Monday Morning Rounds with CMS

ICYMI, here is recent communication from CMS.


December 2021 CMS Quality Programs Bi-Monthly Forum
When: Tuesday, December 14, 2021 1:30 – 2:30 pm ET
Register for this event.

CMS will host the next Quality Programs Bi-Monthly Forum on Tuesday, December 14. During the forum, CMS will provide attendees with important updates relevant to CMS’s Quality Measurement and Value-Based Incentives Group (QMVIG). 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.

Please note that registration for this webinar is limited, but the forum’s slide deck and recording will be posted to the Promoting Interoperability Events webpage and Quality Payment Program Webinar Library in the weeks following the webinar.


Reminder: Virtual Group Election Period Closes on December 31
If you’re interested in forming a virtual group for the 2022 Merit-based Incentive Payment System (MIPS) performance year, you must submit an election to CMS via email by 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).

Quality Payment Program SURS Initiative Ending
Over the past 5 years, CMS has successfully implemented a technical assistance initiative for clinicians in small practices participating in the QPP known as the Small, Underserved, and Rural Support (SURS). This initiative provides free, customized technical assistance to practices with 15 or fewer MIPS eligible clinicians. Since QPP began in 2017, SURS technical assistance organizations have provided direct support to an average of 107,250 clinicians annually and achieved a 99% average annual small practice clinician satisfaction rate for the technical assistance received based on an average of 19,281 responses. Overall, the feedback we’ve heard from clinicians that have worked with SURS technical assistance organizations has been overwhelmingly positive and shows the strong impact this initiative has had on small practice clinicians’ participation in QPP.

HHS Seeks Public Comments to Advance Equity and Reduce Disparities in Organ Transplantation, Improve Life-Saving Donations, and Dialysis Facility Quality of Care
The U.S. Department of Health and Human Services, through CMS issued a Request for Information (RFI) to solicit stakeholder and public feedback that will be used to inform potential changes and future rulemaking to improve the organ transplantation system and seek to enhance the quality of life of those living with organ failure. This is part of the Biden-Harris Administration’s ongoing efforts to improve the health outcomes of the more than 106,000 people who are waiting to receive a life-saving or life-enhancing organ transplant. CMS is focused on identifying potential system-wide improvements that would increase organ donations, improve transplants, enhance the quality of care in dialysis facilities, increase access to dialysis services, and advance equity in organ donation and transplantation.

Primary Care First Model: Seriously Ill Population Component Update
CMS announced that, after careful consideration, it will not move forward with the Seriously Ill Population (SIP) Component of the Primary Care First (PCF) Model. The SIP component of Primary Care First was designed to have advanced primary care practices, including providers whose clinicians are enrolled in Medicare and who typically provide hospice or palliative care services, coordinate care for high need, seriously ill beneficiaries. SIP proposed a novel method for identifying and attributing eligible beneficiaries to participants. A beneficiary outreach process that effectively engages and recruits beneficiaries is central to the SIP component and is necessary to ensure that there are enough beneficiaries to allow for a robust evaluation of the model. After careful review, CMS has determined that the proposed SIP outreach method, which was designed to comply with statutory beneficiary privacy protections, is unlikely to result in sufficient beneficiary uptake to allow for model evaluation.

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.

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

  • Hospital Inpatient EHR Reductions
  • ICD-10: New Diagnosis & Procedure Codes Effective April 1, 2022
  • 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.

Medicare-Medicaid Financial Alignment Initiative (FAI)
CMS posted four reports on the FAI. This initiative aims to improve quality, reduce expenditures, and integrate primary, acute and behavioral health, and long-term services and supports for Medicare-Medicaid enrollees. Through this initiative and related work, CMS is partnering with states to test models intended to achieve those goals. CMS has released the sixth actuarial report for the Washington Managed Fee-for-Service Demonstration, a preliminary second evaluation report on the California Cal MediConnect Demonstration, a second evaluation report for the Illinois Medicare-Medicaid Alignment Initiative, and a preliminary fourth evaluation report on the Massachusetts One Care demonstration.

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: 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.