Centers for Medicare & Medicaid ServicesSpecial Open Door Forum:
Medicare Documentation Requirement Lookup ServiceTuesday, October 23, 20182:00-3:00 pm Eastern TimeConference Call Only The Centers for Medicare & Medicaid Services, Center for Program Integrity will host a series of Special Open Door Forum (SODF) calls to educate the public about a new initiative underway to develop a Medicare Fee for Service (FFS) Documentation Requirement Lookup Service prototype. Also, to allow physicians, suppliers, IT and Electronic Health Record (EHR) Developers and Vendors, and/or all other interested parties to provide feedback to CMS and inform how interested parties can get involved or track the progress of this initiative.
CMS is collaborating with ongoing industry efforts to streamline workflow access to coverage requirements, starting with developing a prototype Medicare FFS Documentation Requirement Lookup Service and is participating in two workgroups to promote development of standards that will support the Lookup Service. One workgroup is a private sector initiative hosted by Health Level Seven (HL7), the Da Vinci project. The second workgroup is The Office of the National Coordinator for Health Information Technology (ONC) Payer + Provider (P2) Fast Healthcare Interoperability Resource (FHIR) Taskforce. By working with HL7, ONC, other payers, providers, and EHR vendors, CMS is helping define the requirements and architect the standards-based solutions. In parallel, CMS is preparing to support pilots testing the information exchanges for Medicare FFS programs and possibly coordinate pilots with volunteer participants to verify and test the new FHIR based solutions.
The goals of the Documentation Requirement Lookup Service prototype are to reduce provider burden, reduce improper payments and appeals, and improve "provider to payer" information exchange. The prototype will be made accessible to pilot participants and will allow providers to be able to discover the following at the time of service and within their EHR or practice management system:
For more information and to access the slide presentation for the SODF, please visit our website: go.cms.gov/MedicareRequirementsLookup.We look forward to your participation.Special Open Door Participation Instructions:Participant Dial-In Number: 1-(800)-837-1935Conference ID: 7277693
A transcript and audio recording of this Special ODF will be posted to the Podcast and Transcripts website at https://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/PodcastAndTranscripts.html for downloading.For automatic emails of Open Door Forum schedule updates (E-Mailing list subscriptions) and to view Frequently Asked Questions please visit our website at http://www.cms.gov/OpenDoorForums/.
Thank you for your interest in CMS Open Door Forums.Note: TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.
CMS announced the 2019 premiums, deductibles, and coinsurance amounts for Medicare Parts A and B.
“CMS is committed to empowering beneficiaries with the information they need to make informed decisions about their healthcare,” said CMS Administrator Seema Verma. “In addition to the information we recently released for Medicare Advantage, the program through which private plans provide Medicare benefits, today we are releasing information for fee-for-service Medicare, so enrollees understand their options for receiving Medicare benefits.”
As announced earlier this month, CMS launched the eMedicare Initiative that aims to modernize the way beneficiaries get information about Medicare and create new ways to help them make the best decisions for themselves and their families. Ahead of Medicare Open Enrollment – which begins on October 15, 2018 and ends December 7, 2018 – CMS is making improvements the Medicare.gov website to help beneficiaries compare options and decide if Original Medicare or Medicare Advantage is right for them. Among the tools released as part of the eMedicare Initiative is a stand-alone, mobile optimized out of pocket cost calculator that will provide information on both overall costs and prescription drug costs.
Medicare Part B Premiums/Deductibles
Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.
The standard monthly premium for Medicare Part B enrollees will be $135.50 for 2019, a slight increase from $134 in 2018. An estimated 2 million Medicare beneficiaries (about 3.5 percent) will pay less than the full Part B standard monthly premium amount in 2019 due to the statutory hold harmless provision, which limits certain beneficiaries’ increase in their Part B premium to be no greater than the increase in their Social Security benefits.
CMS also announced that the annual deductible for Medicare Part B beneficiaries is $185 in 2019, an increase from $183 in 2018.
Medicare Part A Premiums/Deductibles
Medicare Part A covers inpatient hospital, skilled nursing facility, and some home health care services. About 99 percent of Medicare beneficiaries do not have a Part A premium since they have at least 40 quarters of Medicare-covered employment.
The Medicare Part A inpatient deductible that beneficiaries will pay when admitted to the hospital is $1,364 in 2019, an increase of $24 from $1,340 in 2018.
Medicare Advantage Premiums
Medicare beneficiaries can choose to enroll in fee-for-service Medicare (Parts A and B) or can select a private Medicare Advantage plan to receive their Medicare benefits. Premiums and deductibles for Medicare Advantage and Medicare Prescription Drug plans are already finalized and are unaffected by this announcement.
Last month, CMS released the benefit, premium, and cost sharing information for Medicare Advantage plans in 2019. On average, Medicare Advantage premiums will decline while plan choices and new benefits increase. On average, Medicare Advantage premiums in 2019 are estimated to decrease by six percent to $28, from an average of $29.81 in 2018.
For a fact sheet on the 2019 Medicare Parts A & B premiums and deductibles, please visit: https://www.cms.gov/newsroom/fact-sheets/2019-medicare-parts-b-premiums-and-deductibles.
For more information on the 2019 Medicare Parts A and B premiums and deductibles (CMS-8068-N, CMS-8069-N, CMS-8070-N), please visit https://www.federalregister.gov/public-inspection.
Did you know that there have already been multiple flu-related deaths in the earliest days of the 2018-19 flu season?
“Medical Matters” will begin its 2019 webinar series with “Influenza 2018-19” on Wednesday, October 17, 2018 at 7:30 a.m. Registration is now open for this webinar here.
William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. The educational objectives are: 1) Describe key indicators to look for when diagnosing patients presenting with flu-like symptoms. 2) Describe clinical and laboratory diagnostic features and treatment specific to each flu season. 3) Identify recommended immunizations and antiviral medications for treatment and how best to effectively encourage patients to get vaccinated.
Medical Matters is a series of Continuing Medical Education (CME) webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response. A copy of the flyer can be accessed (Please upload the flyer and put the link here).
The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Additional Medical Matters programs will be conducted in November 14, 2018 – June, 2019. Registration is also open for the November 14, 2018 program: Cybersecurity: A Daily Threat for Healthcare here. Additional program dates for Medical Matters will be announced shortly.
Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at firstname.lastname@example.org.
Know someone who has made exceptional contributions to our community through their service and dedication? Nominate them for our 2019 Edward Mott Moore Award to celebrate their success! http://bit.ly/2yuaxLf
This highest honor bestowed annually by the Medical Society is given to both a physician and a layperson in recognition of outstanding and dedicated service to the medical profession and the community.
If you participated in MIPS in 2017, your MIPS score and performance feedback are available on the Quality Payment Program website. The payment adjustment you will receive in 2019 will be based on your 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 score through a process called targeted review if they believe an error has been made in the 2019 payment adjustment calculation.
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 factor. 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 less than 2 weeks 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 2019 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 2017 MIPS 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 score and payment adjustment factor for 2019 (if applicable), as soon as technically feasible. CMS will determine the amount of the 2019 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.
For More Information
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 2017 MIPS score, or whether you should submit a targeted review request, please contact the Quality Payment Program by:
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.
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.