ICYMI, here is recent communication from CMS.
Upcoming MIPS Important Dates and Deadlines
CMS would like to remind clinicians of important upcoming Merit-based Incentive Payment System (MIPS) dates and deadlines:
October 2024
- MIPS eligibility for the 2024 performance year will be updated based on the June 30 Alternative Payment Model (APM) snapshot (snapshot 2).
- Note: Qualifying APM Participant (QP) determinations and MIPS APM participation information will be available on the QPP Participation Status Tool.
- The 2025 virtual group election period opens, allowing solo practitioners and groups with 10 or fewer clinicians to submit an election to participate in MIPS as a virtual group for the 2025 performance period.
- Note: 2025 virtual group election period details will be available on the QPP website later this year.
- The final day to request a MIPS targeted review for your 2023 MIPS final score will be 60 days after the release of 2025 MIPS payment adjustment factor(s).
- The exact date will be identified when we announce final performance feedback is available.
- You’d only request a targeted review if you believe there’s an error in your MIPS performance feedback.
October 3, 2024
- Last day to begin implementing an activity for a continuous 90-day performance period for the improvement activities performance category in the 2024 performance period.
- Note: Most, but not all, improvement activities have a continuous 90-day performance period, but several improvement activities require completion of modules where there’s a year-long or alternate performance period. The performance period is 90 days unless otherwise stated in the activity description.
November 2024
- Updated MIPS eligibility for the 2024 performance year will be available on the QPP Participation Status Tool.
- Initial MIPS eligibility for the 2025 performance year will be available on the QPP Participation Status Tool.
December 2, 2024
- Last day to register to report a MIPS Value Pathway (MVP) for the 2024 performance year.
- Learn more about MVP registration.
December 2024
- Final MIPS eligibility for the 2024 performance year will be available on the QPP Participation Status Tool after the release of the August 31 APM snapshot (snapshot 3) data.
- QP determinations and MIPS APM participation information will be available on the QPP Participation Status Tool.
December 31, 2024
- Last day of the 2024 performance year, after which clinicians will no longer be able to collect data for the year.
- QPP Exception Application window closes at 8 p.m. ET for MIPS eligible clinicians reporting traditional MIPS, an MVP, or the APM Performance Pathway (APP) who want to submit a MIPS Extreme and Uncontrollable Circumstances Exception Application or MIPS Promoting Interoperability Performance Category Hardship Exception Application for the 2024 performance year.
- The 2025 virtual group election period closes at 11:59 p.m. ET, after which prospective applicants will no longer be able to submit, revise, or retract their elections for the 2025 performance year.
January 2, 2025
- Data submission period opens for the 2024 performance year.
Events
RSVP to Join CMS for an Office Hour Session on October 4th
Do you have questions about the Antibiotic Use and Antibiotic Resistance Surveillance measure(s) of the Public Health and Clinical Data Exchange Objective for the Medicare Promoting Interoperability Program? In conjunction with the Centers for Disease Control and Prevention and the Assistant Secretary for Technology Policy and Office of the National Coordinator for Health Information Technology, CMS is hosting an office hour session on October 4, 2024, at 2:00 PM ET. They will discuss the requirements for CY 2024 and CY 2025. If you have a question related to the Antibiotic Use and Antibiotic Resistance Surveillance measure(s) and would like to attend this office hour session, please email Elizabeth.Holland@cms.hhs.gov with your question and they will send the dial-in information.
News
CMS HQR System Now Accepting CY 2024 eCQM Data
CMS is notifying hospitals and vendors that the Hospital Quality Reporting (HQR) System is now accepting electronic clinical quality measure (eCQM) data for the calendar year (CY) 2024 reporting period. The HQR System now accepts Quality Reporting Document Architecture (QRDA) Category I test and production files using CY 2024 requirements.
Test QRDA Category I data submissions are considered practice submissions, and they do not count towards CMS program credit. Production QRDA Category I data submissions by hospitals, or by health information technology vendors on the hospital’s behalf, count as final data submissions to fulfill the eCQM reporting requirements for the Hospital Inpatient Quality Reporting (IQR) and Medicare Promoting Interoperability Programs.
CMS Seeks Requests for Comments on Templates to Aid Compliance with Mental Health Parity in Medicaid & CHIP
CMS requests comments on templates and instructional guides to help states and managed care plans document compliance with mental health and substance use disorder parity in Medicaid managed care arrangements, Medicaid alternative benefits plans, and CHIP in accordance with Medicaid and CHIP Mental Health Parity and Addiction Equity Act Final Rule requirements. The templates, along with detailed guides, will help standardize and streamline the information states submit to CMS to demonstrate compliance. These tools are also designed to facilitate CMS’ analysis of parity compliance documentation and coordinate the review across divisions within CMS.
CMS Announces Date for Conference on Optimizing Healthcare Delivery to Improve Patient Lives
CMS posted a save the date for the 2024 CMS Conference on Optimizing Healthcare Delivery to Improve Patient Lives, which will take place on December 12, 2024. This free virtual conference will convene changemakers from across the healthcare community and federal government to share new ideas, lessons learned, and best practices to reduce administrative burden and strengthen access to quality care. Details on session topics, speakers, and registration are coming soon.
CMS Issues Revised Guidance for Eligible Providers Interested in Being Certified as Rural Emergency Hospitals
CMS posted revised guidance regarding the Rural Emergency Hospital (REHs) enrollment and conversion process to assist eligible providers interested in participating in Medicare and Medicaid as REHs. REHs are a new provider type established by the Consolidated Appropriations Act of 2021 to address concerns over rural hospital closures. The revised memo incorporates additional information to help clarify the process and respond to stakeholder feedback.
Now Available: 2025 Eligible Clinicians and Eligible Hospitals/Critical Access Hospitals Electronic Clinical Quality Measure Flows
CMS developed and published the 2025 electronic clinical quality measure (eCQM) flows to the eCQI Resource Center. The eCQM flows supplement eCQM specifications for the 2025 reporting period for Eligible Hospitals/Critical Access Hospitals, and the 2025 performance period for Eligible Clinicians.
MIPS News
Reminder: 2024 MIPS Value Pathway (MVP) Registration Open
The Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs) registration window is open for the 2024 performance year. Individuals, groups, subgroups, and Alternative Payment Model (APM) Entities that wish to report an MVP can register until December 2, 2024, at 8 p.m. ET.
Reminder: 2023 Targeted Review Available
Review your MIPS performance feedback, including your MIPS final score and payment adjustment factor(s), on the Quality Payment Program website.
- Individual clinicians, groups, subgroups, virtual groups, APM Entities (including Shared Savings Program ACOs), designated support staff and authorized third party intermediaries may request that CMS review the calculation of their MIPS payment adjustment factor(s) through a process called targeted review.
When to Request a Targeted Review
If you believe there’s an error in the calculation of your MIPS  payment  adjustment factor(s), you can request a targeted review now until October 11, 2024, at 8 p.m. ET.
Quality Payment Program
#MIPS Participants can submit exception applications for the 2024 performance year until 8 p.m. ET on December 31, 2024. Review the 2 types of exception applications available to clinicians on the #QPP website: https://t.co/0NWx6WZsrZ pic.twitter.com/1mCrVTtzJD
— CMSGov (@CMSGov) September 13, 2024
Administrative Simplification
Interested in learning more about #HIPAA Administrative Simplification? Make sure to visit the #AdminSimp Resources and FAQs webpage: https://t.co/oUESXN7Hb4 #CMSOptimizingCare pic.twitter.com/QESbwqGWl4
— CMSGov (@CMSGov) September 18, 2024
The National Standards Group (NSG) administers #HIPAA Administrative Simplification requirements related to the format & content of electronic, administrative health care transactions, such as claims & payment. Learn more: https://t.co/BvCs5iaTEN #AdminSimp #CMSOptimizingCare pic.twitter.com/sCB3b6BWCx
— CMSGov (@CMSGov) September 17, 2024
Administrative Simplification aims to bring to health care the efficiencies that the financial and retail sectors have realized with electronic transactions. Read our #AdminSimp Fundamentals Fact Sheet to learn more: https://t.co/w4YbYQJMjp #HIPAA #CMSOptimizingCare pic.twitter.com/ajH1vQTk0R
— CMSGov (@CMSGov) September 12, 2024
MLN Matters Articles
- Ambulatory Surgical Center Payment Update – October 2024
- Changes to the Laboratory National Coverage Determination Edit Software: January 2025 Update
- Hospital Outpatient Prospective Payment System: October 2024 Update
- Inpatient & Long-Term Care Hospital Prospective Payment System: FY 2025 Changes
- New Waived Tests
- Inpatient Psychiatric Facilities Prospective Payment System: FY 2025 Updates
- Revisions to Medicare Part B Coverage of Pneumococcal Vaccinations Policy
- Annual Wellness Visit: Social Determinants of Health Risk Assessment — Revised
- National Coverage Determination 110.23: Allogeneic Hematopoietic Stem Cell Transplantation — Revised
- Hospice Payments: FY 2025 Update
- ICD-10 & Other Coding Revisions to National Coverage Determinations: January 2025 Update
- Hospital Outpatient Prospective Payment System: July 2024 Update — Revised
- Clinical Laboratory Fee Schedule & Laboratory Services Reasonable Charge Payment: October Update
- Lymphedema Compression Treatment Items: Implementation — Revised
Claims, Pricers, & Codes
- ACO REACH Model: Adjusting Claims
- Influenza Vaccine: Holding Claims for CPT Code 90658
- ICD-10 Medicare Severity Diagnosis-Related Group Version 42
- National Correct Coding Initiative: October Update
- Integrated Outpatient Code Editor Version 25.3
- Alzheimer’s Monoclonal Antibody Treatment: New Code for Kisunla Drug
- Claim Status Category & Claim Status Codes
- DMEPOS: Provider Level Adjustment Codes on Remittance Advice
- Home Health Consolidated Billing: CY 2025 HCPCS Code Update
- HCPCS Application Summaries & Coding Decisions: Non-Drug & Non-Biological Items and Services
- Seasonal Flu Vaccine Pricing for 2024–2025 Season
- Inpatient Rehabilitation Facility Prospective Payment System: FY 2025 Pricer Update
- Home Health Prospective Payment System Grouper: October Update
- Telehealth Services: Billing & Payment for Place of Service Code 10
- Medicare Physician Fee Schedule Database: October Update
CMS Innovation Center
#WhatDoYouValue? A doctor in the Enhancing Oncology Model explains how investing in staff & services through #ValueBasedCare ensures patients get needed treatment & help navigating health care system: https://t.co/hV5KGAWdBy pic.twitter.com/4OAVpy58uC
— CMS Innovation Ctr (@CMSinnovates) September 18, 2024
Kidney Care Choices (KCC) Model initial evaluation findings now online🔎: https://t.co/qF4XYk74KH. KCC is designed to improve the quality of care for people with #Medicare who have chronic kidney disease and end-stage renal disease. #KidneyCare pic.twitter.com/bx8rvgPiKn
— CMS Innovation Ctr (@CMSinnovates) September 17, 2024