Give Us Your Suggestions! • Many CMS improvements were suggested by providers. • Keep the ideas coming! 1 Send suggestions and comments to: How Your ReducingProviderBurden@cms.hhs.gov Voice Can 2 Be Heard 1
E&M Payment Amounts
CMS Roa dma p to Addre ss the Opioid E pide mic https:/ / www.c ms.g o v/ Ab o ut-CMS/ Ag e nc y-I nfo rma tio n/ E me rg e nc y/ Do wnlo a ds/ Opio id-e pide mic -ro a dma p.pdf
Medicare Diabetes Prevention Program (MDPP) Months 0-6 Months 7-12 Months 13-24 Core Sessions Core Maintenance Sessions Ongoing Maintenance Sessions A minimum of 16 sessions offered at A minimum of 6 monthly sessions Monthly sessions for an additional 12 least a week apart during the first 6 during the second 6 months of core months months sessions Eligible beneficiaries have coverage for 3 month intervals of monthly maintenance sessions for 1 year Available to eligible beneficiaries regardless of weight loss and attendance Available to eligible beneficiaries who achieve and maintain weight loss and attendance goals A CDC-approved curriculum is used to guide sessions In-person and virtual make-up sessions are available and must meet specific requirements 4
Merit-based Incentive Payment System (MIPS) Timelines Performance period submit Feedback available adjustment 2019 March 31, 2020 Feedback January 1, 2021 Performance Year Data Submission Payment Adjustment • Performance period • Deadline for • CMS provides • MIPS payment opens January 1, submitting data is performance adjustments are 2019 March 31, 2020 feedback after the prospectively applied data is submitted to each claim • Closes December 31, • Clinicians are beginning 2019 encouraged to submit • Clinicians will January 1, 2021 data early receive feedback • Clinicians care for before the start of patients and record the payment year data during the year 5
Quality Payment Program: Merit-based Incentive Payment System (MIPS) Year 3 (2019) Final MIPS Eligible Clinician Types: Year 3 (2019) Final Year 2 (2018) Final MIPS eligible clinicians include: MIPS eligible clinicians • Same five clinician types from include: Year 2 (2018) • Physicians AND: • Physician Assistants • Clinical Psychologists • Physical Therapists • Nurse Practitioners • Occupational Therapists • Clinical Nurse Specialists • Speech-Language Pathologists • Certified Register Nurse Anesthetists • Audiologists • Registered Dieticians or Nutrition • Groups of such clinicians Professionals 26
QPP: MIPS Year 3 (2019) Final Low-Volume Threshold Determinations: • Added a third element – Number of Services – to the low-volume threshold determination criteria • The finalized criteria include: Dollar amount - $90,000 in covered professional services under the Physician Fee o Schedule (PFS) Number of beneficiaries – 200 Medicare Part B beneficiaries o Number of services ( New ) – 200 covered professional services under the PFS o • Added an opt-in option for Year 3: o If you are a MIPS eligible clinician and meet or exceed at least one, but not all, of the low-volume threshold criteria, you may opt-in to MIPS o If you opt-in, you’ll be subject to the MIPS performance requirements, MIPS payment adjustment, etc. 27
MIPS Opt-In Scenarios Dollars Beneficiaries Professional Services ( New ) Eligible for Opt-in? ≤ 90K ≤ 200 ≤ 200 No – excluded ≤ 90K ≤ 200 > 200 Yes (may also voluntarily report or not participate) > 90K ≤ 200 ≤ 200 Yes (may also voluntarily report or not participate) > 90K ≤ 200 >200 Yes (may also voluntarily report or not participate) ≤ 90K > 200 > 200 Yes (may also voluntarily report or not participate) > 90K > 200 > 200 No – required to participate MIPS eligible clinicians who meet or exceed at least one, but not all, of the low-volume • threshold criteria may choose to participate in MIPS 28
MIPS Year 3 (2019) Final MIPS Determination Period Year 2 (2018) Final Year 3 (2019) Final Low V w Volum lume T e Thr hresho hold ld D Det etermin inatio ion P Perio iod: d: Change t e to t the MI he MIPS D Det etermin inatio ion P Perio iod: d: • First 12-month segment: Oct. 1, 2017-Sept. 30, 2018 • First 12-month segment: Sept. 1, 2016-Aug. 31, 2017 (including a 30-day claims run out) (including 30-day claims run out) • Second 12-month segment: Oct. 1, 2018-Sept. 30, • Second 12-month segment: Sept. 1, 2017 to Aug. 31, 2019 (does not include a 30-day claims run out) 2018 (including a 30-day claims run out) • Goal: consolidate the multiple timeframes and align Special S Sta tatus the determination period with the fiscal year • Use various determination periods to identify MIPS • Goal: streamlined period will also identify MIPS eligible clinicians with a special status and apply the eligible clinicians with the following special status: designation. - Non-Patient Facing • Special status includes: - - Small Practice Non-Patient Facing - Small Practice - Hospital-based - Rural Practice - - ASC-based Health Professional Shortage Area (HPSA) - Hospital-based - Ambulatory Surgical Center-based (ASC-based) Note: Rural and HPSA status continue to apply in 2019 Quic uick T Tip: p: MIPS eligible clinicians with a special status are i e includ luded d in MI MIPS and qualify for special rules. Having a special status does n not ex exempt a clinician from MIPS. 9
MIPS Year 3 (2019) Final Reporting Options What a are m my reporting o options i if I am required to p participate i in MIPS? Same me reporting options as Year 2. Clinicians can report as an/part of a: Individual Group Virtual Group 1. As an Individual—under an 2. As a Group 3. As a Virtual Group – made National Provider Identifier up of solo practitioners and a) 2 or more clinicians (NPIs) who (NPI) number and Taxpayer groups of 10 or fewer have reassigned their billing eligible clinicians who come Identification Number (TIN) rights to a single TIN* where they reassign benefits together “virtually” (no b) As an APM Entity matter what specialty or location) to participate in MIPS for a performance period for a year 10
Medicare Reimbursement/Adjustments 2026 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 & on Fee BBA of 2018 reduced the +0.5% each year No change update for 2019 to +0.25% +0.25% Schedule or 0.75% Max Adjustment MIPS 4 5 7 9 9 9 (+/-) Participation in +5% bonus Qualifying APM (excludedfromMIPS) 31
Participation Status for Year 2 (2018) • Fo For M MIPS: Start by checking your participation status using the National Provider Identifier (NPI) Look-up Tool on qpp.cms.gov. Please note that we did not mail individual letters outlining your Year 2 participation o status. 12
Technical Assistance Available Resources CMS has free resources and organizations on the ground to provide help to clinicians who are participating in the Quality Payment Program: Learn more about technical assistance: https://qpp.cms.gov/about/help-and-support#technical-assistance 13
2019 Opioid Policy Resources Medicare Prescription Drug Coverage and Your Rights Fact Sheet at: https://www.cms.gov/Outreach- and-Education/Outreach/Partnerships/downloads/yourrightsfactsheet.pdf Information regarding the CDC Guideline for Prescribing Opioids for Chronic Pain, please visit https://www.cdc.gov/drugoverdose/prescribing/guideline.html. A Prescriber’s Guide to the New Medicare Part D Opioid Overutilization Policies for 2019 at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network- MLN/MLNMattersArticles/Downloads/SE18016.pdf Additional Guidance on Contract Year 2019 Formulary-Level Opioid Point-of-Sale Safety Edits or Medicare Part D Drug Management Programs at: https://www.cms.gov/Medicare/Prescription-Drug- coverage/PrescriptionDrugCovContra/RxUtilization.html To review the notice of appeal rights that patients receive from pharmacies about their appeal rights when a prescription is not filled as written, please visit https://www.cms.gov/Outreach-and- Education/Outreach/Partnerships/downloads/yourrightsfactsheet.pdf 14
Other Resources New Medicare Card www.cms.gov/Medicare/New-Medicare-Card/ Medicare Diabetes Prevention Program https://innovation.cms.gov/initiatives/medicare-diabetes-prevention-program/ Interoperability Proposed Rule https://www.cms.gov/newsroom/fact-sheets/cms-advances-interoperability- patient-access-health-data-through-new-proposals Physician Fee Schedule Final Rule https://www.cms.gov/Medicare/Medicare-Fee-for-Service- Payment/PhysicianFeeSched/ 15
Other Resources Patients Over Paperwork https://www.cms.gov/About-CMS/story-page/patients-over-paperwork.html Quality Payment Program qpp.cms.gov Rural Health https://www.cms.gov/About-CMS/Agency-Information/OMH/equity- initiatives/rural-health/index.html Medicare Learning Network https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network- MLN/MLNGenInfo/Index.html 16
Contact Info Michelle Wineinger Health Insurance Specialist Rural Health Coordinator Centers for Medicare & Medicaid Services Kansas City Regional Office michelle.wineinger@cms.hhs.gov 17
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