Monday Morning Rounds with CMS

ICYMI, here is recent communication from CMS.

Upcoming Events

APM Performance Pathway (APP) Webinar
When: Monday, September 27, 2021  1:30 – 3:00 pm ET
Register for this event.

CMS is hosting a webinar to provide an overview of APP-related policies for the Quality Payment Program. The APP is a new reporting and scoring pathway for Merit-based Incentive Payment System (MIPS) eligible clinicians who participate in MIPS APMs.

During the webinar, CMS subject matter experts will review:

  • Quality Payment Program basics
  • APP reporting information
  • APP requirements for Shared Savings Program ACOs
  • APP reporting scenarios

September 2021 CMS Quality Programs Bi-Monthly Forum
When: September 28, 2021  1:30 – 2:30 pm ET
Register for this event.

During the forum, CMS will provide attendees with important updates relevant to CMS’s Quality Measurement and Value-Based Incentives Group. 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.

This forum will include updates on the following topics:

  • Medicare Promoting Interoperability Program
  • Electronic Clinical Quality Improvement (eCQI) Resource Center
  • Clinical Quality Language Libraries
  • Annual Change Review Process
  • Quality Payment Program (QPP)
  • Alternative Payment Models (APMs) and the APM Performance Pathway

APM Incentive Payment Webinar
When: Thursday, September 30, 2021  2:00 – 3:00 pm ET
Register for this event.

CMS is hosting a Quality Payment Program webinar to provide an overview of the 2021 Alternative Payment Model Incentive Payment for Qualifying APM Participants or APM Entities associated with QPs. Eligible clinicians who were Qualifying APM Participants based on their 2019 performance should have begun receiving their 2021 5% APM Incentive Payments earlier this summer.

During the webinar, CMS subject matter experts will discuss:

  • How the APM Incentive Payment was paid;
  • Scenarios to receive the APM Incentive Payment; and
  • How to access payment information on

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


Hurricane Ida Added to Automatic Extreme and Uncontrollable Circumstances Policy for MIPS
In response to the FEMA designation of Hurricane Ida as a major disaster, CMS has determined that the automatic extreme and uncontrollable circumstances policy will apply to Merit-based Incentive Payment System eligible clinicians in FEMA-designated disaster areas of Louisiana, Mississippi, New York, New Jersey, and Missouri.

Community Health Access and Rural Transformation (CHART) Model Announces Award Recipients
CMS will award up to $20 million to entities in four states to improve health care in rural areas, the agency announced. The funding will be awarded through the Community Transformation Track under the CHART Model. The CHART Model is intended to address disparities in health equity by improving access to quality health care and the sustainability of the health care system in rural communities. These funds will help test whether providing upfront funding, an innovative value-based payment, and operational flexibility can maintain or improve care quality and lower costs.

CMS is awarding up to $5 million in cooperative agreement funding to each of the following entities:

Important Reminders about CEHRT Requirements for Medicare Promoting Interoperability Program Participants
CMS would like to spotlight the certified electronic health record technology options that Medicare Promoting Interoperability Program participants may use for the remainder of calendar year 2021 to avoid a downward Medicare payment adjustment.

As a reminder, in accordance with the ONC 21st Century Cures Act Final Rule, eligible hospitals and critical access hospitals (CAHs) can use one of three CEHRT certification criteria options when participating in the Medicare Promoting Interoperability Program:

Administration to Expand Vaccination Requirements for Health Care Settings
The Biden-Harris Administration will require COVID-19 vaccination of staff within all Medicare and Medicaid-certified facilities to protect both them and patients from the virus and its more contagious Delta variant. Facilities across the country should make efforts now to get health care staff vaccinated to make sure they are in compliance when the rule takes effect.

Now Available: 2021 Change Review Process
CMS announces the availability of the 2021 Change Review Process for electronic clinical quality measures. The CRP provides eCQM users the opportunity to review and comment on draft changes to the eCQM specifications and supporting resources under consideration by the measure steward. The goal of the CRP is for eCQM implementers to comment on the potential impact of draft changes to eCQMs so CMS and measure stewards can make improvements to meet CMS’s intent of minimizing provider and vendor burden in the collection, capture, calculation, and reporting of eCQMs.

Quality Payment Program

Quality Payment Program: 2021 Performance Period Merit-based Incentive Payment System (MIPS) Quality Measures Impacted by the Annual ICD-10 Coding Update
In the Calendar Year (CY) 2021 Quality Payment Program Final Rule (85 FR 84898 through 84900), CMS finalized the policy allowing for the review of quality measures for significant impacts due to International Classification of Diseases, Tenth Revision (ICD-10) coding changes during the performance period. Performance for these quality measures will be assessed based only on the first 9 months of the 12-month performance period. Additional information regarding this policy can be found in the 2021 MIPS Quality Measures Impacted by ICD-10 Updates located on the QPP Resource Library.

Reminder: 2021 APM Incentive Payment Details Available; Learn if Action Needed
CMS previously published 2021 Alternative Payment Model (APM) Incentive Payment details on the Quality Payment Program (QPP) website. To access this information, clinicians and surrogates can now log in to the QPP website using their HARP credentials. Eligible clinicians who were Qualifying APM Participants (QPs) based on their 2019 performance should have begun receiving their 2021 5% APM Incentive Payments earlier this summer. CMS has posted the 2021 Learning Resources for QP Status and APM Incentive Payment (ZIP) with more details.

Update: 2020 MIPS Performance Feedback, Final Score, and 2022 MIPS Payment Adjustment Information
CMS will be updating the Merit-based Incentive Payment System (MIPS) performance feedback and final scores for some clinicians for performance year 2020 and the associated MIPS payment adjustment information for payment year 2022. You can view your current MIPS performance feedback, final score, and payment adjustment on the Quality Payment Program website. Please note the information you see now may be changing.

Claims, Pricers & Codes

  • Health Care Code Sets: ICD-10 — Revised
    Read new information (PDF) in this Medicare Learning Network fact sheet:

    • Simple code explanations
    • HIPAA requirement
    • Resources to advance health equity and help eliminate health disparities
  • HCPCS Level II Application Submission: Launch of MEARISTM
    The Medicare Electronic Application Request Information System (MEARIS) is available for HCPCS Level II fourth quarter 2021 and first biannual 2022 application submissions. For more information, visit the HCPCS – General Information webpage.
  • HCPCS Level II Application Submission Deadlines
    CMS announced HCPCS Level II application submission deadlines:

    • First quarter and first biannual 2022 coding cycles — January 4, 2022
    • Second quarter 2022 coding cycle — April 1, 2022
  • Non-Drug & Non-Biological Items and Services: HCPCS Application Summaries & Coding Decisions
    Visit the HCPCS Level II Coding Decisions webpage for more information.
  • ICD-10-CM Diagnosis Code Files for FY 2022
    Visit the 2022 ICD-10-CM webpage for Fiscal Year (FY) 2022 diagnosis code information
  • ICD-10-CM Codes: FY 2022
    Fiscal year (FY) 2022 ICD-10-CM codes are available on the 2022 ICD-10-CM webpage. Use these codes for discharges and patient encounters on or after October 1, 2021, through September 30, 2022.
  • ICD-10-PCS Procedure Codes: FY 2022
    Fiscal year 2022 ICD-10-PCS procedure codes are available on the 2022 ICD-10 PCS webpage. Use these codes for discharges on or after October 1, 2021, through September 30, 2022.
  • Average Sales Price Files: July 2021
    CMS posted the July 2021 Average Sales Price (ASP) and Not Otherwise Classified (NOC) pricing files and crosswalks on the 2021 ASP Drug Pricing Files webpage.


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.

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, (@CMSinnovates) also known as “the Innovation Center,” develops and tests new healthcare payment and service delivery models.

Announced: Financial Alignment Initiative for Medicare-Medicaid Enrollees
The Financial Alignment Initiative is designed to provide individuals dually enrolled for Medicare and Medicaid with a better care experience and to better align the financial incentives of the Medicare and Medicaid programs. Through the Initiative, CMS partners with states to test two new models for their effectiveness in accomplishing these goals. This initiative is possible through the collaboration of the CMS Innovation Center and the CMS Medicare-Medicaid Coordination Office.

Announced: Rural Community Hospital Demonstration
The goal of the program is to test the feasibility and advisability of cost-based reimbursement for small rural hospitals that are too large to be Critical Access Hospitals. CMS is conducting an intensive evaluation of the demonstration, assessing the financial impact on participating hospitals, as well as the effect on health care for the populations served.

Announced: Emergency Triage, Treat, and Transport (ET3) Model
Emergency Triage, Treat, and Transport (ET3) is a voluntary, five-year payment model that will provide greater flexibility to ambulance care teams to address emergency health care needs of Medicare Fee-for-Service (FFS) beneficiaries following a 911 call. CMS will continue to pay to transport a Medicare FFS beneficiary to a hospital emergency department or other covered destination. In addition, under the model, CMS will pay participants to 1) transport to an alternative destination partner, such as a primary care office, urgent care clinic, or a community mental health center (CMHC), or 2) initiate and facilitate treatment in place with a qualified health care partner, either at the scene of the 911 emergency response or via telehealth.

Announced: CHART Model
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.