Monday Morning Rounds with CMS

TOPICS:

Posted By: HHS/ONC/CMS Communications June 19, 2023

ICYMI, here is recent communication from CMS.

News

CMS is Accepting Measure Proposals for the Medicare Promoting Interoperability Program until July 1
CMS wants to remind eligible hospitals and critical access hospitals that the Annual Call for Measures for the Medicare Promoting Interoperability Program is open through July 1, 2023. The submission form can be found here. Proposals submitted by the deadline will be considered for inclusion in future rulemaking and must be sent to CMSPICallforMeasures@ketchum.com. Applicants will receive email confirmations of their submission. Please note that proposals that don’t provide information for every field/section in the form won’t be evaluated for consideration. Any information/field not applicable to the measure proposal must state “N/A” or “not applicable” or the proposal won’t be considered.

CMS Office of the Actuary Releases 2022-2031 National Health Expenditure Projections
The Centers for Medicare & Medicaid Services’ (CMS) Office of the Actuary released projections of National Health Expenditures (NHE) and health insurance enrollment for the years 2022-2031. The report contains expected impacts from the Inflation Reduction Act (IRA), including that people with Medicare prescription drug coverage (Part D) are projected to experience lower out-of-pocket spending on prescription drugs for 2024 and beyond as several provisions from the law begin to take effect.

Billing Medicare Part B for Insulin with New Limits on Patient Monthly Coinsurance
Starting July 1, 2023, Part B coinsurance for a month’s supply of insulin used in an insulin pump covered under the DME benefit can’t exceed $35. CMS will adjust payments to suppliers and pharmacies to account for the balance of the reduced coinsurance. Suppliers will continue to get the Medicare payment amount for the insulin (average sales price plus 6%) minus any applicable coinsurance, which is capped at $35 for a month’s supply.

ESRD Prospective Payment System: July Update
See the instruction to your Medicare Administrative Contractor for updates to the ESRD Prospective Payment System, including:

  • Attachment A: CMS made routine changes to the list of outlier services effective July 1, 2023:
    • Updated the mean unit cost for renal dialysis drugs that are oral equivalents to injectable drugs based on the most recent prices from the Medicare Prescription Drug Plan Finder
    • Added or removed renal dialysis items and services
    • Revised the mean dispensing fee of qualifying National Drug Codes (NDCs) to $0.50 per NDC per month
  • Attachment B: We updated the Consolidated Billing list effective April 1, 2023, to replace J0610 with J0612 in the Bone and Mineral Metabolism category

Events

MIPS News

Reminder: 2023 MIPS Value Pathway (MVP) Registration is Open
The Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs) registration window is open for the 2023 performance year. Individuals, groups, subgroups, and Alternative Payment Model (APM) Entities that wish to report an MVP can register until November 30, 2023, at 8 p.m. ET.

For the 2023 performance year, MVPs are a new, voluntary way to meet MIPS reporting requirements. Each MVP includes a subset of measures and activities that are related to a specialty or medical condition to offer more meaningful participation in MIPS.

2022 MIPS Final Score Preview Now Available
The Centers for Medicare & Medicaid Services (CMS) has opened the Final Score Preview period for the Merit-based Incentive Payment System (MIPS). Authorized representatives of practices, virtual groups, and Alternative Payment Model (APM) Entities can now sign into the Quality Payment Program (QPP) website to preview 2022 MIPS final scores.

The MIPS Final Score Preview period is available until final performance feedback, including payment adjustments, is released in August 2023.

Quality Payment Program

Visit the Quality Payment Program Resource Library to Access 2024 Qualified Clinical Data Registry and Qualified Registry Self-Nomination Materials
The 2024 Self-Nomination Toolkit for Qualified Clinical Data Registries (QCDRs) and Qualified Registries (ZIP), including the below files, are now posted on the Quality Payment Program (QPP) Resource Library:

  • 2024 QCDR Fact Sheet
  • 2024 Qualified Registry Fact Sheet
  • 2024 Self-Nomination User Guide for QCDRs and Qualified Registries
  • 2024 QCDR Measure Development Handbook

Open and Close Dates
As a reminder, the 2024 self-nomination period will take place from 10:00 a.m. ET on July 1, 2023, to 8:00 p.m. ET on September 1, 2023.

Administrative Simplification

MLN Matters Articles

Claims, Pricers, & Codes

CMS Innovation Center