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LEGISLATIVE NEWS-ON THE HILL
ASCRS/ASOA WEB SEMINAR SERIES ON MEDICARE INCENTIVE PROGRAMS
Representatives Tom Price and Charles Boustany have released details on their joint proposal to transition to a new Medicare physician payment model and are seeking input from ASCRS and other medical specialty organizations. Specifically, the proposal would
Unfortunately, because the proposal does not repeal the sustainable growth rate (SGR) formula and uses “cliff financing,” the magnitude of the reductions and the cost to permanently fix the SGR continues to increase. ASCRS will provide comments, which will include suggestions to improve the proposal. We will keep you updated.
Click on the link for a copy of the summary.
On June 14, the Senate Finance Committee held the second in a series of three roundtables focused on physician reimbursement. The second roundtable, which included a panel of insurance company executives and a physician group, focused on how the private sector manages physician reimbursement. The third roundtable, which will be held at the end of the month, will include representatives of various medical specialty organizations. Click here to access the testimony of witnesses.
ASCRS/ASOA will hold the third and final in a three-part series of web seminars on Medicare Incentive Programs on Wednesday, June 20 from 2:00 – 3:00 PM. As an ASCRS/ASOA Member, you receive complimentary registration for this web seminar.
Wednesday, June 20, 2012
2:00-3:00 p.m. EDT
ASCRS/ASOA Members: Free Registration with Promo Code: j1255
Nonmembers - $199.00
Synopsis: This seminar will provide an overview of the PQRS incentive payment program for EPs who satisfactorily report data on quality measures for covered professional services furnished to Medicare beneficiaries, including a discussion on the 2012 PQRS Outcome Registry (Ophthalmic Patient Outcomes Database, the PQRS registry services provider for ASCRS/ASOA.)
Credits: Earn 1.00 COE credits by attending this seminar.
Enter Promo Code: j1255 at the end of the credit card registration process to receive this web seminar for free.
All attendees must register at least 24 hours in advance of the web seminar.
Warning: 2 Weeks Remain to Avoid 2013 eRx Payment Reduction
Unless you have successfully e-prescribed or qualify for an exemption by June 30, 2012, you will be hit with a -1.5% payment reduction on your total estimated Medicare Part B allowed charges in 2013.
You submitted 10 or more eRx codes (G8553) on your Medicare Part B claim forms, for any Medicare Part B physician fee schedule service provided between January 1, 2012 to June 30, 2012, using a qualifying eRx system or certified electronic health record (EHR), and the claims were received and processed by CMS by no later than July 31, 2012.
If you submit 25 eRx claims (must be denominator eligible) between July 1 and December 31, 2012, you are eligible for the 1% incentive, and would also avoid an e-prescribing penalty in 2014.
Qualifying for an Exemption
If you meet the following criteria, you are not subject to the payment reduction and no further action is needed:
If you meet any of the following hardship exemptions, you must file for an exemption that applies to your particular hardship situation no later than June 30, 2012, by using CMS’ on-line Web-based tool.
If you are not sure whether you successfully participated in the eRx program or if you are subject to penalties, apply on-line for an exemption that pertains to your particular hardship anyway.
Submitting an Exemption Request
Go to the Quality Reporting Communication Support Page to request a significant hardship exemption for the 2013 electronic prescribing (eRx) payment adjustment.
Important Things to Remember
ASCRS Meets with Center for Medicare and Medicaid Services (CMS) Officials on Value-Based Payment Modifier Initiative
On June 14, ASCRS, in conjunction with the Alliance of Specialty Medicine, met with officials from the Performance-Based Payment Policy Group at CMS to discuss concerns regarding the Value-Based Payment Modifier (VBPM) program and the Quality and Resource Use Reports (QRURs), as well as the Physician Compare website. Representatives from CMS included Dr. Sheila Roman, Senior Medical Officer, Michael Wroblewski, Senior Technical Advisor, and John Pilotte, Director, Performance-Based Payment. At the meeting, specialty society representatives provided feedback to CMS on the recent release of the QRURs to physicians and the associated problems with the reports, emphasizing the difficulty of accessing the reports and stressing that the current methodology analyzes of information attributed to the individual patient, and reports the findings as allocated to the individual physician. Most problematic, all doctors, regardless of specialty, treating a given patient during a specified period of time, will be compared collectively with other groups of physicians. ASCRS used direct feedback provided by ASCRS members who received and reviewed their reports.
As we reported previously, in March, CMS, in conjunction with contractor Washington Physician Services (WPS), emailed physicians in four states a link to an individualized report (“Confidential 2010 Quality and Resource Use Report (QRUR): Medicare Fee-For-Service”). The report provided information about the quality of care provided to Medicare fee-for-service (FFS) patients the physician treated in 2010 (based on PQRS data); the amount Medicare paid the provider for that care; and how the individual provider compared with other Medicare providers within the same specialty. The primary purpose of the reports is to give doctors a preview of how data will be used to adjust Medicare pay for some physicians under a budget-neutral value-based modifier that will take effect in 2015, which means it will not involve additional Medicare funding, so some physicians deemed to be lower performers based on the quality and efficiency of their care will receive reduced payments so higher performing physicians can receive bonuses. CMS has yet to determine which physicians will have the value-based purchasing modifier applied to their payments in 2015. The agency anticipates releasing a proposal this year on how the modifier will work. CMS will be sending out QRUR reports based on 2011 data to the same four states in the Fall.
ASCRS is encouraging doctors to download the reports and provide feedback on the program. Physician input is critical as CMS moves forward with plans to use 2013 Medicare claims to determine bonuses and penalties for selected physicians in 2015. Physicians with questions about specific data within their individual report are asked to email CMS_Medicare_Physician_Feedback_Program@mathematica-mpr.com.
General questions can be directed to Jenny Liljeberg, associate director of regulatory affairs, at email@example.com. ASCRS remains opposed to the implementation of the budget-neutral value-based purchasing modifier and has been pushing for the program to be delayed.
In its upcoming June report to Congress, MedPAC will include a critique of the state-led demonstrations on dual-eligible beneficiaries. Although a few MedPAC members have raised concerns with the program, up until now the commission had declined to say whether it would weigh in on the demo before the Centers for Medicare and Medicaid Services (CMS) negotiates agreements with states and private health plans that are running them. CMS officials recently told seniors advocates that states may not lock beneficiaries dually eligible for Medicare and Medicaid into managed care programs that some states are planning to run as part of their duals demos, but at least one state, California, is still proposing lock-in periods in its duals demo.
The House Ways and Means will hold a health subcommittee hearing on the broader report, which gives options for adjusting beneficiary cost-sharing to encourage seniors to be more involved in their care. MedPAC's chair Glenn Hackbarth will testify. As the House panel prepares to take up MedPAC's recommendations, several Republican Senate Finance Committee members are telling CMS that they have significant reservations about the CMS duals demonstration.
As we previously reported, ASCRS, in conjunction with the Alliance of Specialty Medicine, sent a letter to CMS on the issue of the dual-eligible demonstration. The Alliance also met with MedPAC and raised concerns about the demonstration.
According to a recently released report published in the journal Health Affairs by the CMS Office of the Actuary, U.S. health spending will increase at 4.0%, a historic low, over the next two years, but will grow more quickly once most provisions of the federal health reform law are implemented in 2014. At that time, spending will increase by 7.4% and will slow again beginning in 2015 and average 6.2% annually through 2021. Medicare spending will rise over the next decade, from 4.5% annually between 2011 and 2013, to 6.1% in 2014 and 6.8% between 2015 and 2021. The report assumes Medicare spending will be reduced by 2% next year as part of efforts to reduce the federal budget deficit and that physicians will face a 31% reduction to Medicare reimbursement rates under the sustainable growth rate formula (SGR). CMS economists found that health spending will account for 19.6% of the gross domestic product in 2021, compared with 17.9% in 2010.
CMS Announces Additional Application Round for Advance Payment Accountable Care Organizations
CMS has announced that beginning August 1, 2012, it will be accepting applications for an additional round of Advance Payment ACOs that would begin on January 1, 2013. The Advance Payment Model is a new initiative designed to help physician-owned and rural providers participate in Medicare ACOs.
To apply for the Medicare Shared Savings Program performance period that begins January 1, 2013, interested organizations must submit a Notice of Intent. As this extension is only for two weeks, physician-led ACOs planning to apply for advance payments must submit their NOI by June 29, 2012. For additional information, click here.
On Tuesday, June 19, CMS subject matter experts will provide an overview of “The 2010 Physician Quality Reporting System and eRx Incentive Program Reporting Experience Including Trends (2007-2011)”. In February, CMS released the report detailing the 2010 participation rates and incentives paid to physicians for PQRS and eRx, and ophthalmology continued to improve their rates of participation and success compared with the 2009 rate. In the eRx program, ophthalmology had the second highest rate of participation at 33.8%; 63% of those who participated qualified for the 2% incentive payment. Ophthalmology is also one of the highest performing specialties for PQRS reporting. In 2010, 39.9% of ophthalmologists participated via claims-based reporting and nearly 60% of those who participated qualified for the incentive payment.
Presentation will be available on the FFS National Provider Calls web page. In addition, a link to the slide presentation will be emailed to all registrants on the day of the call.
On June 20, 2012, CMS is hosting a webinar on Version 5010, the standards that HIPAA-covered entities must use when electronically conducting certain health care administrative transactions, such as claims, remittance, eligibility, and claims status requests and responses. To be compliant, organizations must use Version 5010 to send and receive claims and all other HIPAA-adopted electronic transactions with an original start date of January 1, 2012; however, CMS implemented an enforcement discretion period, which is in effect until June 30, 2012.
The webinar will be available three times:
10:00 am – 11:00 am Eastern
12:00 pm – 1:00 pm Central
1:00 pm – 2:00 pm Mountain-Pacific
Make Your 2012 eyePAC Contribution Today
On May 22, all ASCRS members who have not contributed to eyePAC in 2012 were asked to make their annual contribution. You can make your contribution online at the ASCRS web site by going to Government Relations and clicking on eyePAC in the drop-down box or clicking here to download a contribution form to fax back. Thank you in advance for making a contribution. If you have questions, please contact ASCRS PAC/Grassroots Specialist Gerrie Gray-Benedi at 703-591-2220 or by email at firstname.lastname@example.org.
To find out more about the articles in this communication or to read more about legislative and regulatory issues that affect you and your practice, visit the ASCRS and ASOA websites. You can also visit http://www.specialtydocs.org/, the web site of the Alliance of Specialty Medicine.
© 2012 ASCRS/ASOA