Wednesday, August 22 from 1:30 to 3 pm

Register for Medicare Learning Network events.

Proposed changes to the CY 2019 Physician Fee Schedule would increase the amount of time doctors and other clinicians spend with their patients by reducing the burden of Medicare paperwork.  During this listening session, CMS experts will briefly cover three provisions from the proposed rule and address your clarifying questions to help you formulate your written comments for formal submission:

• Streamlining Evaluation and Management (E/M) payment and reducing clinician burden
• Advancing virtual care
• Continuing to improve the Quality Payment Program to reduce clinician burden, focus on outcomes, and promote interoperability

We encourage you to review the proposed rule prior to the call, as well as the following materials on the provisions to be covered:

• Quality Payment Program Year 3 (2019) Webinar Recording, Transcript, Presentation, and Comparison Fact Sheet
• Slide presentation on E/M and Advancing Virtual Care
• E/M Coding Reform videos:  Introduction, Office Visits and Panel Discussion

Note: Feedback received during this listening session will not be considered formal comments on the rule. See the proposed rule for information on submitting these comments by September 10, 2018.

Target Audience: Medicare Part B fee-for-service clinicians; office managers and administrators; state and national associations that represent healthcare providers; and other stakeholders.

CMS will be hosting a webinar to present the benefits of using the MSPRP, this will include newly available features. The webinar will be held August 16, 2018. The notice for the webinar is available in the Downloads section of the Coordination of Benefits Overview What’s New page on CMS.gov and includes all webinar information

NCQA updates the NYS PCMH publication annually to clarify guidance and refine criteria expectations. Download the NYS PCMH Standards and Guidelines (2017 Edition, Version 3) to review. Highlights of the update include: Organizations with two or more sites are now allowed to share or partially share an additional 21 criteria across practice sites, saving time and reducing documentation. Updates to guidance language for clarity of criteria. Updated selected concept and competency descriptions to align with criteria included in the concepts and competencies.

Summary of Changes to PCMH Standards and Guidelines Practices may share evidence for these criteria: KM 02-KM 05 AC 05 CC 01 CC 02 CC 04 CC 10 CC 14-CC 16 CC 18 CC 19 QI 15 QI 16 BH 02     Criteria Change CM 04-CM 08 Practices may share examples for CM 04-CM 08, although each site must still provide a Record Review Workbook. QI 06 Practices must provide site-specific evidence for QI 06. TC 01, TC 04 Clarified requirements for these criteria. TC 03 Removed the reference to health information exchanges (HIE). Updated guidance to clarify that participating in an ACO or clinically integrated network does not meet this criterion. TC 09 Clarified the criterion language to require practices to periodically remind patients of the roles and responsibilities of the medical home. CM 05 Clarified criterion language to require practices to give written care plans to patients electronically or as a printed document. CC 09/BH 05 Removed text: "The practice must provide a report, log or electronic tracking system as evidence of implementation." CC 14 Updated evidence from "Report" to "Evidence of implementation." CC 16 Evidence updated from "Evidence of follow-up" to "Evidence of implementation."  CC 18-CC 19 Removed the requirement for practices to provide at least three examples of data exchange (CC 18) and obtaining discharge summaries (CC 19). QI 07 Clarified the criteria's language and guidance to further differentiate between QI 05 and QI 07. QI 10 Clarified the criterion language to state that practices that have met their appointment availability access goals may focus on improvement in another patient-access area. QI 15-QI 16 Modified criteria language to clarify that practices may report clinician-level data or practice-level data.

Summary of Changes to NYS PCMH Policies and Procedures Rearranged and updated portions of the Overview section for clarity. Updated the Commit, Transform and Succeed sections to align with changes to the Q-PASS process. Added a section describing the role of the prevalidated vendor and NCQA investigation. Expanded the Reportable Events Policy to clarify when and how to inform NCQA of reportable events such as mergers, acquisitions, consolidations and investigations. Thank you for your ongoing commitment to delivering high-quality, patient-centered care. If you have questions, submit them through My NCQA.

In case you missed it last week, see below for a link to the webcast of the panel discussion on Evaluation & Management Coding:

• Title: CMS Panel Discussion on E/M Coding Reform

Link: https://youtu.be/W2QBTQNxfSY

CMS is hosting a series of webinars on the Merit-based Incentive Payment System (MIPS) Performance Categories for Year 2 (2018) of the Quality Payment Program. The webinars will provide an overview of the Improvement Activities and Quality performance categories for Year 2 (2018). CMS subject matter experts will cover topics including category requirements, scoring details, and data submission mechanisms.

Below are details for the following webinars and how to register:

MIPS Improvement Activities Performance Category for Year 2 (2018) Overview Webinar

• Date: Wednesday, August 1, 2018
• Time: 1:00 to 2:00 PM ET
• Register: https://engage.vevent.com/rt/cms/index.jsp?seid=1138

MIPS Quality Performance Category for Year 2 (2018) Overview Webinar

• Date: Monday, August 6, 2018
• Time: 1:00 to 2:00 PM ET
• Register: https://engage.vevent.com/rt/cms/index.jsp?seid=1134

The audio portion of these webinars will be broadcast through the web. You can listen to the presentation through your computer speakers. CMS will open the phone line for the Q&A portion, but if you are unable to hear audio through your computer speakers, please contact CMSQualityTeam@ketchum.com.

CMS Will Answer Questions about Performance Feedback & Targeted Review During Two “Office Hours” Sessions

If you participated in the Merit-based Incentive Payment System (MIPS) in 2017, your MIPS final score and performance feedback are now available for review on the Quality Payment Program website. If you believe that an error has been made in your 2019 MIPS payment adjustment calculation, you can request a targeted review until October 1, 2018 at 8:00 pm (EDT).

CMS will be hosting two “Office Hours” sessions over the next few weeks to:

• Provide a brief overview of MIPS 2017 performance feedback and targeted review
• Answer some frequently asked questions
• Highlight helpful performance feedback and targeted review resources available

We encourage you to email your questions prior to the Office Hours sessions. If you are interested in submitting a question to be considered, please email CMSQualityTeam@ketchum.com. Please note, this email address is only for office hours questions; do not use this to submit a targeted review request.

Office Hours Details

Title: Performance Feedback and Targeted Review Office Hours Session

Date: Tuesday, July 31, 12:00 – 1:00 p.m. ET

Register: https://meetingconnect.webex.com/meetingconnect/onstage/g.php?MTID=e4c6390a9eb367919b4e5c25c96107d43

 

Title: Performance Feedback and Targeted Review Office Hours Session

Date: Tuesday, August 14, 2:00 – 3:00 p.m. ET

Register: https://meetingconnect.webex.com/meetingconnect/onstage/g.php?MTID=e91df49e0f68fa7073866f0307f82b53b

Please note: Space for these sessions is limited. Register now to secure your spot. The audio portion of the sessions will be broadcast through the web. You can listen to the presentation through your computer speakers.

Learn More

For more information on performance feedback and targeted review, the following resources are available:

• 2017 Performance Feedback User Guide
• 2017 Performance Feedback Fact Sheet
• Targeted Review of the 2019 Merit-based Incentive Payment System Payment Adjustment Fact Sheet
• Targeted Review of 2019 MIPS Payment Adjustment User Guide

Questions? Contact the Quality Payment Program by:

• Email: qpp@cms.hhs.gov
• Phone: 1-866-288-8292 (TTY: 1-877-715-6222)

Updates to the 2018 CMS QRDA III Implementation Guide

The Centers for Medicare & Medicaid Services (CMS) has published an updated 2018 CMS Quality Reporting Document Architecture Category III (QRDA III) Implementation Guide (IG) for Eligible Clinicians and Eligible Professionals. This is an update to the 2018 CMS QRDA III IG for Eligible Clinicians and Eligible Professionals originally published on 11/27/2017 and updated previously on 3/12/2018.

This latest update includes:

• Renaming of the Merit-based Incentive Payment System (MIPS) performance category Advancing Care Information (ACI) to Promoting Interoperability (PI).
• Changes to performance period reporting:
  
  The performance period under MIPS can be reported at either of the following levels:

1. The individual measure level for the MIPS quality measures and at the individual activity level for the MIPS improvement activities (IA), as defined by CMS, or
2. The performance category level for Quality and IA performance categories, as previously specified in the 2018 CMS QRDA III IG.

• Performance period reporting for PI will remain at the performance category level only.
• Performance period reporting for Comprehensive Primary Care Plus (CPC+) for the Quality performance category remains at the category level only.
• New CMS program name code created “MIPS_VIRTUALGROUP” to support MIPS virtual group reporting.
• Eight new PI measure identifiers have been developed that indicate active engagement with more than one registries.
  The new measure identifiers consist of an existing measure identifier appended with “_MULTI”. For example, the new measure identifier “PI_PHCDRR_1_MULTI” indicates immunization registry reporting for multiple registry engagement.

Additional QRDA-Related Resources:

• You can find additional QRDA related resources, as well as current and past implementation guides, on the Electronic Clinical Quality Improvement Resource Center.
• For questions related to the QRDA Implementation Guides and/or Schematrons, visit the ONC QRDA JIRA Issue Tracker.
• For questions related to Quality Payment Program/MIPS data submissions, visit the Quality Payment Program website or contact by phone 1-866-288-8292, TTY: 1-877-715-6222 or email QPP@cms.hhs.gov.

CMS is hosting a webinar on Tuesday, July 17 at 1:00 PM ET to provide information about the proposed rule for Year 3 (2019) of the Quality Payment Program.

During the webinar, CMS subject matter experts will:

• Provide an overview of the proposed rule for Year 3 of the Quality Payment Program
• Highlight key differences between Year 2 and proposed Year 3 requirements
• Discuss the comment submission process
• Provide additional resources

Webinar Details

Title: Overview of Proposed Rule for Year 3 (2019) of the Quality Payment Program Webinar

Date: Tuesday, July 17, 2018

Time: 1:00 – 2:30 p.m. ET

Registration Link: https://engage.vevent.com/rt/cms/index.jsp?seid=1142

The audio portion of this webinar will be broadcast through the web. You can listen to the presentation through your computer speakers. CMS will open the phone line for the Q&A portion. If you cannot hear audio through your computer speakers, please contact CMSQualityTeam@ketchum.com.

The Deadline for Submitting a MIPS Targeted Review Request Is Now October 1, 2018

If you participated in the Merit-based Incentive Payment System (MIPS) in 2017, your MIPS final score and performance feedback is now available for review 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. 

When to Request a Targeted Review

If you believe an error has been made in your 2019 MIPS payment adjustment calculation, you can request a targeted review until October 1, 2018 at 8:00pm (EDT). The following are examples of circumstances in which you may wish to request a targeted review: 

• Errors or data quality issues on the measures and activities you submitted
• Eligibility issues (e.g., you fall below the low-volume threshold and should not have received a payment adjustment)
• Being erroneously excluded from the APM participation list and not being scored under APM scoring standard
• Not being automatically reweighted even though you qualify for automatic reweighting due to the 2017 extreme and uncontrollable circumstances policy

Note: This is not a comprehensive list of circumstances. CMS encourages you to submit a request form if you believe a targeted review of your MIPS payment adjustment (or additional MIPS payment adjustment) is warranted.

How to Request a Targeted Review

You can access your MIPS final score and performance feedback and request a targeted review by:

• Going to the Quality Payment Program website
• Logging in using your Enterprise Identity Management (EIDM) credentials; these are the same EIDM credentials that allowed you to submit your MIPS data. Please refer to the EIDM User Guide for additional details.

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.

For more information about how to request a targeted review, please refer to the Targeted Review of the 2019 Merit-based Incentive Payment System Payment Adjustment Fact Sheet and the Targeted Review of 2019 MIPS Payment Adjustment User Guide.

Questions?

If you have questions about your performance feedback or MIPS final score, please contact the Quality Payment Program by:

• Phone: 1-866-288-8292/TTY: 1-877-715-6222 or
• Email: QPP@cms.hhs.gov

http://www.wcb.ny.gov/content/main/SubjectNos/sn046_1079.jsp