The Centers for Medicare and Medicaid Services (CMS) proposed the first pay boost for physicians in five years in its proposed 2026 Physician Fee Schedule (PFS). The proposed rule also contains means to curb spending and introduces billing codes for behavioral health and chronic disease.
Physicians groups have warned for the past five...
The Centers for Medicare and Medicaid Services (CMS) has posted notice and a fact sheet for Quality Payment Program (QPP) exemptions notifying providers that the deadline for data submission has been pushed back from March 31 to April 14.
The extension does not apply to certain opt-in eligible groups or to Alternative Payment Model...
Last week, the Centers for Medicare and Medicaid Services (CMS) finalized the Medicare Physician Fee Schedule for 2025. It includes a 2.9% cut to physician pay.
The fee schedule includes policies aimed at improving access to primary care and boosting reimbursement for behavioral health, but the pay cut instantly drew harsh criticism...
The rule is designed to advance health equity and support whole-person care. Medicare physician payments would decline 2.9% in 2025 under the new proposed policy from CMS that also aims to offer six new MIPS Value Pathways (MVPs): ophthalmology, dermatology, gastroenterology, pulmonology, urology, and surgical care.
The Centers for...
This week saw further fallout from the Change Healthcare cyberattack, this time affecting local Arizona providers and the Merit-based Incentive Payment System (MIPS) data submission window. On Wednesday, the HHS Office of Civil Rights (OCR) launched an investigation of Change Healthcare and UnitedHealth Group (UHG) focused on whether a...
This week in value-based care (VBC), the Biden Administration is making headway on its goal to reform alternative payment models (APMs) for the Medicare program to boost program savings and advance the administration's goal of health equity in medicine.
MIPS
To get a refresh on value-based care models including the Quality Payment...National News
This week in value-based care, CMMI director Elizabeth Fowler defends criticism of the ACO REACH payment model, CMS improves ACO quality care reporting and data aggregation, the White House moves to support a value-based program for skilled nursing facilities, FQHCs struggle to keep up with systemic transformation and MedPAC moves to...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) will give physician groups participating in the Merit-based Incentive Payment System (MIPS) additional time to apply for a waiver that will allow their data to be re-weighted to account for the impacts of COVID-19 and the surge in cases related to the Omicron variant. CMS has assured...National News
This week, Congressional Democrats are sparring amongst themselves to bring President Joe Biden's infrastructure bill to a vote and the most public figure against the package as it stands now is Arizona's own Senator Kyrsten Sinema. What she wants is unclear, but what's in the balance includes closing a Medicaid loop hole and expansion...National News
Comments on the Calendar Year 2022 Payment Policies Under the Physician Fee Schedule are now closed as of September 13. Changes to Medicare Part B payment policies as well as updates to the Medicare Shared Savings Program (MSSP) and the Quality Payment Program (QPP) are included in the annual PFS rule. Providers broadly oppose Medicare...National News
This week, skilled nursing facilities are finding new pathways to value-based care and the Medicare Access and CHIP Reauthorization Act (MACRA) is under review for incentives. While ACOs have been struggling, the American Medical Group Association recommended several ways to improve them in a letter to the Centers for Medicare &...National News
A new study published in JAMA Health Forum suggests that the financial costs associated with participating in the Medicare & Medicaid Services Merit-based Incentive Payment System (MIPS) is quite considerable.
Dr. Dhruv Khullar, M.D. from the Weill Cornell Medical College examined costs for independent physician practices for...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) released 20 new proposed measures for quality and efficiency measures under consideration. CMS reviews and updates all quality measures annually for its programs, reviewing and removing less relevant ones and proposing more innovative metrics.
From CMS Administrator Seema...National News
The Centers for Medicare and Medicaid Services alternative payment models have found immediate difficulty navigating the COVID-19 pandemic with limited resources and occasionally difficult reporting requirements, but the issues between participants in these payment models and the structures of them actually go much further back than the...National News
The maximum MIPS payment adjustment for exceptional performance is the highest ever while participation is nearly at 100% with more than half a million clinicians participating and about 85% of small practices.
Clinicians with a final score equal to or above 75.00 points will receive a positive payment adjustment in 2021 of up to...National News
The noble experiment of value-based care is being put on hold by some providers and the path toward risk has been stop and go at the Centers for Medicare & Medicaid Services. But studies and professional opinion suggests that it is beneficial to patients and clinics alike, and therefore might be worth saving.
According to Modern...National News
The Medicare Payment Advisory Commission (MedPAC) voted unanimously to maintain updates to Medicare physician payments planned for 2021 -- with some caveats.
Primarily, the commission was concerned with the lack of data available on physician expenses. They stressed a need to better understand these expenses to improve the...National News
The Centers for Medicare and Medicaid Services (CMS) solicited information on how best to curb administrative tasks and streamline process, the American Medical Group Association (AMGA) and the Medical Group Management Association (MGMA) responded with several regulatory and policy reforms.
AMGA recommended CMS revise regulations and...National News
CMS released preliminary second-year participation data for the Quality Payment Program on July 11; includes 2017-2018 year-over-year data comparisons.
According to the agency, participation in Advanced APMs increased from 99,076 to 183,306 clinicians from 2017-2018. Eligible clinicians receive a five percent APM incentive payment...Arizona News
Last week, Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma released an update to her Merit-based Incentive Payment System (MIPS) original performance evaluation published in May. The November 8 blog post revealed 93 percent of participants merited a positive payment adjustment for their 2017...
