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) Proposed Rule. Submit a Formal Comment by July 10, 2020

CMS has posted the 2021 CMS Quality Reporting Document Architecture (QRDA) Category I Implementation Guide (IG), Schematron, and Sample File for Hospital Quality Reporting. The 2021 CMS QRDA I IG outlines requirements for eligible hospitals and critical access hospitals (CAHs) to report electronic clinical quality measures (eCQMs) for the calendar year 2021 reporting period. Learn more.

CMS released a brief on “Partnering for Impact: Early Insights from the Accountable Health Communities Model.” The Accountable Health Communities (AHC) Model assesses whether bridging the gap between clinical care and social services can reduce health care utilization and costs for high risk Medicare and Medicaid beneficiaries. In November 2019, CMS convened 29 bridge organizations participating in the AHC Model and key partners for the second annual AHC meeting to brainstorm and share promising strategies to address beneficiaries’ health-related social needs. Learn more about their insights in the brief “Partnering for Impact: Early Insights from the Accountable Health Communities Model.”