ICYMI, here is recent communication from CMS.
CMS Proposes Rule to Advance Health Equity, Improve Access to Care, & Promote Competition and Transparency
CMS is proposing actions to advance health equity and improve access to care in rural communities by establishing policies for Rural Emergency Hospitals (REH) and providing for payment for certain behavioral health services furnished via communications technology. Additionally, in line with President Biden’s Executive Order on Promoting Competition in the American Economy, the calendar year 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Payment System proposed rule includes proposed enhanced payments under the OPPS and the Inpatient Prospective Payment System for the additional costs of purchasing domestically made NIOSH-approved surgical N95 respirators and a comment solicitation on competition and transparency in our nation’s health care system.
CMS Proposes Physician Payment Rule to Expand Access to High-Quality Care
CMS issued the Calendar Year 2023 Physician Fee Schedule proposed rule, which would significantly expand access to behavioral health services, Accountable Care Organizations, cancer screening, and dental care — particularly in rural and underserved areas. These proposed changes play a key role in the Biden-Harris Administration’s Unity Agenda — especially its priorities to tackle our nation’s mental health crisis, beat the overdose and opioid epidemic, and end cancer as we know it through the Cancer Moonshot — and ensure CMS continues to deliver on its goals of advancing health equity, driving high-quality, whole-person care, and ensuring the sustainability of the Medicare program for future generations.
Calendar Year 2023 Medicare Physician Fee Schedule Proposed Rule – Medicare Shared Savings Program Proposals
On July 7, 2022, CMS issued the Calendar Year 2023 Physician Fee Schedule proposed rule that includes proposed changes to the Medicare Shared Savings Program (Shared Savings Program) to advance CMS’ overall value-based care strategy of growth, alignment, and equity.
Additional Resources to Improve Oversight and Ensure Access to Quality Care in Medicaid and CHIP Managed Care Programs
CMS unveiled a suite of new resources to improve CMS and state oversight of Medicaid and Children’s Health Insurance Program managed care programs. These programs provide people with health benefits and additional services through contracted arrangements with managed care plans. Released in a Center for Medicaid and CHIP Services Informational Bulletin, this new information includes tools, templates, and updates on tactics to improve states reporting on their managed care programs, which promotes access to care for millions of people enrolled in Medicaid and CHIP.
CMS Publishes Program Year 2021 Open Payments Data on Health Care Providers
CMS published Program Year 2021 Open Payments data to publicly disclose the financial relationships between applicable manufacturers and group purchasing organizations(known as reporting entities) and certain health care providers (known as covered recipients). This data publication reflects a total of 12.10 million records and $10.90 billion in publishable payments or transfers of value made to covered health care providers during PY 2021. It also includes newly submitted or updated records from previous program years.
Now Available: Revised eCQM Specification for CMS156, Use of High-Risk Medications in Older Adults for 2023 Reporting/Performance Period for Eligible Clinicians
CMS has revised the electronic clinical quality measure specification for CMS156v11, Use of High-Risk Medications in Older Adults, for the 2023 reporting/performance period for Eligible Clinician programs. CMS revised the age criteria from the previously published specification on May 5, 2022, to better align with clinical guidelines. Please note, measures will not be eligible for 2023 reporting unless and until they are proposed and finalized through notice-and-comment rulemaking for each applicable program.
Performance Period 2022 Eligible Clinician Electronic Clinical Quality Measure Education and Outreach Webinar Series
CMS developed and published webinar content from the Performance Period 2022 Eligible Clinician Electronic Clinical Quality Measure Education and Outreach Webinar Series. PDF slides and links to the webinar video recordings are available to review on the eCQI Resource Center (under “Get Started with eCQMs – Implementing eCQMs Eligible Clinicians”).
Quality Payment Program
Visit the Quality Payment Program (QPP) Resource Library to Access 2023 MIPS Performance Period Self-Nomination Materials
This message is notification that the 2023 MIPS Performance Period Self-Nomination Materials (ZIP), including the below files, are now posted on the Quality Payment Program Resource Library:
- 2023 Qualified Clinical Data Registry (QCDR) Fact Sheet
- 2023 Qualified Registry Fact Sheet
- 2023 Self-Nomination User Guide for QCDRs and Qualified Registries
- 2023 QCDR Measure Development Handbook
Open and Close Dates
As a reminder, the 2023 MIPS Performance Period Self-Nomination Period will take place from 10 a.m. ET on July 1, 2022, to 8 p.m. ET on September 1, 2022.
Planning to submit quality data as part of your participation in traditional #MIPS? Check out our guide for an overview of the performance category for the 2022 performance year: https://t.co/yqg2EF0AZs #QPP pic.twitter.com/sdYJsR4MWa
— CMSGov (@CMSGov) July 13, 2022
If you’ll have difficulties meeting performance year 2022 #MIPS requirements due to circumstances out of your control, you can apply for a reweighting of any or all performance categories. Learn about the exceptions CMS offers: https://t.co/wQpNxqrYP9 #QPP pic.twitter.com/O7xlAMY6Mp
— CMSGov (@CMSGov) July 8, 2022
Have questions as you check your 2021 #MIPS Final Score Preview? We’ve provided dozens of answers in our new FAQs document, available for download here: https://t.co/gYGViVN5io #QPP pic.twitter.com/v82ZTQeuE7
— CMSGov (@CMSGov) July 6, 2022
The Medicare Promoting Interoperability Program Hardship Exception Application for Eligible Hospitals and Critical Access Hospitals is Now Available
On May 1, CMS opened the Hardship Exception Application period for eligible hospitals and critical access hospitals that participated in the Medicare Promoting Interoperability Program in Calendar Year 2021. For the CY 2021 reporting period, CMS required that all eligible hospitals and CAHs use (1) existing 2015 Edition certification criteria, (2) the 2015 Edition Cures Update criteria, or (3) a combination of the two in order to successfully meet the program requirements, as finalized in the CY 2021 Physician Fee Schedule final rule (85 FR 84818 through 84828). CMS mandates that downward payment adjustments be applied to eligible hospitals and CAHs that were not meaningful users of CEHRT and score below the 50-point minimum requirement and failed to report two self-selected calendar quarters of eCQMs data on four self-selected eCQMs.
Now Available: Updated eCQM Specifications and Implementation Resources for 2023 Reporting/Performance Period
CMS has posted the eCQM specifications for the 2023 reporting/performance period for the Eligible Hospitals and Critical Access Hospitals, Hospital Hybrid, Outpatient Quality Reporting, and Eligible Clinician programs. CMS updates the specifications annually to align with current clinical guidelines and code systems so they remain relevant and actionable within the clinical care setting. Measures will not be eligible for 2023 reporting unless and until they are proposed and finalized through notice-and-comment rulemaking for each applicable program.
We have released a new Information Bulletin that explains the correct way to use the NM1 Corrected Patient/Insured segment on the 2100 Loop of the ASC X12N Version 5010 X 221 Health Care Claim Payment/Advice (835). Learn more: https://t.co/GxfQnaaI2z #AdminSimp pic.twitter.com/tevdGWunRa
— CMSGov (@CMSGov) July 12, 2022
#HIPAA standards apply when coordinating the payment responsibilities for a patient covered by multiple health plans. Learn about the coordination of benefits transaction: https://t.co/jR7Yzk23vO #AdminSimp pic.twitter.com/1DnDp4NBkF
— CMSGov (@CMSGov) July 8, 2022
We’ve updated our Compliance Review Program Findings report to include new findings from 19 compliance reviews completed between April 2021 and March 2022. Download the new report here: https://t.co/Y8KWTePWdD #AdminSimp pic.twitter.com/3823Fd8r4M
— CMSGov (@CMSGov) July 7, 2022
Updated Compliance Review Program Findings Now Available
The National Standards Group (NSG) has released an updated Compliance Review Program Findings report identifying the most common violations of standards and operating rules from compliance reviews. This report expands on the Compliance Review Program Findings report released in July 2020 and includes insights from 19 additional reviews.
MLN Matters Articles
- July 2022 Update of the Ambulatory Surgical Center (ASC) Payment System — Revised
- Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP), and PC Print Update
- Changes to the Laboratory National Coverage Determination (NCD) Edit Software for October 2022
- Revisions to Medicare Part B Coverage of Pneumococcal Vaccinations for the Medicare Benefit Policy Manual Chapter 15, Section 18.104.22.168 — Revised
- International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs) ̶ July 2021 — Revised
- July Quarterly Update for 2022 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule
- July 2022 Update of the Ambulatory Surgical Center (ASC) Payment System
- Mental Health Visits via Telecommunications for Rural Health Clinics & Federally Qualified Health Centers — Revised
- Update to ‘J’ Drug Code List for Billing Home Infusion Therapy (HIT) Services
- July 2022 Update of the Hospital Outpatient Prospective Payment System (OPPS)
Claims, Pricers & Codes
- Claims Processing Instructions for the New Hepatitis B Vaccine Code 90759
- HCPCS Application Summaries & Coding Decisions: Drugs & Biologicals
- New Edit for Prospective Payment System (PPS) Outpatient and Inpatient Bill Types Receiving an Outlier Payment When a Device Credit is Reported
- Long COVID: Use ICD-10 Code U09.9
- Quarterly Update to the National Correct Coding Initiative [NCCI] Procedure-to-Procedure [PTP] Edits, Version 28.2, Effective July 1, 2022
- ICD-10-CM Diagnosis Codes: Fiscal Year 2023
- July 2022 Quarterly Average Sales Price [ASP] Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
- ICD-10-PCS Procedure Codes: Fiscal Year 2023
- July 2022 Integrated Outpatient Code Editor (I/OCE) Specifications Version 23.2
CMS Innovation Center
You asked & we answered! See the recording and slides from the Enhancing Oncology Model Overview webinar from June 30: https://t.co/SRqfy3XQua
— CMS Innovation Ctr (@CMSinnovates) July 13, 2022
We’re seeking comments on how benchmarking can create a path for long-term ACO & CMS savings, ⬆ ACO participation, + reduce ACO performance’s impacts on benchmarks. See the PFS proposed rule RFI: https://t.co/387fNfSolv, & submit your comments: https://t.co/AP2UlFffOQ pic.twitter.com/Zn6D8NWPrK
— CMS Innovation Ctr (@CMSinnovates) July 8, 2022
Interested in seeing where innovation is happening at the national & state level? Healthcare innovation might be closer than you think! Check the CMS Innovation Center interactive map to find out: https://t.co/tyOvEHbu0C pic.twitter.com/82wynFNBfq
— CMS Innovation Ctr (@CMSinnovates) July 7, 2022