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How does your practice succeed in Medicare’s MIPS program? Print E-mail
Written by Accountable Care Options, LLC   
Friday, 10 February 2017 18:19

Medicare is pushing practitioners to shift from a fee-for-service to a value-based payment system that rewards keeping patients healthy and imposes financial penalties for poor performance. While accountable care organizations have been at the forefront of the quality care program called QPP, most practices will be affected by rules finalized in November.
The launch of the merit-based incentive payment system, or MIPS, allows practitioners to ease into the transition and still be rewarded. Their 2019 payments will be adjusted based on their 2017 performance. Only new Medicare providers, and practices with less than 100 patients or that generate less than $30,000 in annual billings, are excluded from evaluation.
While avoiding a MIPS penalty of 4 percent is relatively easy, 2017 is the best time to test the performance waters and prepare for a rapid push in healthcare reform. So, how does a practice secure the biggest payout under MIPS without overwhelming staff members?
Practices should work on activities that earn the most points and best prepare them for higher incentives or advanced payment model participation. MIPS works on a 100-point system that’s organized into three domains for 2017:
·         60 percent from meeting quality measure thresholds

·         25 percent from Advancing Care Information, which replaces meaningful-use measures

·         15 percent from clinical improvement activities, some of which earn bonus points when completed
The final rules vary from what was originally proposed, such as the elimination of the cost performance category. For details, visit from Medicare and from the AMA.
Medicare’s timeline drives the numbers. In 2017, a practice with minimal involvement in MIPS will avoid the 4 percent reduction in payments imposed for nonparticipation. With 90 days of data, the entity can earn a small positive payment adjustment; a full year of data guarantees a chance at the greatest amount of payment.
Medicare will review the data during 2018 and provide feedback to the practice. In 2019, the payment adjustment goes into effect.

Last Updated on Friday, 10 February 2017 18:27
Should Medicare allow total joints in ASCs? Print E-mail
Written by Laura Dyrda | Becker's ASC   
Tuesday, 24 January 2017 19:44

Outpatient total joint replacements are gaining steam; physicians across the country are performing outpatient total joints in hospitals as well as ASCs. Medicare is also considering removing total joint replacements from the inpatient only list.

Barry Waldman, MD, director of the Center for Joint Preservation and Replacement at the Rubin Institute for Advanced Orthopedics in Baltimore and Derek Johnson, MD, an orthopedic surgeon and secretary at Denver-Vail Orthopedics discuss outpatient total joint replacements in their practices and where the procedure is headed in the future.

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Last Updated on Tuesday, 24 January 2017 19:52
A Battle to Change Medicare Is Brewing, Whether Trump Wants It or Not Print E-mail
Written by Robert Pear | New York Times   
Monday, 28 November 2016 00:00

Donald J. Trump once declared that campaigning for "substantial" changes to Medicare would be a political death wish.

But with Election Day behind them, emboldened House Republicans say they will move forward on a years-old effort to shift Medicare away from its open-ended commitment to pay for medical services and toward a fixed government contribution for each beneficiary.

The idea rarely came up during Mr. Trump's march toward the White House, but a battle over the future of Medicare could roil Washington during his first year in office, whether he wants it or not.

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CMS offers plan (again) in hopes of clearing Medicare appeals backlog Print E-mail
Written by Vitale Health Law   
Friday, 18 November 2016 19:14

Hospital executives who are tired of waiting for their Medicare appeals cases to be settled are being presented with an option. The Centers for Medicare and Medicaid is offering to pay hospitals 66 percent of the net allowable for short-term inpatient stays in exchange for dropping their pending appeals of denied claims.

CMS recently announced that beginning December 1, it will make available an administrative settlement process for inpatient status claims. This process will be open to eligible hospitals willing to withdraw certain pending appeals in exchange for timely partial payment.

The move is intended to make a dent in the Medicare appeals backlog, which according to the Department of Health and Human Services, grew to nearly 900,000 at the end of last year.

CMS made a similar offer in 2014, at which time it completed settlements with 2,022 hospitals, representing approximately 346,000 claims. CMS paid approximately $1.47 billion to providers that agreed to the settlement process. However, it also paid out 68 percent of hospital claims.

CMS has indicated four main reasons for the backlog... 

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Final Medicare Fee Schedule Sweetens Primary Care Pay Print E-mail
Written by Robert Lowes | Medscape Medical News   
Monday, 07 November 2016 00:00

The Center for Medicare and Medicaid Services (CMS) today <11/2/16> released a final version of its Medicare fee schedule for 2017 that makes good on earlier proposals to pay primary care physicians more for work that was previously uncompensated or undercompensated... Medicare will begin to pay more in 2017 for treating patients with chronic illnesses and those with cognitive and behavioral problems.

Read more in the current issue of Week in Review>>

Last Updated on Monday, 07 November 2016 17:27
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