Monday Morning Rounds with CMS

ICYMI, here is recent communication from CMS.

Reminder: Applications for the 2020 Promoting Interoperability Hardship and Extreme and Uncontrollable Circumstances Exception are Due December 31. If you are interested in applying for a Merit-based Incentive Payment System (MIPS) Promoting Interoperability Hardship Exception or Extreme and Uncontrollable Circumstances Exception for the 2020 Performance Year of MIPS, you must submit your application to CMS by Thursday, December 31, 2020 at 8:00 p.m. ET.

CMS Changes Medicare Payment to Support Faster COVID-19 Diagnostic Testing. CMS announced new actions to pay for expedited coronavirus disease 2019 (COVID-19) test results. CMS previously took action in April 2020 by increasing the Medicare payment to laboratories for high throughput COVID-19 diagnostic tests from approximately $51 to $100 per test. CMS is announcing that starting January 1, 2021, Medicare will pay $100 only to laboratories that complete high throughput COVID-19 diagnostic tests within two calendar days of the specimen being collected. Also effective January 1, 2021, for laboratories that take longer than two days to complete these tests, Medicare will pay a rate of $75.

CMS updated its Quality Payment Program Participation Status Tool based on the second snapshot of data from Alternative Payment Model (APM) entities. The second snapshot includes data from Medicare Part B claims with dates of service between January 1, 2020 and June 30, 2020. The tool includes 2020 Qualifying APM Participant (QP) and Merit-based Incentive Payment System (MIPS) APM participation status. To learn more about how CMS determines QP and the APM participation status for each snapshot, please visit the Advanced APMs webpage on the QPP website.

New Repayment Terms for Medicare Loans Made to Providers During COVID-19. CMS announced amended terms for payments issued under the Accelerated and Advance Payment (AAP) Program as required by recent action by President Trump and Congress. This Medicare loan program allows CMS to make advance payments to providers, which are typically used in emergency situations. Under the Continuing Appropriations Act, 2021 and Other Extensions Act, repayment will now begin one year from the issuance date of each provider or supplier’s accelerated or advance payment. CMS issued $106 billion in payments to providers and suppliers in order to alleviate the financial burden health care providers faced while experiencing cash flow issues in the early stages of combating the Coronavirus Disease 2019 (COVID-19) public health emergency.

Provider Compliance Tips for Glucose Monitors and Diabetic Accessories/Supplies. CMS revised the Provider Compliance Tips for Glucose Monitors, and Diabetic Accessories/Supplies Medicare Learning Network Fact Sheet.

CMS expanded the list of telehealth services that Medicare Fee-for-Service will pay for during the COVID-19 Public Health Emergency (PHE). CMS is also providing additional support to state Medicaid and Children’s Health Insurance Program (CHIP) agencies in their efforts to expand access to telehealth. The actions reinforce the Executive Order on Improving Rural Health and Telehealth Access to improve the health of all Americans by increasing access to better care. The list of these newly added services is available on the List of Telehealth Services webpage.

Protecting Integrity of COVID-19 Testing. CMS is taking every action to ensure U.S. laboratories are fit to deliver reliable, accurate and timely patient test results for coronavirus disease 2019 (COVID-19) by confirming Clinical Laboratory Improvement Amendments of 1988 (CLIA) certifications are up- to-date. A recent record check by CMS resulted in the issuance of 171 cease and desist letters to facilities that did not have proper CLIA certifications in place. CLIA certification is important because it verifies that laboratories meet federal performance, quality and safety standards to properly diagnose, prevent and treat diseases.


Updated guidance is available on the Electronic Clinical Quality Improvement (eCQI) Resource Center.

MLN Matters Articles

From CMS Innovation Center

Comprehensive Primary Care Plus (CPC+). Second Annual Evaluation Report Key Takeaways: In the second year of the initiative, practices used the CPC+ supports to build on their progress from the first year and continue to make important changes in care. These changes included adding care management processes and staff to help patients with complex needs manage their conditions, integrating behavioral health care into their practices, and establishing formal processes with hospitals and emergency departments to improve care transitions. Although practices made beneficial changes to care delivery, many indicated that additional payments, more timely and user-friendly data feedback, and stronger health IT support would be helpful in achieving the five Comprehensive Primary Care Functions.

Accountable Care Organization (ACO) Investment Model (AIM). Final Evaluation Report – Three Performance Years Key Takeaways: Selected key takeaways from the AIM final report include: AIM ACOs were located in areas with greater health care needs and less access to accountable care. Many AIM ACOs indicated that AIM funds were critical to their formation. AIM ACOs were successful in reducing total Medicare spending and related utilization without decreasing the quality of care they provided. AIM generated net savings to Medicare during each of the three performance years. Most AIM ACOs ended participation in the Shared Savings Program (SSP) at the end of 2018. However, many of their providers partially or fully joined other SSP ACOs in 2019.

The CMS Innovation Center maintains a portfolio supporting the development and testing of innovative health care payment and service delivery models. It performs evaluations of these models and makes the results available to the public. Stay Connected with the Innovation Center.