With less than three months remaining until the nation switches from ICD-9 to ICD-10 coding for medical diagnoses and inpatient hospital procedures, the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) are announcing efforts to continue to help physicians get ready ahead of the October 1 deadline. In response to requests from the provider community, CMS is releasing additional guidance that will allow for flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD- 10 code set. For more details, please see the joint announcement on the CMS ICD-10 website.

Get Ready Now with the New CMS Quick Start Guide!

In lieu of holding Summer District Dialogue sessions, the BPR team is going on the road to update interested stakeholders on the status of the BPR project. Roadshow sessions will be held in each District Office beginning in mid-June and ending the first week of July.

On May 4, in a report issued by the New York State Assembly Labor and Insurance Committees regarding the proposed Workers Compensation fee schedule changes, the Assembly Majority clearly recommended that the new fee schedule not be adopted, as requested by both NYSCA and the Council. In support of their decision to oppose the new fee schedule, the report included specific references to testimony jointly offered by the NYSCA and the Council, who testified at a hearing in the fall, along with other specialty groups. The summary of our joint testimony is on pages 16-17 of the report.  Both Jason Brown, DC, of the NYSCA and Bryan Ludwig, DC, of the Council and testified and raised numerous concerns about the new fee schedule, in particular its proposed linkage to the Medicare fee schedule. The report also specifically cited the testimony of Dr. Brown, detailing many of his concerns and objections. Here is a link to the full report: http://assembly.state.ny.us/comm/Labor/20150504/index.pdf. This is very good news for the profession!

Chiropractic documentation education, new quality-reporting incentives included in measure

On April 1, 2015, the Medicare Physician Fee Schedule (MPFS) was updated using the Sustainable Growth Rate (SGR) methodology as required by current law. The SGR methodology required a 21% decrease in all MPFS payments beginning April 1, 2015. The Centers for Medicare & Medicaid Services (CMS) took steps to limit the impact on Medicare providers and beneficiaries by holding claims paid under the MPFS with dates of service on and after April 1, 2015. In the absence of additional legislation to avert the negative update, CMS must update payment systems to comply with the law, and implement the negative update.

The negative 21% payment rate adjustment under current law for the Medicare Physician Fee Schedule is scheduled to take effect on April 1, 2015.  CMS is taking steps to limit the impact on Medicare providers and beneficiaries by holding claims for a short period of time beginning on April 1st.  Holding claims for a short period of time allows CMS to implement any subsequent Congressional action while minimizing claims reprocessing and disruption of physician cash flow in the event of legislation addressing the 21% payment reduction.  Under current law, electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt. As we stated in our recent email to physicians, CMS will provide more information about next steps by April 11, 2015.

CMS to hold claims until April to avert reimbursement cuts

Providers in Connecticut (98941), Queens, NY (98940), Downstate NY (98941) and Upstate NY (98941)

National Government Services’ Medical Review Department is currently conducting a prepayment review on JK Part B chiropractic services in the states of CT and NY. This article includes the results of these reviews for September, October, November and December 2014.

The CMS just blinked in the ongoing cold war between providers and the agency over meaningful-use requirements for electronic health-record systems.

The CMS announced Thursday that it is considering proposals to shorten the meaningful-use reporting period to 90 days in 2015, something providers and others have been requesting. 

Shortening the period essentially means providers can meet the meaningful-use requirements and avoid financial penalties with software in place for less time than is currently required.

The College of Healthcare Information Management Executives, a key advocate for changes in the reporting period, was positive about the announcement. “It is indeed” what the organization was looking for, said Jeff Smith, the organization's vice president of public policy. 

In a separate statement, Russ Branzell, CHIME's president and CEO, said, “Meaningful use has the potential to be a transformative program for the nation's healthcare delivery system and we commend CMS for recognizing the need for a course-correction.”

The Medical Group Management Association and the American Medical Association praised the CMS for agreeing to modify the window, and they urged the agency to issue the new rule quickly. The MGMA noted that the number of physicians who have attested to meeting the program's Stage 2 requirements dropped sharply from the number who cleared the first bar.The AMA, meanwhile, also took a broader swipe at the program, saying that it fails to "help physicians improve care for their patients." 

The CMS also is considering changing reporting periods to the calendar year to “allow eligible hospitals more time to incorporate 2014 Edition software into their workflows and to better align with other CMS quality programs,” and will “modify other aspects of the program” that may lessen providers' reporting burdens. 

The CMS clarified that the rulemaking on reporting period flexibility will be separate from the upcoming third-stage meaningful-use rule, which may be released in March. 

The changes may mollify calls from providers and legislators to change reporting periods. Rep. Renee Ellmers (R-N.C.) and 29 fellow House Republicans had sent a letter to Sylvia Matthews Burwell grousing about the reporting periods in the program. Bipartisan legislation also had been introduced by Ellmers and then-Rep. Jim Matheson (D-Utah) to change the reporting periods. 

Follow Darius Tahir on Twitter: @dariustahir

Please review these instructions for how to access the 2015 Medicare Physician Fee Schedule (MPFS)

The Patient Protection and Affordable Care Act (PPACA) mandated that non-participation or unsuccessful/unsatisfactory reporting in Medicare’s Physician Quality Reporting System (PQRS), formerly referred to as PQRI, will result in negative payment adjustments to Medicare reimbursement beginning in 2015. In the 2012 Medicare Physician Fee Schedule Final Rule, the Centers for Medicare and Medicaid Services (CMS) ruled that providers who did not successfully/satisfactorily participate in PQRS by the 2013 reporting period will have their Medicare reimbursement decreased by 1.5 percent beginning on January 1, 2015. Non-participation or unsuccessful/ unsatisfactory reporting during the 2014 performance period will result in a 2% reduction in a provider's 2016 Medicare reimbursement, and further non-participation or unsuccessful/unsatisfactory reporting this year (Jan. 1 -  Dec. 31, 2015) will affect a provider's 2017 Medicare reimbursement by applying a payment reduction of 2%.