The Centers for Medicare and Medicaid Services (CMS) is reporting these events, updates and deadlines for providers. These items focus on the agency’s financial and payment responsibilities to providers. Read and sign up for the CMS weekly newsletter MLN Connects® Provider eNews for the most current news.
2016 PQRS Negative Payment Adjustment and the Informal Review Process Deadline December 16
EPs, CPC practice sites, PQRS group practices, and ACOs that believe they have been incorrectly assessed the 2016 PQRS negative payment adjustment may submit an informal review between September 9, 2015 and December 16, 2015 requesting CMS investigate incentive eligibility and/or payment adjustment determination. All informal review requestors will be contacted via email of a final decision by CMS within 90 days of the original request for an informal review. All decisions will be final and there will be no further review.
Self-Nomination for 2016 Qualified Registries and Qualified Clinical Data Registries Open Now Through January 31, 2016
Entities interested in becoming a PQRS qualified registry or QCDR for 2016 must submit a self-nomination to CMS electronically using a self-nomination form on JIRA prior to the 5:00 p.m. Eastern Time on January 31, 2016. For additional information on becoming a 2016 qualified registry, please see the 2016 PQRS: Qualified Registry Criteria Toolkit posted on the Registry Reporting page.
CMS Seeking Comment on MACRA Episode Groups
As required by Section 101(f) of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), enacted April 16, 2015, CMS is soliciting comment on episode groups, and on specific clinical criteria and patient characteristics to classify patients into care episode and patient condition groups. The purpose is to provide background and context to solicit stakeholder input on the episode groups that the Centers for Medicare & Medicaid Services (CMS) has developed pursuant to section 3003 of the Affordable Care Act (ACA). Comments should be sent to episodegroups@cms.hhs.gov by 11:59 pm EST on February 15, 2016. Please note that comments will not be accepted after this date.
Comprehensive Care for Joint Replacement (CJR) Model Announced
Hip and knee replacements are the most common inpatient surgery for Medicare beneficiaries and can require lengthy recovery and rehabilitation periods. In 2014, there were more than 400,000 procedures, costing more than $7 billion for the hospitalizations alone. The Comprehensive Care for Joint Replacement (CJR) model addresses low quality and high costs that come from fragmentation by promoting coordinated, patient-centered care. This model aims to improve the care experience for the many and growing numbers of Medicare beneficiaries who receive joint replacements, making the patient’s successful surgery and recovery a top priority for the health care system.
ICD-10 Transition: Clarifications about NCDs and LCDs
All Medicare national and local coverage policies are translated for ICD-10, and to receive payment, providers must bill using ICD-10 codes for services rendered on or after October 1, 2015. Check the National Coverage Determination (NCD) and Local Coverage Determination (LCD) policies in the Medicare Coverage Database to find out which ICD-10 codes support medical necessity.
Resources for Specialties, Selected Health Conditions, and Services
With the ICD-10 compliance date two months behind us, many practices have moved beyond their initial transition activities and into the regular rhythm of coding using ICD-10. To help coders as they become more comfortable with ICD-10, the Centers for Medicare & Medicaid Services (CMS) has developed a new guide with resources for specialties and selected health conditions and services.