Latest News

4/3/2018

CMS video provides information to patients on new Medicare cards
Are your Medicare patients aware that beginning in April they will receive new beneficiary ID cards? Help keep them up to date by playing the "New Medicare Cards are coming!" video in your waiting room. The Center for Medicare and Medicaid’s (CMS’s) short video informs patients of when and how they will receive the new card. This initiative will help prevent fraud and identity theft and protect beneficiaries’ financial information. Start readying your systems to accept the new MBI format now to ensure that your systems will reflect these changes. For information on how to prepare your practice for the new cards, visit CMS’ Provider webpage.

3/30/2018

MedPAC recommends changes to MIPS in annual report to Congress
In its annual report to Congress, the Medicare Payment Advisory Commission (MedPAC) recommended replacing the Merit-based Incentive Payment System (MIPS) with a Voluntary Value Program (VVP). MedPAC believes that MIPS is overly complex and burdensome and will not succeed. The VVP would assess clinicians on clinical quality, patient experience and value. MedPAC believes that the VVP would significantly reduce clinician burden, while not affecting beneficiaries’ access to care, and will get clinicians comfortable with being measured in a manner similar to Advanced Alternative Payment Models (A-APMS).

The report outlines three important features that distinguish a VVP from MIPS:

  1. Clinicians would be eligible to receive a payment adjustment at a voluntary group level. A VVP would require minimal administrative structure and would entail less risk and reward than is required in A-APMs.
  2. The voluntary groups would be assessed on a uniform set of population-based measures.
  3. Clinicians would no longer need to report quality data to Medicare because all measures would be calculated by CMS from claims and surveys.

It is important to note that this the VVP is a recommendation to Congress, and there is no guarantee that Congress will act on this recommendation.

3/27/2017

Billing for Maintenance Care 
It has recently come to our attention the dissemination of information that alludes that it would be appropriate to use ICD-10 code Z00.00 when billing Medicare for annual wellness exams, initial preventive physical examinations (IPPE), or similar chiropractic wellness or maintenance care.  Given the limitations for reimbursement of chiropractic services under Medicare, it is not appropriate to submit claims for wellness or maintenance care to Medicare in this manner.  Chiropractors should always use the M99.0 ICD-10 code category, even when billing for wellness or maintenance care, and procedure codes 98940-98942 with the GA modifier appended.  Additionally, doctors should make sure they have the current version of the ABN form signed by the patient on file. For private insurance, providers should always review the payer policy for maintenance or wellness care. In some cases, S8990 (the HCPCS code for “physical or manipulative therapy performed for maintenance rather than restoration”) can be used as the procedure code. However, acceptance by payers varies, and chiropractors should verify use/coverage with each payer.  If the payer allows S8990, then the appropriate ICD-10 code should be used.   

Reminder:  CERT Reviews
Recently ACA has received reports that chiropractors are receiving CERT requests for medical record documentation. Because CERT reviews determine the accuracy of Medicare claims processing (i.e., the error rate), ACA reminds doctors that first and foremost, it is imperative to respond to these requests. Not responding to a CERT records request factors into the error rate for “no documentation” for the profession. If you receive a CERT records request: first, don’t panic – CERT reviews are random in nature; second - thoroughly review the letter for the specific items of documentation requested and the response deadline; and finally, review ACA’s CERT information and resources.  If you have any questions, please send an email to Medicare@acatoday.org

Updates

11/27/2017 - ACA Submits Comments on CMS-9930-P, Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2019 

11/20/2017  ACA Submits Comments in Response to a Request for Information (RFI) from CMS' Center for Medicare and Medicaid Innovation (CMMI)

11/17/2017 - CMS Announces 2018 Medicare Part A and B Deductibles and Premiums.  Read CMS' Fact Sheet.

11/02/2017  -  CMS Releases Final Rule on the Medicare Physician Fee Schedule giving Medicare providers a payment increase of 0.41%.  Read CMS' Fact Sheet.

11/01/2017 - Physician Compare Preview Period is Now Open Until Dec. 1 at 8pm ET

The Physician Compare 30-day preview period is officially open. Providers can preview their 2016 performance data as it will appear on Physician Compare later this year. You can access the secured measure preview site through the PQRS portal - Provider Quality Information Portal (PQIP).

CMS Resources:

(Note: These resources indicate that providers only have until Nov. 17 to preview their data; however, due to technical difficulties that have been resolved, CMS has extended the deadline until Dec. 1.)

To learn more about the PY 2016 performance information and PY 2015 clinician utilization data that are available for preview, download the measure crosswalks from the Physician Compare Initiative page:


10/27/2017 - ACA submits comments on HHS Strategic Plan FY 2018-2022

10/25/2017 - New Medicare Cards Are Coming in April 2018

08/21/2017 -  ACA submits comments on  CMS-5522-P, Medicare Program; CY 2018 Updates to the Quality Payment Program 


06/21/2017 - 
CMS issues proposed rule to amend some existing requirements and implement new policies in the second year of the Quality Payment Program (QPP). Proposed changes are intended to increase flexibility, reduce burden, and encourage provider participation in the Merit‐Based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs).

10/14/2016 - CMS finalizes regulations implementing the Merit‐Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule. All DCs are urged to review ACA’s new Final Rule overview

06/27/2016 -  ACA submits comments on CMS–5517–P, Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models; Proposed Rule