New Online Tool Displays Cost Differences for Certain Surgical ProceduresProcedure Price Lookup will help patients with Medicare consider potential cost differences when choosing among safe and clinically appropriate settings
Today, the Centers for Medicare & Medicaid Services (CMS) launched a new online tool that allows consumers to compare Medicare payments and copayments for certain procedures that are performed in both hospital outpatient departments and ambulatory surgical centers. The Procedure Price Lookup tool displays national averages for the amount Medicare pays the hospital or ambulatory surgical center and the national average copayment amount a beneficiary with no Medicare supplemental insurance would pay the provider.
“Price transparency in health care is a priority for the Trump Administration. Working with their clinicians, the Procedure Price Lookup will help patients with Medicare consider potential cost differences when choosing where to have a medical procedure that best meets their needs,” said CMS Administrator Seema Verma.
The Procedure Price Lookup tool is launching as required by Congress in the 21st Century Cures Act. Medicare’s statutes require that CMS maintain separate payment systems for different types of healthcare providers, meaning both CMS and patients may pay different amounts for the same service, depending on the site of care.
“The different payment rates are a prime example of Medicare’s misaligned financial incentives, under which providers can make more money if they see patients at one location as opposed to another,” Administrator Verma said.
Procedure Price Lookup, part of the agency’s eMedicare initiative, joins other patient-oriented transparency tools, including an overhauled version of the agency’s drug pricing and spending dashboards, which provide patients with Medicare and Medicaid spending information for thousands more drugs than ever before and, for the first time, list the prescription drug manufacturers that were responsible for price increases.
CMS recently launched the eMedicare initiative to empower beneficiaries with cost and quality information. This announcement included the launch of an enhanced interactive online decision support feature to help people better understand and evaluate their Medicare coverage options. eMedicare also offers a mobile-optimized out-of-pocket cost calculator to provide beneficiaries with information on overall plan costs and prescription drug costs.
For a blog post on the Procedure Price Lookup took by Administrator Verma, please visit: https://www.cms.gov/blog/you-have-right-know-price.
The Procedure Price Lookup tool is available at: https://www.medicare.gov/procedure-price-lookup/.
Below are links to MLMIC’s most recent issues of Dateline and Case Review that can be found at MLMIC.com.
11.1.18 Fact Sheet PFS (CMS-1693-F).pdf
11.1.18 Press Release 2019 PFS-QPP (CMS-1693-F).pdf
EM Payment Chart-Updated-Nov1.pdf
https://www.eventbrite.com/e/offender-accountability-victim -safety-dv-t raining-opportunity tickets-51517636638
The 2018 performance year for the Merit-based Incentive Payment System (MIPS) ends on December 31, 2018. To access the Quality Payment Program Portal and submit your 2018 performance data, you’ll need your EIDM User ID and Password.
Creating an EIDM Account
CMS established the EIDM system to provide clinicians and practices with a single User ID that can be used to access one or more CMS Applications.
How to Obtain an EIDM Account
If you do not have an EIDM account, navigate to the CMS Enterprise Portal and select ‘New User Registration’ to create one. The following information is required for registration:
Your organization or CMS can help you identify the information needed for your application.
Once you complete your EIDM account registration, you will receive an e-mail acknowledging your successful account creation with your EIDM User ID. Use your unique EIDM User ID and Password to login to the Quality Payment Program Portal.
CMS encourages you to create an EIDM account or verify your EIDM credentials now to prepare for your 2018 MIPS data submission.
For More Information:
AFTER SUCCESSFUL PILOT, INJURED WORKERS AND OTHER PARTICIPANTS CAN NOW CHOOSE TO ATTEND HEARINGS REMOTELY, AVOIDING TRAVEL BURDEN
New York State Workers' Compensation Board Chair Clarissa M. Rodriguez today announced the Board has launched a first-in-the-nation initiative that allows injured workers and other participants to attend workers' compensation hearings right from their homes or offices. The Board's virtual hearings provide injured workers a way to move the claim process forward without the need to travel many miles for a hearing that may last only minutes, which is especially beneficial depending on the extent of their injuries.
The New York State Workers' Compensation Board developed virtual hearings in partnership with the Office of Information Technology Services to give all parties involved the option of using a smart phone, tablet or computer to attend hearings. This is the first high definition, all access system for legal hearings in the nation, where multiple users in different locations log in once and then move from one hearing to another.
"This state-of-the-art, secure technology removes obstacles and stress for hard-working New Yorkers who were injured on the job, as well as for business owners and the professionals who participate in the system," Board Chair Rodriquez said. "Virtual hearings allow injured workers to remain in their homes and other participants to attend from their workplaces. Our successful pilot and now statewide launch demonstrate New York's commitment to helping people hurt on the job."
To participate in a virtual hearing, the party of interest needs only a smart phone, tablet or computer with a microphone and video camera, as well as a high-speed internet connection. All participants can see and hear each other on their respective screens. Additionally, workers’ compensation law judges can share claim documents with all involved parties. The system includes security.
The Board is also developing a mobile app, for future release, that parties may download and use to attend hearings.
"Virtual hearings save injured workers the burden of travel, which is particularly helpful for someone with impaired mobility, especially during the harsh winter months," Chair Rodriguez said. "They make it easier for injured workers to receive benefits and for other parties, such as employers and attorneys, to participate in the workers' compensation system."
"The Office of Information Technology Services is pleased to partner with the Workers' Compensation Board to deploy technology that makes it easier to serve injured workers across New York State," said New York State Chief Information Officer Robert H. Samson. "Here in New York, we are harnessing the power of technology to deliver innovation that matters … for all New Yorkers, and virtual hearings are the latest example of this."
Many workers' compensation hearings last less than 10 minutes, but injured workers can still lose time from work and suffer inconvenience traveling to Board offices. Weather-related complications can also make these trips difficult. Virtual hearings are entirely optional though, and parties may now choose them over attending a hearing at a Board office. They can always choose to attend in-person if they prefer.
Virtual hearings were first tested in the Capital District Office in Menands in November 2017, then rolled out across the state. Since the beginning of the pilot, more than 33,000 hearings have included at least one party who appeared remotely, successfully connecting injured workers, law judges and representatives from all over New York and nationally. The Board has trained more than 780 participants on the system, including law judges and other staff, attorneys and legal representatives. Feedback has been overwhelmingly positive.
Todd L., an injured worker, said, "Once we got connected, we had great audio and visual and everything ran smoothly right up to the resolution. It was actually very convenient – given that the hearing was in New York and I was in Georgia – versus having to travel back to a central location in Albany." (Privacy laws protect the identities of injured workers.)
Attorney Matt Mead said, "Virtual hearings save me travel time and as a result have saved my clients some fees because I don't have to bill them to get back and forth to the locations. I think it could be really useful to out-of-town witnesses. I deal with some employers who are out of the immediate area and would have to take time away from their businesses to travel. If they could appear virtually, that would be helpful to them."
Virtual hearings are another successful element of the Board’s Business Process Re-engineering, which has been improving the overall health of workers’ compensation in New York since 2013. More information on virtual hearings, including instructional videos and other training materials, is at www.wcb.ny.gov/virtual-hearings.
WEBINAR NOVEMBER 14TH REGISTRATION NOW OPEN
One of the biggest threats to healthcare is cyberattacks on medical records. The Medical Society of the State of New York is hosting its next Medical Matters webinar “Cybersecurity: A Daily Threat for Healthcare” on Wednesday, November 14, 2018 at 7:30 a.m. Registration is now open for this webinar here.
Mahesh Nattanmai, Deborah Sottolano, PhD of New York State Department of Health and Peter Bloniarz of the New York State Cyber Security Advisory Board will serve as faculty for this program. The educational objectives are: 1) Describe vulnerabilities within medical practices, hospitals and daily life. 2) Identify methods to increase protection from cyberattacks. 3) Review methods for reporting and responding to a cybersecurity incident.
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 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 information or assistance with registration may be obtained by contacting Melissa Hoffman at email@example.com.
MLMIC Insurance Company hosted a moderated discussion with Berkshire Hathaway CEO Warren Buffett and MLMIC Chairman of the Board Dr. James Reed - covering the state of today's economy and its interplay with New York's ever-changing healthcare marketplace. It can be viewed here: https://www.mlmic.com/blog/physicians/warren-buffett-on-protecting-physicians
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.