A CMS fact sheet reminds providers to brush up on their MIPS knowledge in regard to the quality performance category. This performance category is worth 50% of providers’ final MIPS score for 2018, and providers who demonstrate improvement from their performance in the category in 2017 could earn bonus points this year.
Providers should be preparing for another rulemaking cycle from CMS as we hit April, with the IPPS rule expected to include a discussion on how the existing payment system can address new and emerging cellular and gene therapies.
CMS held a listening session March 21 to gather input from stakeholders on potential updates to the E/M documentation guidelines. The current guidelines are considered outdated in light of medical advances and the advent of the electronic health record.
CMS reminded organizations to pay attention to billing and coding for specimen validity testing done in conjunction with drug testing. The agency reviewed recent code changes and billing guidelines for these lab tests in Special Edition MLN Matters 18001 released on March 29. CMS emphasized that providers that perform validity testing on urine specimens cannot separately bill the validity testing.
The shift from fee-for-service to value-based programs for outpatient payment systems has increased the need for outpatient CDI staff to review documentation for pertinent clinical factors.
Amidst the hospital-of-the-future buzz at HIMSS18 was keen interest in resources aimed at helping providers navigate the present-day transition to value-based care. Many healthcare executive and clinician attendees were eager to identify ways healthcare technology can help their organizations transition from fee-for-service to pay-for-performance reimbursement models.
Medicare Advantage plan payment rates will increase by an average of 3.4% in 2019 due to higher projected per-capita cost growth for Medicare fee-for-service. The final pay bump is significantly higher than the 1.84% increase proposed in the 2019 advance notice.
With the expansion of telehealth services, providers for both the originating site and distant site can also count on the expansion of Medicare contractor audits.
