Medicare/Medicaid

Electronically Submit CQM Data for Medicare EHR Incentive Program

The Medicare EHR Incentive Pilot allows Eligible Professionals (EPs) to meet the Clinical Quality Measure (CQM) reporting objective of Meaningful Use requirements for the EHR Incentive Program through electronic submission while also reporting for the PQRS program. If a provider is interested in participating in the electronic reporting pilot, they must submit 12 months of CQM data. EPs must submit the data between January 1, 2013 and February 28, 2013. The data for the pilot must be derived from a certified EHR. If you decide to submit the data directly from your EHR, your EHR must also be PQRS “qualified.” You can register for the pilot program while attesting for the EHR Incentive Program. Check “Yes” on the eReporting page as you go through the attestation process.

CMS Names New Accountable Care Organization in New Jersey

CMS announced July 9, 2012 that New Jersey is among 40 states and Washington, D.C. where people with Medicare can receive health care from an Accountable Care Organization (ACO). Barnabas Health ACO-North, located in West Orange, is the newest ACO for New Jersey. It is comprised of partnerships between hospitals and ACO professionals and includes 435 physicians. It is the fourth entity in New Jersey to become a CMS approved ACO.

All ACOs have entered into agreements with CMS, taking responsibility for the quality of care they provide to people with Medicare in return for the opportunity to share in savings realized through high-quality, well-coordinated care. There are currently 154 ACOs participating in the Medicare shared savings initiatives; more than 2.4 million beneficiaries are receiving care. Read more.

CMS Delays Implementation of Sunshine Act Reporting Requirements

CMS has delayed the reporting requirements contained in the proposed regulations implementing the Sunshine Act until January 1, 2013. MSNJ opposed the proposed regulations in an AMA sign-on letter and a letter on behalf of our Continuing Medical Education Committee. The controversial law will require pharmaceutical companies to report transfers of $10 or more in value to physicians. CMS intends to publish the final rule later this year. See related story and how MSNJ has affected this rule through the AMA below.

US Health Spending Projected to Grow an Average of 5.7% Annually through 2021

A recent article in Health Affairs discusses government spending at all levels for healthcare being projected to reach nearly 50 percent of total health expenditures in 2021. The report examines the effect on Medicare and physician health spending growth if the significant reduction in Medicare payment rates in 2013 under current law is overridden.

AMA Suggests Alternative Medicare Payment Models to Congress

In a letter to the Committee on Ways & Means and Subcommittee on Health the AMA outlines alternative payment models to the current Medicare physician payment system in an effort to address SGR issues and to slow the growth of costs. The AMA recommends payment for quality and efficiency and supports programs such as multi-payer medical homes. The AMA also lists a number of regulatory impediments to a transition to a new healthcare payment system.

Policy Brief on Premium Support for Private Medicare Plans

Health Affairs has posted a policy brief titled, “Premium Support in Medicare” that would enable Medicare enrollees to choose a private health plan and the federal government would pay a predetermined contribution to that plan. With Medicare enrollment projected to grow to 80 million by 2030, the premium support would help slow the growth of Medicare spending by having private plans compete on price to provide care to beneficiaries.

MSNJ Objects to Ten Year Look-Back Period for Medicare Overpayment Requests

This week, MSNJ filed comments on CMS’s proposed rule that would expand the look-back period for Medicare overpayment requests to ten years. We objected to this expanded look-back period and suggested that CMS consider the 18 month look-back period that covers private commercial plans in New Jersey. We believe that the costs of implementation were woefully underestimated and, therefore, requested that CMS return the rule to the OMB to recalculate the expense and burden of implementation of the proposal. The AMA filed comments in which we joined. The Physician Advocacy Institute filed comments which we supported through our membership on its compliance committee and our status as a founding member.

CMS Responds to AMA/MSNJ’s Question about the Medicare “Fourth Option”

MSNJ recently joined with the AMA asking CMS to explain its payment policy for Medicare-covered services furnished by physicians who are not enrolled in Medicare. This question was crystallized by a Form-1490S which permits beneficiaries to seek Medicare payments for services rendered by non-enrolled physicians. In addition, CMS had taken the position that non-enrolled physicians would be subject to penalties for using this as a method to obtain payment from the Medicare program. Because this appeared to be a “fourth option” for treating Medicare patients and being reimbursed, it was necessary to formally seek a clarification from CMS on this payment policy. (The three understood options are: participating, non-participating and opted-out).

CMS has formally responded in a letter indicating that the form may not be used by non-enrolled physicians as a method to seek reimbursement. CMS explained that the form has a limited use, for a beneficiary to seek a determination where a physician refuses to submit a claim for covered services. Read more on our blog.