In the CY 2018 Quality Payment Program final rule (82 FR 53716), CMS finalized a process to stabilize measure data throughout the performance period when a measure is impacted by ICD-10 updates mid-performance period. ICD-10 code updates are effective annually on October 1st. An annual review process was established to analyze and assess the quality measures to determine which measures are significantly impacted (determined by a 10% threshold) by ICD–10 code changes during the performance period. If a quality measure is impacted by 10% or more ICD-10 code changes, the performance score for the quality measure will be based only on the first 9 months of the 12-month performance period for those identified measures. CMS has published a list of 2018 quality measures that have been identified as impacted by this update in the Quality Payment Program resource library.
Join CMS on October 11th for a Virtual Office Hours Session Regarding the 2019 MIPS Self-Nomination Process
During the 2019 Performance Period Self-Nomination period, CMS will offer a 2019 Merit-Based Incentive Payment System (MIPS) Performance Period Self-Nomination Virtual Office Hours session. The purpose of this session is to allow current and potential Qualified Clinical Data Registries (QCDRs) and Qualified Registries the opportunity to participate in a question and answer session regarding the self-nomination process and its related tasks.
Qualified Registries and QCDRs are CMS-approved vendors that collect clinical data on behalf of clinicians for data submission to CMS for the MIPS program. Please note that eligible clinicians wishing to report for the 2019 performance period of the MIPS program via the Qualified Registry or QCDR reporting mechanism do NOT need to self-nominate. Only entities wishing to participate (and who meet the requirements) as a Qualified Registry and/or QCDR need to complete and submit the self-nomination form. Please attend the session on October 11th from 1-2:30 pm ET if your organization plans to self-nominate as a Qualified Registry or QCDR and you have questions regarding the Self-Nomination process and its related tasks. Participation in this session is optional.
The audio portion of this webinar will be broadcast through the web. You can listen to the presentation through your computer speakers. If you cannot hear audio through your computer speakers, please contact CMSQualityTeam@ketchum.com. Phone lines will be available for the Q&A portion of the webinar.
For More Information
If you’re interested in forming a virtual group for the 2019 Merit-based Incentive Payment System (MIPS) performance year, the election period is now open. To form a virtual group, you must follow an election process and submit your election to CMS via e-mail by December 31, 2018.
Who Can Join a Virtual Group?
You can participate in a virtual group if you are either:
Please note: TIN size is based on the total number of clinicians, or National Provider Identifiers (NPIs), billing under a TIN, which includes clinicians who are and are not MIPS eligible.
What is the Virtual Group Election Process?
There is a two-stage election process for forming a virtual group:
Stage 1 (optional):
Stage 2 (required):
As part of Stage 2 of the election process, you must:
Download the 2019 Virtual Groups Toolkit to learn more about the election process and how to participate in MIPS as a virtual group for the 2019 performance year. The toolkit also contains sample templates for the submission e-mail and the virtual group formal agreement.
Why Join a Virtual Group?
Forming a virtual group gives you the opportunity to effectively and efficiently coordinate resources to achieve and meet requirements under each MIPS performance category, and potentially increase your performance. You can choose the size and composition of your virtual group, and your virtual group may be formed based on location, specialty, or shared patient population.
2018 Virtual Groups - Participation in MIPS
For the 2018 performance year, only a couple of elections for virtual group formation were received as clinicians explored the benefits of virtual groups. Although only a few participated, we were able to gain valuable insights into important considerations for virtual groups. We recognize that the formation of a virtual group requires time and coordination among the small practices within a virtual group. To support the establishment and implementation of virtual groups, free, one-on-one technical assistance is available. We continue to create and provide useful resources and tools that are easily accessible and available for virtual groups. Currently, virtual groups are diligently operationalizing and preparing for the submission of data to meet MIPS requirements.
September 27, 2018
Reports of patients using standard pen needles to inject insulin without removing the inner needle cover have prompted the US Food and Drug Administration (FDA) to issue a safety communication on proper use of pen needles.
Posted September 27 on the agency's website, the safety notice reminds healthcare providers, patients, and caregivers about the correct use of pen needles and potential risks if the standard pen needle's inner needle cover is not removed before injection.
Pen needles are used to inject different types of medicine with pen injectors. Standard pen needles often have an outer cover and a removable inner needle cover. Both the outer cover and inner needle cover must be removed before an injection.
If you participated in the Merit-based Incentive Payment System (MIPS) in 2017, your MIPS final score and performance feedback are available on the Quality Payment Program website. The payment adjustment you will receive in 2019 is based on this final score. A positive, negative, or neutral payment adjustment will be applied to the Medicare paid amount for covered professional services furnished under the Medicare Physician Fee Schedule in 2019.
MIPS eligible clinicians or groups (along with their designated support staff or authorized third-party intermediary), including those who are subject to the APM scoring standard, may request for CMS to review their performance feedback and final score through a process called targeted review if they believe an error has been made in the 2019 payment adjustment calculation.
Please read the following article from Modern HealthCare, as well:
Please note, on September 13, 2018, CMS updated MIPS 2017 performance feedback for clinicians affected by scoring issues previously identified through the targeted review process. Additionally, to ensure that we maintain the budget neutrality required by law under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), some clinicians will see slight changes in their payment adjustment. If you believe an error exists in your 2019 MIPS payment adjustment calculation, you can request a targeted review by the extended deadline of October 15 at 8:00 PM EDT-which is just 20 days away. To learn more, view this 2017 MIPS Performance Feedback Statement.
When to Request a Targeted Review
The following are examples of circumstances in which you may wish to request a targeted review:
This is not a comprehensive list of circumstances. CMS encourages you to contact the Quality Payment Program if you believe a targeted review of your MIPS payment adjustment (or additional MIPS payment adjustment) is warranted. We’ll help you to determine if you need to submit a targeted review request.
How to Request a Targeted Review
You can access your MIPS final score and performance feedback and request a targeted review by:
When evaluating a targeted review request, we will generally require additional documentation to support the request. If your targeted review request is approved, CMS will update your final score and associated payment adjustment (if applicable), as soon as technically feasible. CMS will determine the amount of the upward payment adjustments after the conclusion of the targeted review submission period. Please note that targeted review decisions are final and not eligible for further review.
To learn more about the steps for requesting a targeted review, please review the following:
If you have questions about your MIPS performance feedback or final score, or whether you should submit a targeted review request, please contact the Quality Payment Program by:hone: 1-866-288-8292/TTY: 1-877-715-6222; or email: QPP@cms.hhs.gov
2019 flu vaccine code.pdf
2018-2019 flu season.pdf
The American Cancer Society and the YMCA of Greater Rochester are hosting a Policy Forum on children and cancer prevention.
The invite and registration link are finalized! To register, simply go to: https://www.acscan.org/events/children-cancer-prevention-policy-forum
CMS has posted the following new Merit-based Incentive Payment System (MIPS) resources on CMS.gov:
FROM NYS WORKERS' COMP BOARD
As of September 10, 2018, the Special Funds Conservation Committee (SFCC) will no longer be administering workers compensation, volunteer firefighter, and volunteer ambulance worker claims.
These claims are being transferred to new third-party administrators (TPAs), who will assume all claims administration services.
Notifying Injured Workers
Injured workers have been notified of the name and contact information of their new TPA, and have been advised to inform their legal representatives and medical providers of this change.
Medical Reporting and Billing
All requests for treatment authorization on and after September 10, 2018, must be sent to the correct TPA for the injured worker.
All medical bills received by SFCC in error during this period of transition will be forwarded to the proper TPA for resolution and payment.
Finding the New TPA
If you are providing medical treatment or legal representation for an injured worker who lists SFCC as their insurer on or after September 10, 2018, please inquire further, as the SFCC will no longer be the claims administrator at that time.
For information about the new TPA, the injured worker (or your office if you have previously submitted Form OC-400 or medical bills to the Workers Compensation Board for that person in that workers compensation case) may contact SFCC or the Workers Compensation Board.
Contact SFCC Buffalo: (716) 686-5700
Dewitt: (315) 445-9405
New York City: (212) 883-3900
Contact the Workers Compensation Board (877) 632-4996
Please note, the distribution of claims amongst the new TPAs does not follow any identifiable pattern (such as injured worker last name or injury date) that can be shared ahead of or after the transfer; however, the SFCC and the Board can provide this information to you on a case-by-case basis upon your request.