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Tag: Physician

Final Rule – Physician Fee Schedule/Other Part B Revisions – CY2017

From: Federal Register CMS-1654-F; Filed 11/2/16; Published 11/15/16


This major final rule addresses changes to the physician fee schedule and other Medicare Part B payment policies, such as changes to the Value Modifier, to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services, as well as changes in the statute. This final rule also includes changes related to the Medicare Shared Savings Program, requirements for Medicare Advantage Provider Networks, and provides for the release of certain pricing data from Medicare Advantage bids and of data from medical loss ratio reports submitted by Medicare health and drug plans. In addition, this final rule expands the Medicare Diabetes Prevention Program model.

Click here to view the CMS newsroom release.

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CMS Releases Final Rule Implementing MACRA with 2017 Resources

From: Hooper Lundy & Bookman – 10/18/16

Article Excerpt:

On Friday, October 14, the Centers for Medicare and Medicaid Services (CMS) released the much anticipated Final Rule with comment period implementing the Medicare Access and CHIP Reauthorization Act (MACRA).

The Final Rule establishes a new program, the Quality Payment Program (QPP) with two tracks for physicians and other eligible clinicians being paid under Medicare fee-for-service.  The first performance year for both tracks of the QPP will be 2017, for payment adjustments in 2019.  The Final Rule provides further flexibilities from the proposed rule in order to help clinicians transition into the new payment system.


For the first year of the program, as determined in statute, eligible clinicians will include physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists.  In response to concerns from stakeholders and small and solo practices, in the Final Rule CMS has eased the low-volume threshold for being exempt from the QPP as an eligible clinician with:

  • less than or equal to $30,000 in Medicare Part B allowed charges, or
  • less than or equal to 100 Medicare patients.

CMS estimates that this change to the low-volume threshold will result in approximately 32 percent of clinicians being exempt in 2017.

Transition Year – 2017

CMS refers to the first performance year, 2017, as a transition year, providing choices to eligible clinicians to participate in ways appropriate for their practice.  The Pick Your Pace provision offers a four ways of participating in 2017 to avoid a negative payment adjustment.  Non-reporting in 2017 will lead to an automatic negative adjustment of 4 percent in 2019.

Option 1: Test the program. By reporting one measure each in the quality and improvement activity categories or reporting the measures in the advancing care information category, clinicians can avoid a negative adjustment in 2019.

Option 2: Partially report. By reporting one measure in each performance category for a full 90 days in 2017, clinicians can avoid a negative adjustment and have the opportunity to possibly receive a small positive adjustment in 2019.

Option 3: Fully report. By reporting fully for 90 days to a full year, a clinician can earn a moderate positive payment adjustment and may be eligible for additional payment adjustments as exceptional performers.

Option 4: Participate in an Advanced Alternative Payment Model (AAPM). Those receiving 25% of Medicare payments or seeing 20% of Medicare patients through an AAPM in 2017, can earn a 5% incentive payment in 2019.

Read more…

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Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models

From: Federal Register – CMS-5517-FC; Filed 10/14/16; Published11/4/16

Federal Register Summary:

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repeals the Medicare sustainable growth rate (SGR) methodology for updates to the physician fee schedule (PFS) and replaces it with a new approach to payment called the Quality Payment Program that rewards the delivery of high-quality patient care through two avenues: Advanced Alternative Payment Models (Advanced APMs) and the Merit-based Incentive Payment System (MIPS) for eligible clinicians or groups under the PFS.

This final rule with comment period establishes incentives for participation in certain alternative payment models (APMs) and includes the criteria for use by the Physician-Focused Payment Model Technical Advisory Committee (PTAC) in making comments and recommendations on physician-focused payment models (PFPMs). Alternative Payment Models are payment approaches, developed in partnership with the clinician community, that provide added incentives to deliver high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population.

This final rule with comment period also establishes the MIPS, a new program for certain Medicare-enrolled practitioners. MIPS will consolidate components of three existing programs, the Physician Quality Reporting System (PQRS), the Physician Value-based Payment Modifier (VM), and the Medicare Electronic Health Record (EHR) Incentive Program for Eligible Professionals (EPs), and will continue the focus on quality, cost, and use of certified EHR technology (CEHRT) in a cohesive program that avoids redundancies. In this final rule with comment period we have rebranded key terminology based on feedback from stakeholders, with the goal of selecting terms that will be more easily identified and understood by our stakeholders.

Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models

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