Monday Morning Rounds with CMS

ICYMI, here is recent communication from CMS.


Webinar: 2022 Medicare Promoting Interoperability Program Overview
When: Thursday, December 2, 2021  1:00 pm ET
Register for this event.

CMS is hosting a webinar to discuss program requirements for eligible hospitals and critical access hospitals participating in the Medicare Promoting Interoperability Program in Calendar Year 2022.

During this webinar, CMS subject matter experts will discuss the following:

  • Electronic health record (EHR) reporting requirements;
  • Certified EHR Technology requirements;
  • Program objectives, measures, and scoring requirements;
  • Electronic clinical quality measure changes; and
  • Important dates and where to find additional resources.

CMS subject matter experts will answer questions at the end of the webinar as time permits.


Medicare Fee-For-Service Estimated Improper Payments Decline by Over $20 Billion Since 2014
CMS announced that CMS’ aggressive corrective actions led to an estimated $20.72 billion reduction of Medicare Fee-for-Service improper payments over seven years. “CMS is undertaking a concerted effort to address the root causes of improper payments in our programs,” said CMS Administrator Chiquita Brooks-LaSure. “The continued reduction in Medicare fee-for-service improper payments represents considerable progress toward the Biden-Harris Administration’s goal of protecting CMS programs’ sustainability for future generations. We intend to build on this success and take the lessons we’ve learned to ensure a high-level of integrity across all of our programs.”

Prescription Drug and Health Care Spending Interim Final Rule with Request for Comments
On November 17, 2021, the Department of Health and Human Services, together with the Department of Labor and the Department of the Treasury (collectively, the Departments), as well as the Office of Personnel Management, released an interim final rule with request for comments, entitled “Prescription Drug and Health Care Spending.” This IFC is required under section 204 of Title II (Transparency) of Division BB of the Consolidated Appropriations Act, 2021, and implements new requirements for health plans and health insurance issuers in the group and individual markets to submit to the Departments certain information about prescription drug and health care spending.

Now Open: Virtual Group Election Period for the MIPS 2022 Performance Year
If you’re interested in forming a virtual group for the 2022 Merit-based Incentive Payment System (MIPS) performance year, the election period starts today. To form a virtual group, an election must be submitted to CMS via e-mail between October 1, 2021 and December 31, 2021 (11:59 p.m. ET).

NOTE: A virtual group must submit an election to CMS for each performance year that it intends to participate in MIPS as a virtual group (as required by statute). If your virtual group was approved for the 2021 MIPS performance year and intends to participate in MIPS as a virtual group for the 2022 MIPS performance year, your virtual group is still required to submit an election to CMS for the 2022 MIPS performance year between October 1, 2021 and December 31, 2021 (11:59 p.m. ET).

Promoting Interoperability Programs

On August 2, 2021 CMS released the Fiscal Year (FY) 2022 Medicare Hospital Inpatient Prospective Payment System for Acute Care Hospitals and Long-term Care Hospital Prospective Payment System Final Rule. For more information on the proposed changes, visit the Federal Register and view this fact sheet.

Medicaid Promoting Interoperability Program Participants: December 31, 2021 is the final day that states can make Medicaid Promoting Interoperability Program payments to Medicaid eligible professionals (EPs) and hospitals. For additional details about the end of the Medicaid Promoting Interoperability Program, please contact your state Medicaid agency or review the FY 2019 IPPS and LTCH final rule (83 FR 41676 through 41677).

Quality Payment Program

Performance Year 2021

Automatic Extreme and Uncontrollable Circumstances Policy
We’ve applied the automatic extreme and uncontrollable circumstances policy to all individual MIPS eligible clinicians for 2021 due to the continuing COVID-19 public health emergency.

APM Snapshot #2 Data Is Available
On October 20, 2021, CMS updated the QP status and MIPS APM participation status information on the QPP Participation Status Tool based on the second snapshot of APM data.

MIPS Facility-Based Scoring Not Available for Performance Year (PY) 2021
In response to the impact of the ongoing COVID-19 public health emergency (PHE), the Hospital VBP Program will not be calculating total performance scores for Fiscal Year (FY) 2022.

As a result, facility-based clinicians and groups will need to submit data for the quality performance category. Clinicians without available measures can submit an Extreme and Uncontrollable Circumstances Application, citing “COVID-19” as the triggering event.

Performance Year 2022

2022 Physician Fee Schedule (PFS) Final Rule Is Available
The 2022 PFS Final Rule which includes finalized QPP policies for 2022 and 2023, is now available for viewing.

CMS is Hiring

Upcoming MIPS Important Dates and Deadlines

CMS would like to remind clinicians of important upcoming Merit-based Incentive Payment System (MIPS) dates and deadlines:

  • December 31 – 2021 Promoting Interoperability Hardship Exception and Extreme and Uncontrollable Circumstances (EUC) Applications close. Clinicians, groups, and virtual groups who believe they’re eligible for these exceptions may apply, and if approved, will qualify for a re-weighting of one or more MIPS performance categories. Alternative Payment Model (APM) Entities can also request reweighting of all performance categories through the EUC application. CMS will notify applicants via email whether their requests are approved or denied. If approved, the exception will also be added to the QPP Participation Status Tool but may not appear in the tool until the data submission period begins in 2022.
  • December 31 – 2022 virtual group election period closes.
  • January 3, 2022 – 2021 MIPS performance year data submission period begins.
  • March 31, 2022 – 2021 MIPS performance year data submission period closes.

Claims, Pricers & Codes

  • IPPS, IRF & LTCH: New Web Pricer Released for FY 2022
    CMS released the Fiscal Years (FYs) 2020 – 2022 Web Pricer for the:

    • Inpatient Prospective Payment System (IPPS)
    • Inpatient Rehabilitation Facility (IRF) PPS
    • Long-Term Care Hospital (LTCH) PPS
  • HCPCS Application Summaries & Coding Decisions: 510(k)-Cleared Wound Care Products
    CMS published the 2021 HCPCS Application Summary for Supplemental Coding Cycle (PDF). Visit the HCPCS Level II Coding Decisions webpage for more information.
  • LTCH: New Web Pricer Released
    CMS released the fiscal years 2020 and 2021 Long-Term Care Hospital (LTCH) Web Pricer. For the best experience, access the Web Pricer through Google Chrome. You may also use Microsoft Edge or Mozilla Firefox, but not Microsoft Internet Explorer. Email your feedback on the LTCH Web Pricer to using the subject line “LTCH Web Pricer.”
  • 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.


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: Independence at Home Demonstration
Under the Independence at Home Demonstration, the CMS Innovation Center will work with medical practices to test the effectiveness of delivering comprehensive primary care services at home and if doing so improves care for Medicare beneficiaries with multiple chronic conditions. Additionally, the Demonstration will reward health care providers that provide high quality care while reducing costs.

Announced: Radiation Oncology Model
The Radiation Oncology (RO) Model aims to improve the quality of care for cancer patients receiving radiotherapy (RT) and move toward a simplified and predictable payment system. The RO Model tests whether prospective, site neutral, modality agnostic, episode-based payments to physician group practices (PGPs), hospital outpatient departments (HOPD), and freestanding radiation therapy centers for RT episodes of care reduces Medicare expenditures while preserving or enhancing the quality of care for Medicare beneficiaries. The Consolidated Appropriations Act, 2021 (H.R. 133) enacted on December 27, 2020 includes a provision that prohibits implementation of the RO Model prior to January 1, 2022. CMS has addressed this delay through notice and comment rulemaking in the CY 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule (CMS-1753-F).

Announced: Medicare Diabetes Prevention Program (MDPP) Expanded Model
The Medicare Diabetes Prevention Program expanded model is a structured intervention with the goal of preventing type 2 diabetes in individuals with an indication of prediabetes. The clinical intervention consists of a minimum of 16 intensive “core” sessions of a Centers for Disease Control and Prevention (CDC) approved curriculum furnished over six months in a group-based, classroom-style setting that provides practical training in long-term dietary change, increased physical activity, and behavior change strategies for weight control. After the completing the core sessions, less intensive follow-up meetings furnished monthly help ensure that the participants maintain healthy behaviors. The primary goal of the expanded model is at least 5 percent weight loss by participants. The National DPP is based on the results of the Diabetes Prevention Program (DPP) study funded by the National Institutes of Health (NIH). The study found that lifestyle changes resulting in modest weight loss sharply reduced the development of type 2 diabetes in people at high risk for the disease.