MU Stage 1 - EP Public Health Reporting Exclusion

Size: px
Start display at page:

Download "MU Stage 1 - EP Public Health Reporting Exclusion"

Transcription

1 MU Stage 1 - EP Public Health Reporting Exclusion Final Rule Extract (Final Rule pg. 767+) Meaningful use objectives and measures for EPs, eligible hospitals, and CAHs. (2) Exclusion for non-applicable objectives. (i) An EP may exclude a particular objective contained in paragraphs (d) or (e) of this section, if the EP meets all of the following requirements: (A) Must ensure that the objective in paragraph (d) or (e) of this section includes an option for the EP to attest that the objective is not applicable. (B) Meets the criteria in the applicable objective that would permit the attestation. (C) Attests. (ii) An exclusion will reduce (by the number of exclusions applicable) the number of objectives that would otherwise apply. For example, an EP that has an exclusion from one of the objectives in paragraph (e) of this section must meet four (and not five) objectives of the EP s choice from such paragraph to meet the definition of a meaningful EHR user. Public Health Reporting Specifics (pg. 776+) (9) Submission to Immunization Registries (i) Objective; Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice. (ii) Measure; Performed at least one test of certified EHR technology's capacity to submit electronic data to immunization registries and follow up submission if the test is successful (unless none of the immunization registries to which the EP submits such information has the capacity to receive the information electronically). (iii) Exclusion in accordance with paragraph (a)(2) of this section. An EP who administers no immunizations during the EHR reporting period or where no immunization registry has the capacity to receive the information electronically.

2 (10) Submission of Syndromic Surveillance Data (i) Objective; Capability to submit electronic syndromic surveillance data to public health agencies and actual submission according to applicable law and practice. (ii) Measure; Performed at least one test of certified EHR technology's capacity to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which an EP submits such information has the capacity to receive the information electronically). (iii) Exclusion in accordance with paragraph (a)(2) of this section. An EP who does not collect any reportable syndromic information on their patients during the EHR reporting period or does not submit such information to any public health agency that has the capacity to receive the information electronically.

3 Supporting CMS FAQs [EHR Incentive Program] Do specialty providers have to meet all of the meaningful use objectives for the Medicare and Medicaid EHR Incentive Programs... Published 02/17/ :53 PM Updated 07/12/ :38 AM Answer ID Do specialty providers have to meet all of the meaningful use objectives for the Medicare and Medicaid EHR Incentive Programs, or can they ignore the objectives that are not relevant to their scope of practice? For eligible professionals (EPs) who participate in the Medicare and Medicaid EHR Incentive Programs, there are a total of 25 meaningful use objectives. To qualify for an incentive payment, 20 of these 25 objectives must be met. There are 15 required core objectives. The remaining 5 objectives may be chosen from the list of 10 menu set objectives. Certain objectives do provide exclusions. If an EP meets the criteria for that exclusion, then the EP can claim that exclusion during attestation. However, if an exclusion is not provided, or if the EP does not meet the criteria for an existing exclusion, then the EP must meet the measure of the objective in order to successfully demonstrate meaningful use and receive an EHR incentive payment. Failure to meet the measure of an objective or to qualify for an exclusion for the objective will prevent an EP from successfully demonstrating meaningful use and receiving an incentive payment.

4 [EHR Incentive Program] How should EPs select menu objectives for the EHR Incentive Programs? Published 10/18/ :41 AM Updated 03/24/ :11 AM Answer ID How should eligible professionals (EPs) select menu objectives for the Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs? EPs are required to report on a total of 5 meaningful use objectives from the menu set. When selecting five objectives from the menu set, EPs must choose at least one option from the public health menu set. If an EP is able to meet the measure of one of the public health menu objectives but can be excluded from the other, the EP should select and report on the public health menu objective they are able to meet. If an EP can be excluded from both public health menu objectives, the EP should claim an exclusion from only one public health objective and report on four additional menu objectives from outside the public health menu set. We encourage EPs to select menu objectives that are relevant to their scope of practice, and claim an exclusion for a menu objective only in cases where there are no remaining menu objectives for which they qualify or if there are no remaining menu objectives that are relevant to their scope of practice. For example, we hope that EPs will report on 5 measures, if there are 5 measures that are relevant to their scope of practice and for which they can report data, even if they qualify for exclusions in the other objectives. Please note that EPs must have complete certified EHR technology (or a complete set of certified EHR modules) capable of supporting all of the core and menu set objectives, including any objectives for which the EP can claim an exclusion and menu set objectives the EP does not select.

5 [EHR Incentive Programs] If my certified EHR technology only includes the capability to submit information to an immunization registry using the HL standard... Published 07/11/ :08 AM Updated 07/12/ :42 AM Answer ID If my certified EHR technology only includes the capability to submit information to an immunization registry using the HL standard but the immunization registry only accepts information formatted in the HL or some other standard, will I qualify for an exclusion because the immunization registry does not have the capacity to receive the information electronically? What if the immunization registry has a waiting list or is unable to test for other reasons but can accept information formatted in HL , is that still a valid exclusion? If the immunization registry does not accept information in the standard to which your EHR technology has been certified-that is, if your EHR is certified to the HL standard and the immunization registry only accepts HL , or vice versa-and if the immunization registry is the only immunization registry to which you can submit such information, then you can claim an exclusion to this objective because the immunization registry does not have the capacity to receive the information electronically. The capacity of the immunization registry is determined by the ability of the immunization registry to test with an individual EP or eligible hospital. An immunization registry may have the capacity to accept immunization data from another EP or hospital, but if for any reason (e.g. waiting list, on-boarding process, other requirements, etc) the registry cannot test with a specific EP or hospital, that EP or hospital can exclude the objective. It is the responsibility of the EP or hospital to document the justification for their exclusion (including making clear that the immunization registry in question is the only one it can submit information to). If the immunization registry, due to State law or policy, would not accept immunization data from you (e.g., not a lifespan registry, etc), you can also claim the exclusion for this objective. Please note, this FAQ applies in principle to all of the Stage 1 public health meaningful use measures (syndromic surveillance and reportable lab conditions). NOT APPLICABLE FOR MI For more information about the Medicare and Medicaid EHR Incentive Program, please visit

Payment Adjustments & Hardship Exceptions for Eligible Hospitals and CAHs Last Updated: March 2014

Payment Adjustments & Hardship Exceptions for Eligible Hospitals and CAHs Last Updated: March 2014 Payment Adjustments & Hardship Exceptions for Eligible Hospitals and CAHs Last Updated: March 2014 Overview As part of the American Recovery and Reinvestment Act of 2009 (ARRA), Congress mandated payment

More information

Extra Time to Succeed in Meaningful Use, A New CMS FAQ Confirms

Extra Time to Succeed in Meaningful Use, A New CMS FAQ Confirms IT Strategy Council Extra Time to Succeed in Meaningful Use, A New CMS FAQ Confirms Naomi Levinthal Consultant LevinthN@advisory.com Anantachai (Tony) Panjamapirom Consultant PanjamaT@advisory.com 2445

More information

Payment Adjustments & Hardship Exceptions Tipsheet for Eligible Professionals Last Updated: August, 2012

Payment Adjustments & Hardship Exceptions Tipsheet for Eligible Professionals Last Updated: August, 2012 Overview Payment Adjustments & Hardship Exceptions Tipsheet for Eligible Professionals Last Updated: August, 2012 As part of the American Recovery and Reinvestment Act of 2009 (ARRA), Congress mandated

More information

RELIEF FOR ELIGIBLE PROFESSIONALS? PROPOSED STAGE 2 MEANINGFUL USE RULE INCLUDES IMPORTANT (POTENTIAL) EXCEPTIONS [OBER KALER]

RELIEF FOR ELIGIBLE PROFESSIONALS? PROPOSED STAGE 2 MEANINGFUL USE RULE INCLUDES IMPORTANT (POTENTIAL) EXCEPTIONS [OBER KALER] RELIEF FOR ELIGIBLE PROFESSIONALS? PROPOSED STAGE 2 MEANINGFUL USE RULE INCLUDES IMPORTANT (POTENTIAL) EXCEPTIONS Publication RELIEF FOR ELIGIBLE PROFESSIONALS? PROPOSED STAGE 2 MEANINGFUL USE RULE INCLUDES

More information

National Provider Call:

National Provider Call: National Provider Call: Physician Quality Reporting System (Physician Quality Reporting) and Electronic Prescribing (erx) Incentive Program May 22, 2012 Disclaimers This presentation was current at the

More information

QUARTERLY PROVIDER NEWSLETTER FALL 2017

QUARTERLY PROVIDER NEWSLETTER FALL 2017 INSIDE THIS ISSUE: MEETINGS 1 CIN 2 PROVIDER OPERATIONS 3 MIPS UPDATE 5 MSIVA 9 VA PREMIER 11 QUARTERLY PROVIDER NEWSLETTER FALL 2017 ADDRESSING THE NEEDS OF OUR PROVIDERS AND BUILDING THE FOUNDATION FOR

More information

CY 2018 Quality Payment Program Final Rule Summary

CY 2018 Quality Payment Program Final Rule Summary CY 2018 Quality Payment Program Final Rule Summary On November 2, 2017, the Centers for Medicare and Medicaid Services (CMS) released its final rule outlining the requirements for year two of the Quality

More information

On Track for MACRA The Provider s Guide to QPP

On Track for MACRA The Provider s Guide to QPP On Track for MACRA The Provider s Guide to QPP Bizmatics, Inc. 4010 Moorpark Avenue, Suite 222 San Jose, CA 95117 www.prognocis.com training@bizmaticsinc.com Copyright 2017 Bizmatics, Inc. Overview CMS

More information

Aligning PQRS and Meaningful Use. Maximize your Medicare Reimbursement

Aligning PQRS and Meaningful Use. Maximize your Medicare Reimbursement Aligning PQRS and Meaningful Use Maximize your Medicare Reimbursement INTRODUCTION Brux McClellan, MPH, MHA Project Coordinator, HealthInsight Payment Adjustments Incentive $$ & Payment Adjustments Value

More information

2014 Physician Quality Reporting System: Group Reporting Requirements

2014 Physician Quality Reporting System: Group Reporting Requirements 2014 Physician Quality Reporting System: Group Reporting Requirements Lisa Lentz, MPH, Health Insurance Specialist and LeTonya Smith, CRNP, Health Insurance Specialist Presentation to the American Medical

More information

Medicare Update Rural Hospi Rural Hospi al Fi al nance

Medicare Update Rural Hospi Rural Hospi al Fi al nance Medicare Update Rural Hospital Finance Workshop- August 24, 2012 PS&R Redesign Update PS&R Redesign Issue-Negative Charges A problem has occurred in the claims processing system where non covered charges

More information

ehealth Privacy & Security Interest Group Monthly Call Friday September 26, 2014

ehealth Privacy & Security Interest Group Monthly Call Friday September 26, 2014 ehealth Privacy & Security Interest Group Monthly Call Friday September 26, 2014 Meaningful Use (MU) Incentives and the Security Risk Analysis (SRA) Jim Tate 1 www.americanbar.org ehealth Privacy & Security

More information

CMS PROPOSES KEY PROVISIONS OF MACRA PHYSICIAN PAYMENT SYSTEM FOR 2019

CMS PROPOSES KEY PROVISIONS OF MACRA PHYSICIAN PAYMENT SYSTEM FOR 2019 Thursday, April 28, 2016 CMS PROPOSES KEY PROVISIONS OF MACRA PHYSICIAN PAYMENT SYSTEM FOR 2019 The Centers for Medicare & Medicaid Services (CMS) late yesterday issued a proposed rule implementing key

More information

Tuesday, January 7, :00 Noon EST Dial In: Meeting ID: No audio available through Webinar

Tuesday, January 7, :00 Noon EST Dial In: Meeting ID: No audio available through Webinar CMS 2014 Physician Quality Reporting System (PQRS) Webinar Tuesday, January 7, 2014 12:00 Noon EST Dial In: 1-877-267-1577 Meeting ID: 992 953 262 No audio available through Webinar Introduction 2 Series

More information

MEDICARE PAID HUNDREDS OF MILLIONS IN ELECTRONIC HEALTH RECORD INCENTIVE PAYMENTS THAT DID NOT COMPLY WITH FEDERAL REQUIREMENTS

MEDICARE PAID HUNDREDS OF MILLIONS IN ELECTRONIC HEALTH RECORD INCENTIVE PAYMENTS THAT DID NOT COMPLY WITH FEDERAL REQUIREMENTS Department of Health and Human Services OFFICE OF INSPECTOR GENERAL MEDICARE PAID HUNDREDS OF MILLIONS IN ELECTRONIC HEALTH RECORD INCENTIVE PAYMENTS THAT DID NOT COMPLY WITH FEDERAL REQUIREMENTS Inquiries

More information

Patricia Gray, J.D., LL.M. Health Law & Policy Institute University of Houston Law Center September 27, 2012

Patricia Gray, J.D., LL.M. Health Law & Policy Institute University of Houston Law Center September 27, 2012 Patricia Gray, J.D., LL.M. Health Law & Policy Institute University of Houston Law Center September 27, 2012 the ACA has put the nation on a path that will transform the nation s sick care system into

More information

The Physician Value-Based Payment Modifier under the 2014 Medicare Physician Fee Schedule. December 3, 2013

The Physician Value-Based Payment Modifier under the 2014 Medicare Physician Fee Schedule. December 3, 2013 The Physician Value-Based Payment Modifier under the 2014 Medicare Physician Fee Schedule December 3, 2013 Medicare Learning Network This MLN Connects National Provider Call (MLN Connects Call) is part

More information

Connecticut Medicaid Electronic Health Record Incentive Program

Connecticut Medicaid Electronic Health Record Incentive Program * This document was revised on 6/20/2011 to clarify that, per the final rule, nursery bed days and discharges are not used in cost data. An EH may receive a Medicaid incentive payment from only one State

More information

PQRS - The Basics PQRS Physician Quality Reporting System. Presented by: Marcy Le

PQRS - The Basics PQRS Physician Quality Reporting System. Presented by: Marcy Le PQRS - The Basics 2014 PQRS Physician Quality Reporting System Presented by: Marcy Le WHY TALK ABOUT PQRS? WHY DO WE CARE ABOUT THIS? 2014 is the last year that incentive money is available **incentive

More information

MEDICARE ACCESS AND CHIP REAUTHORIZATION ACT (MACRA) MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS) REVIEW

MEDICARE ACCESS AND CHIP REAUTHORIZATION ACT (MACRA) MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS) REVIEW MEDICARE ACCESS AND CHIP REAUTHORIZATION ACT (MACRA) MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS) REVIEW I. MIPS Overview 1) Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) i) Signed into Law

More information

2012 Medicare Physician Fee Schedule Final Rule Summary

2012 Medicare Physician Fee Schedule Final Rule Summary 2012 Medicare Physician Fee Schedule Final Rule Summary On November, 1, 2011, the Centers for Medicare and Medicaid Services (CMS) posted the final Medicare Physician Fee Schedule (MPFS) for 2012. It is

More information

2016 Physician Quality Reporting System (PQRS)

2016 Physician Quality Reporting System (PQRS) 2016 Physician Quality Reporting System (PQRS) Virtual Office Hour Session Measure-Applicability Validation (MAV) 301 Sophia Autrey, MPH, CHES Research Analyst Center for Clinical Standards and Quality,

More information

Update on Medicare s Physician Incentive Programs

Update on Medicare s Physician Incentive Programs Physician Practice Roundtable Update on Medicare s Physician Incentive Programs An Overview of the Physician Quality Reporting System (PQRS), Value-Based Payment Modifier (VBPM), and Electronic Prescribing

More information

MEDICARE EHR INCENTIVE PROGRAM 2015 PAYMENT ADJUSTMENT APPLICATION for HARDSHIP EXCEPTION for CRITICAL ACCESS HOSPITALS (CAHs)

MEDICARE EHR INCENTIVE PROGRAM 2015 PAYMENT ADJUSTMENT APPLICATION for HARDSHIP EXCEPTION for CRITICAL ACCESS HOSPITALS (CAHs) MEDICARE EHR INCENTIVE PROGRAM 2015 PAYMENT ADJUSTMENT APPLICATION for HARDSHIP EXCEPTION for CRITICAL ACCESS HOSPITALS (CAHs) The submission deadline for a critical access hospital (CAH) is 11:59PM ET

More information

AAOS MACRA Proposed Rule Summary (Short)

AAOS MACRA Proposed Rule Summary (Short) AAOS MACRA Proposed Rule Summary (Short) Merit-Based Incentive Payment System (MIPS), Advanced Alternative Payment Model (APM) Incentive, and Criteria for Physician-Focused Payment Models Ref: CMS-5517-P

More information

2013 Physician Quality Reporting System (PQRS): 2015 PQRS Payment Adjustment

2013 Physician Quality Reporting System (PQRS): 2015 PQRS Payment Adjustment June 2013 2013 Physician Quality Reporting System (PQRS): 2015 PQRS Payment Adjustment Background Section 1848(a)(8) of the Social Security Act, requires the Centers for Medicare & Medicaid Services (CMS)

More information

The MACRA Proposed Rule on MIPS and APMs: Summary and Key Takeaways

The MACRA Proposed Rule on MIPS and APMs: Summary and Key Takeaways The MACRA Proposed Rule on MIPS and APMs: Summary and Key Takeaways A White Paper May 2016 Impact Advisors LLC 400 E. Diehl Road Suite 190 Naperville IL 60563 1-800- 680-7570 Impact- Advisors.com Executive

More information

2017 MEDICARE EHR INCENTIVE PROGRAM PAYMENT ADJUSTMENT HARDSHIP EXCEPTION APPLICATION

2017 MEDICARE EHR INCENTIVE PROGRAM PAYMENT ADJUSTMENT HARDSHIP EXCEPTION APPLICATION 2017 MEDICARE EHR INCENTIVE PROGRAM PAYMENT ADJUSTMENT HARDSHIP EXCEPTION APPLICATION The submission deadlines are based on the following: Are you using this provider application for eligible professionals?

More information

2011 OIG Work Plan: Projects reflect shifting regulatory environment

2011 OIG Work Plan: Projects reflect shifting regulatory environment Volume Thirteen Number One Published Monthly Meet Paul J. McNulty Partner, Baker & McKenzie, LLP, former Deputy Attorney General of the United States page 14 Feature Focus: 2011 OIG Work Plan: Projects

More information

HIT Fund SFY Receipts Expenditures Balance

HIT Fund SFY Receipts Expenditures Balance Agency of Human Services Department of Vermont Health Access Division of Health Care Reform 312 Hurricane Lane, Suite 201 Williston, VT 05495 hcr.vermont.gov [phone] 802-879-5901 M E M O R A N D U M TO:

More information

Scripps Health ACO Update

Scripps Health ACO Update June 2016 Scripps Health ACO Update Marc Reynolds Senior Vice President, Payer Relations Scripps Health Anil N. Keswani, MD Corporate Vice President, Population Health Management Scripps Health 10 Key

More information

Meaningful Use Requirement for HIPAA Security Risk Assessment

Meaningful Use Requirement for HIPAA Security Risk Assessment Meaningful Use Requirement for HIPAA Security Risk Assessment The MU attestation requirement does not state that any gaps must be resolved prior to meaningful use attestation. Mary Sirois, MBA, PT, CPHIMSS

More information

QUALITY PAYMENT PROGRAM YEAR 3 (2019) FINAL RULE OVERVIEW NOVEMBER 15, 2018

QUALITY PAYMENT PROGRAM YEAR 3 (2019) FINAL RULE OVERVIEW NOVEMBER 15, 2018 QUALITY PAYMENT PROGRAM YEAR 3 (2019) FINAL RULE OVERVIEW NOVEMBER 15, 2018 Disclaimers This presentation was prepared as a tool to assist providers and is not intended to grant rights or impose obligations.

More information

SIM Update. State Innovation Model

SIM Update. State Innovation Model State Innovation Model SIM Update h e a l t h i e r a n d m o r e p r o d u c t i v e l i v e s, n o m a t t e r t h e i r s t a g e i n l i f e. SIM Update Michigan Blueprint for Health Innovation developed

More information

Medicare Advantage FAQ

Medicare Advantage FAQ Medicare Advantage FAQ Contents Medicare Advantage Talking Points... 2 University of Richmond Medicare Advantage Plan Questions... 3 Provider Acceptance Questions... 4 Claims Processing... 6 Frequently

More information

Introduction. Incentive Payments for. Health Care Regulatory and Compliance Insights. Daniel F. Gottlieb, Esq.

Introduction. Incentive Payments for. Health Care Regulatory and Compliance Insights. Daniel F. Gottlieb, Esq. Health Care Regulatory and Compliance Insights CMS Proposes Medicare and Medicaid Reimbursement Rules for Earning Incentive Payments for Meaningful Use of Certified Electronic Health Record Technology

More information

2019 Merit-based Incentive Payment System (MIPS) Quality Performance Category: Medicare Part B Claims Data Submission Fact Sheet

2019 Merit-based Incentive Payment System (MIPS) Quality Performance Category: Medicare Part B Claims Data Submission Fact Sheet 2019 Merit-based Incentive Payment System (MIPS) Quality Performance Category: Medicare Part B Claims Data Submission Fact Sheet The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the

More information

Medicare Quality Payment Program Overview (MACRA)

Medicare Quality Payment Program Overview (MACRA) Medicare Quality Payment Program Overview (MACRA) December 2016 Rev. 12/1/16 Some general observations MACRA is complex More than a replacement for the SGR Many of the new requirements are revisions to

More information

2014 Physician Quality Reporting System (PQRS): Implementation Guide 10/17/2014

2014 Physician Quality Reporting System (PQRS): Implementation Guide 10/17/2014 2014 Physician Quality Reporting System (PQRS): Implementation Guide 10/17/2014 CPT only copyright 2013 American Medical Association. All rights reserved. Page 1 of 43 Table of Contents Page Introduction

More information

J11 Part A Provider Audit and Reimbursement Update

J11 Part A Provider Audit and Reimbursement Update J11 Part A Provider Audit and Reimbursement Update 1 Agenda Operational Update SSI Update Rural Floor Budget Neutrality Adjustment Wage Index 2014 EHR Audits Contacts 2 Operational Update - Audit Columbia,

More information

Summary of 2017 Medicare Part D Final Call Letter

Summary of 2017 Medicare Part D Final Call Letter Summary of 2017 Medicare Part D Final Call Letter On April 4, 2016, the Centers for Medicare & Medicaid Services (CMS) issued the 2017 Medicare Advantage Capitation Rates and Medicare Advantage and Part

More information

E-Commerce Enrollment

E-Commerce Enrollment Electronic Claims Submission HCIQ will electronically submit your primary carrier, professional claims. Please refer to our payer list to view the insurance companies that we currently submit to. Electronic

More information

Thank you, and enjoy the webinar.

Thank you, and enjoy the webinar. Disclaimer This webinar may be recorded. This webinar presents a sampling of best practices and overviews, generalities, and some laws. This should not be used as legal advice. Itentive recognizes that

More information

Medicare Skilled Nursing Facility Prospective Payment System: Proposed Rule Federal Fiscal Year 2015 June 2014

Medicare Skilled Nursing Facility Prospective Payment System: Proposed Rule Federal Fiscal Year 2015 June 2014 Payment Rule Summary Medicare Skilled Nursing Facility Prospective Payment System: Proposed Rule Federal Fiscal Year 2015 June 2014 1 P age Table of Contents Overview, Resources and Comment Submission...

More information

Application for Certificate of Authority to Operate an Approved Health Information Organization In the State Of Kansas

Application for Certificate of Authority to Operate an Approved Health Information Organization In the State Of Kansas Application for Certificate of Authority to perate an Approved Health Information rganization In the State f Kansas This application and all supporting documentation are subject to public disclosure under

More information

Provider/Payer Enrollment Tips and Tricks

Provider/Payer Enrollment Tips and Tricks Provider/Payer Enrollment Tips and Tricks Thea Hensley Provider Enrollment Coordinator Cody Regional Health 307-578-2498 ahensley@codyregionalhealth.org Vocabulary Provider/Payer Enrollment-Refers to the

More information

Age to Diagnosis Code & Procedure Code Policy

Age to Diagnosis Code & Procedure Code Policy Age to Diagnosis Code & Procedure Code Policy Policy Number 2017R0086C Annual Approval Date 3/8/2017 Approved By Reimbursement Policy Oversight Committee You are responsible for submission of accurate

More information

Staying Alive: Determinants of HIE Sustainability

Staying Alive: Determinants of HIE Sustainability Staying Alive: Determinants of HIE Sustainability A Special ehealth Initiative Report 818 Connecticut Ave. N.W. Suite 500 Washington, D.C. 20006 www.ehealthinitiative.org Staying Alive: Determinants of

More information

Health IT Public Policy Update

Health IT Public Policy Update Health IT Public Policy Update January 21, 2016 Tom Leary HIMSS Vice President Government Relations HHS Set Firm Goals for the Move to Value-Based Care Health Information Technology for Economic and Clinical

More information

2018 Quality Measure Benchmarks Overview

2018 Quality Measure Benchmarks Overview 2018 Quality Benchmarks Overview What Are Quality Benchmarks? When a clinician or group submits measures for the Merit-based Incentive Payment System (MIPS) quality performance category, each measure is

More information

Additional Documentation Request

Additional Documentation Request Additional Documentation Request Complex Review and Concept Development Date Provider Provider Address Provider City and State Re: Provider #123456789 Letter ID: XXXXXX The Centers for Medicare & Medicaid

More information

HOUSE BILL 255 A BILL ENTITLED. Health Maintenance Organizations Payments to Nonparticipating Providers

HOUSE BILL 255 A BILL ENTITLED. Health Maintenance Organizations Payments to Nonparticipating Providers J HOUSE BILL By: Delegates Pena Melnyk and Costa Introduced and read first time: January, 0 Assigned to: Health and Government Operations lr CF lr A BILL ENTITLED AN ACT concerning Health Maintenance Organizations

More information

H. R. ll IN THE HOUSE OF REPRESENTATIVES A BILL

H. R. ll IN THE HOUSE OF REPRESENTATIVES A BILL TH CONGRESS ST SESSION... (Original Signature of Member) H. R. ll To amend titles XVIII and XIX of the Social Security Act to improve the electronic health records meaningful use programs under the Medicare

More information

New Provider Training

New Provider Training New Provider Training Overview www.idmedicaid.com (available 24/7): Public Health PAS Website Secure Health PAS Website 2 Public Health PAS Website Navigating the Website 4 Provider Directory 5 Contact

More information

Best Available Evidence Process Update. FROM: Amy Larrick Chavez-Valdez, Director Medicare Drug Benefit and C & D Data Group

Best Available Evidence Process Update. FROM: Amy Larrick Chavez-Valdez, Director Medicare Drug Benefit and C & D Data Group DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, Maryland 21244-1850 MEMORANDUM DATE: February 17, 2017 TO: SUBJECT: All Part D Sponsors

More information

Medicare Reimbursement Update and Financial Improvement Tools for Rural Hospitals

Medicare Reimbursement Update and Financial Improvement Tools for Rural Hospitals acumen Medicare Reimbursement Update and Financial Improvement Tools for Rural Hospitals Presented by Ann King White, CPA BKD, LLP June 15, 2017 insight ideas attention reach expertise depth agility talent

More information

Welcome to Mid-Year Medical Renewal 2012!

Welcome to Mid-Year Medical Renewal 2012! Inside this issue: Your Current 0 Premiums Dental and Flex Spending Open Enrollment Information Basic Life and AD&D Insurance Humana Supplemental Products Lincoln Financial Ancillary Products FAQs (Medical,

More information

Key Financial and Operational Impacts from the Proposed Rule to Implement MACRA:

Key Financial and Operational Impacts from the Proposed Rule to Implement MACRA: Key Financial and Operational Impacts from the Proposed Rule to Implement MACRA: The proposed rule implementing Access and CHIP Reauthorization Act of 2015 (MACRA) was made available on May 9, 2016. A

More information

Medicare Access and CHIP Reauthorization Act of 2015 (HR. 2; MACRA)

Medicare Access and CHIP Reauthorization Act of 2015 (HR. 2; MACRA) Fact Sheet April 23, 2015 H.R.2 - Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Background. The Medicare Sustainable Growth Rate formula (SGR), passed by Congress in 1997, was intended to

More information

Cost Report Compliance Issues for Critical Access Hospitals

Cost Report Compliance Issues for Critical Access Hospitals Cost Report Compliance Issues for Critical Access Hospitals OIG s Compliance Guidance Model Compliance Plan Published February 23, 1998 Supplemental Guidance: January 31, 2005 False or Fraudulent Cost

More information

Office of ehealth Standards and Services Update: An Overview of Priorities and Key initiatives

Office of ehealth Standards and Services Update: An Overview of Priorities and Key initiatives Office of ehealth Standards and Services Update: An Overview of 2010-2011 Priorities and Key initiatives Lorraine Tunis Doo Senior Policy Advisor, OESS March 11, 2011 AREAS OF FOCUS Our Ever Changing World

More information

The Audits are coming!

The Audits are coming! HIPAA and Meaningful Use (MU) Governmental Program Audits The Audits are coming! The Audits are coming! 1 Audit Readiness Meaningful Use and HIPAA Both CMS and the Office for Civil Rights (OCR) have been

More information

CIN FAQ. FREQUENTLY ASKED Questions about Clinically Integrated Networks from The Care Centered Collaborative

CIN FAQ. FREQUENTLY ASKED Questions about Clinically Integrated Networks from The Care Centered Collaborative FAQ FREQUENTLY ASKED Questions about Clinically Integrated Networks from The Care Centered Collaborative What is a Clinically Integrated Network (CIN)? CINs are generally formed by independent healthcare

More information

MEDICARE PLAN PAYMENT GROUP

MEDICARE PLAN PAYMENT GROUP DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, Maryland 21244-1850 MEDICARE PLAN PAYMENT GROUP Date: June 23, 2017 To: From: All Part

More information

2018 Quality Payment Program Final Rule. Summary

2018 Quality Payment Program Final Rule. Summary Summary On Thursday, November 3, 2017, CMS issued the 2018 Quality Payment Program (QPP) final rule. Comments on the final rule are due January 1, 2018. The QPP encompasses the Merit-based Incentive Payment

More information

MEDICARE PLAN PAYMENT GROUP

MEDICARE PLAN PAYMENT GROUP DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, Maryland 21244-1850 MEDICARE PLAN PAYMENT GROUP Date: May 30, 2018 To: From: All Part D

More information

OUT-OF-POCKET ASSISTANCE PROGRAM

OUT-OF-POCKET ASSISTANCE PROGRAM OUT-OF-POCKET ASSISTANCE PROGRAM Helping Provide Patients with Affordable Access to RADICAVA (edaravone) IV infusion Please see accompanying full Prescribing Information, including Patient Information,

More information

Subtitle B: Incentives for the Use of Health Information Technology SEC. 4311: INCENTIVES FOR ELIGIBLE PROFESSIONALS.

Subtitle B: Incentives for the Use of Health Information Technology SEC. 4311: INCENTIVES FOR ELIGIBLE PROFESSIONALS. American Recovery and Reinvestment Act of 2009 Title IV: Health Information Technology and Quality Subtitle B: Incentives for the Use of Health Information Technology Part I: Medicaid Program SEC. 4311:

More information

Medicare s Shared Savings Program: Accountable Care Organizations Proposed Rule

Medicare s Shared Savings Program: Accountable Care Organizations Proposed Rule Medicare s Shared Savings Program: Accountable Care Organizations Proposed Rule On March 31, 2011, the Centers for Medicare and Medicaid Services (CMS) issued its proposed rule on Medicare s Shared Savings

More information

Compensation and Reimbursement

Compensation and Reimbursement 492 Pharmacy Management: Compensation and Reimbursement Positions Compensation and Reimbursement Revenue Cycle Compliance and Management (1710) To encourage pharmacists to serve as leaders in the development

More information

CMS Proposals for Quality Reporting Programs Under the 2015 Medicare Physician Fee Schedule Proposed Rule

CMS Proposals for Quality Reporting Programs Under the 2015 Medicare Physician Fee Schedule Proposed Rule CMS Proposals for Quality Reporting Programs Under the 2015 Medicare Physician Fee Schedule Proposed Rule PQRS, EHR Incentive Program, Physician Compare, and VBM Kate Goodrich, M.D., M.H.S. Director, Quality

More information

Claim Form Billing Instructions CMS-1500 (08-05) Claim Form

Claim Form Billing Instructions CMS-1500 (08-05) Claim Form Claim Form Billing Instructions CMS-1500 (08-05) Claim Form Presbyterian Health Plan / Presbyterian Insurance Company, Inc Original: 06/24/07 Page 1 of 10 Presbyterian Health Plan / Presbyterian Insurance

More information

NPAIHB Regional Extension Center

NPAIHB Regional Extension Center NPAIHB Reginal Extensin Center Suggestins fr an Audit File Under Stage 1 MU Build an audit file fr each EP Include Dcumentatin fr the Y/N Attestatin Measures Include ther dcumentatin as needed Drug Interactin

More information

FACT SHEET. The Physician Payments Sunshine Act: CMS Proposed Rule

FACT SHEET. The Physician Payments Sunshine Act: CMS Proposed Rule FACT SHEET The Physician Payments Sunshine Act: CMS Proposed Rule Executive Summary: CMS is making rules to implement sections of the Patient Protection and Affordable Care Act that would require eye banks

More information

2016 ELIGIBLE HOSPITAL HARDSHIP EXCEPTION APPLICATION

2016 ELIGIBLE HOSPITAL HARDSHIP EXCEPTION APPLICATION 2016 ELIGIBLE HOSPITAL HARDSHIP EXCEPTION APPLICATION SECTION 1: HOSPITAL INFORMATION Section 1.1 Provide the following information regarding the hospital that is applying for the hardship exception for

More information

Medicare s s 2009 eprescribing Program

Medicare s s 2009 eprescribing Program Medicare s s 2009 eprescribing Program Daniel Green, MD, FACOG Medical Officer, Quality Measurement Health Assessment Group Office of Clinical Standards and Quality Centers for Medicare & Medicaid Services

More information

Arizona Long Term Care Winter 2018 practicematters For More Information UHCCommunityPlan.com

Arizona Long Term Care Winter 2018 practicematters For More Information UHCCommunityPlan.com Arizona Long Term Care Winter 2018 practicematters For More Information Call our Provider Services Center at 800-445-1638 Visit UHCCommunityPlan.com In This Issue... Overcoming Barriers with 270/271 Eligibility

More information

EXCEL TRAINING. 4th Annual DZA Seminar. The Davenport Hotel, Spokane, Washington Guadalupe County Hospital. October 25-27, 2011

EXCEL TRAINING. 4th Annual DZA Seminar. The Davenport Hotel, Spokane, Washington Guadalupe County Hospital. October 25-27, 2011 EXCEL 4th Annual DZA Seminar TRAINING The Davenport Hotel, Spokane, Washington Guadalupe County Hospital October 25-27, 2011 A Component Unit of Guadalupe County, New Mexico Basic Financial Statements

More information

Medicare Part B Crossover Claim Submission User Guide

Medicare Part B Crossover Claim Submission User Guide Thank you for using MDH s newest web application to process your Medicare Part B Crossover Claims. Each claim you file is official and will supersede any paper claim you may have filed within the past

More information

Washington Update. Suzanne Falk, MPP Associate Director, Government Affairs

Washington Update. Suzanne Falk, MPP Associate Director, Government Affairs Washington Update Suzanne Falk, MPP Associate Director, Government Affairs sfalk@mgma.org Agenda 2017 Medicare Physician Fee Schedule Changes Miscellaneous Updates 2016 Quality Reporting Wrap-Up MACRA

More information

Frequently asked questions and answers for pharmacy providers

Frequently asked questions and answers for pharmacy providers Frequently asked questions and answers for pharmacy providers The purpose of Medicare s Limited Income Newly Eligible Transition (NET) Program is to ensure individuals with Medicare s low-income subsidy

More information

CY 2014 Physician Quality Reporting System (PQRS)

CY 2014 Physician Quality Reporting System (PQRS) CY 2014 Physician Quality Reporting System (PQRS) 101 Table of Contents Step 1: Understand PQRS and how it impacts you A. When was PQRS first established and implemented? B. What is PQRS? C. How does CMS

More information

Member Fact Sheet Medicare Secondary Payer Small Employer Exception

Member Fact Sheet Medicare Secondary Payer Small Employer Exception Member Fact Sheet Medicare Secondary Payer Small Employer Exception The Episcopal Church Medical Trust (Medical Trust) is providing eligible employers with the option to apply for the Medicare Secondary

More information

Current Status Of Legislation on Quality Bench Marks

Current Status Of Legislation on Quality Bench Marks Conflicts of Interest Current Status Of Legislation on Quality Bench Marks None Sean P. Roddy, MD Albany, NY Reason For Quality Measures Progressive increase in healthcare costs under the fee-for-service

More information

A Guide to Submitting Medicare Health Plan Requests for Other Payer Advanced APM Determinations

A Guide to Submitting Medicare Health Plan Requests for Other Payer Advanced APM Determinations A Guide to Submitting Medicare Health Plan Requests for Other Payer Advanced APM Determinations Payer Initiated Submission Form Purpose This is a guide on how Medicare Health Plans, including Medicare

More information

Clinical Policies and Procedures for Major Joint and Lower Extremity Services Overview and FAQs for BCBSNC In-Network Providers.

Clinical Policies and Procedures for Major Joint and Lower Extremity Services Overview and FAQs for BCBSNC In-Network Providers. Clinical Policies and Procedures for Major Joint and Lower Extremity Services Overview and FAQs for BCBSNC In-Network Providers October 17, 2016 Overview Blue Cross and Blue Shield of North Carolina (BCBSNC)

More information

HITECH and Stimulus Payment Update

HITECH and Stimulus Payment Update HITECH and Stimulus Payment Update David S. Szabo Agenda HIPAA Breach Notification Rules HITECH and Meaningful Use Open Question Period 2 Data Security Breaches A total of 245,216,093 records containing

More information

A Guide to Submitting CMS Multi-Payer Model Requests for Other Payer Advanced APM Determinations Commercial Payers (Payer Initiated Submission Form)

A Guide to Submitting CMS Multi-Payer Model Requests for Other Payer Advanced APM Determinations Commercial Payers (Payer Initiated Submission Form) A Guide to Submitting CMS Multi-Payer Model Requests for Other Payer Advanced APM Determinations Commercial Payers (Payer Initiated Submission Form) Purpose Through the Payer Initiated Submission Form

More information

Effective June 3rd, 2019, Virginia Premier will reject paper claims submitted with incomplete information for required fields.

Effective June 3rd, 2019, Virginia Premier will reject paper claims submitted with incomplete information for required fields. April 1, 2019 Provider Billing Guidelines Policy Dear Provider, Per the Centers for Medicaid and Medicare Services (CMS) and Department of Medical Assistance (DMAS), it is the provider's responsibility

More information

MACRA: Redefining How CMS Pays Doctors. White Paper ELLIS MAC KNIGHT, MD DAN KIEHL, JD CONTACT. Senior Vice President/CMO. Associate Consultant

MACRA: Redefining How CMS Pays Doctors. White Paper ELLIS MAC KNIGHT, MD DAN KIEHL, JD CONTACT. Senior Vice President/CMO. Associate Consultant MACRA: Redefining How CMS Pays Doctors White Paper ELLIS MAC KNIGHT, MD Senior Vice President/CMO DAN KIEHL, JD Associate Consultant June 2016 CONTACT For further information about Coker Group and how

More information

Frequently Asked Questions (FAQ) Pay for Performance Measurement Year 2014 June 2015

Frequently Asked Questions (FAQ) Pay for Performance Measurement Year 2014 June 2015 P4P Controlling Blood Pressure for People with Hypertension (CBPH) Posted 6/29/15 Question: Why are there are no codes that encompass the 140-149 BP range that is new for senior hypertensive patients (BP

More information

MACRA: New Medicare Reimbursement Models Sharp HealthCare

MACRA: New Medicare Reimbursement Models Sharp HealthCare MACRA: New Medicare Reimbursement Models Sharp HealthCare August 15, 2016 Nathan M. Bays, Esq. General Counsel, The Health Management Academy Executive Director, Advisors Caitlin Greenbaum, MPH Director,

More information

Legislative Text Section 218(b), Protecting Access to Medicare Act of 2014 (Public Law No )

Legislative Text Section 218(b), Protecting Access to Medicare Act of 2014 (Public Law No ) Legislative Text Section 218(b), Protecting Access to Medicare Act of 2014 (Public Law No. 113-93) (b) PROMOTING EVIDENCE-BASED CARE. (1) IN GENERAL. Section 1834 of the Social Security Act (42 U.S.C.

More information

QUALITY PAYMENT PROGRAM YEAR 3 (2019) FINAL RULE OVERVIEW

QUALITY PAYMENT PROGRAM YEAR 3 (2019) FINAL RULE OVERVIEW QUALITY PAYMENT PROGRAM YEAR 3 (2019) FINAL RULE OVERVIEW NEAL LOGUE, HEALTH INSURANCE SPECIALIST, DIVISION OF FINANCIAL MANAGEMENT & FEE FOR SERVICE OPERATIONS DECEMBER 12, 2018 Disclaimers This presentation

More information

Patient Information. Financial Handbook For Liver Transplant Patients

Patient Information. Financial Handbook For Liver Transplant Patients Patient Information Financial Handbook For Liver Transplant Patients Beaumont Transplant Clinic Directory Beaumont Hospital, Royal Oak Medical Office Building 3535 West 13 Mile Road, Suite 644 Royal Oak,

More information

Copyright Scottsdale Institute All Rights Reserved.

Copyright Scottsdale Institute All Rights Reserved. Copyright Scottsdale Institute 2017. All Rights Reserved. No part of this document may be reproduced or shared with anyone outside of your organization without prior written consent from the author(s).

More information

School Based Health Centers and RHC/FQCH April 23, 2012

School Based Health Centers and RHC/FQCH April 23, 2012 School Based Health Centers and RHC/FQCH April 23, 2012 Bayou Health Implementation A Transition from Legacy Medicaid to Medicaid Managed Care Transition Began February 1, 2012. Approximately 800,000 Medicaid

More information

Pamela Ballou-Nelson, RN, MSPH, CMPE, PhD, Principal, MGMA Consulting April 10, , Telligen, Inc.

Pamela Ballou-Nelson, RN, MSPH, CMPE, PhD, Principal, MGMA Consulting April 10, , Telligen, Inc. MIPS 2018 Cost Reporting and Your QRUR Pamela Ballou-Nelson, RN, MSPH, CMPE, PhD, Principal, MGMA Consulting April 10, 2018 2016, Telligen, Inc. Quality Payment Program Cost Reporting Quality Payment Program

More information

Patient Volume Threshold (PVT) Massachusetts Medicaid EHR Incentive Program

Patient Volume Threshold (PVT) Massachusetts Medicaid EHR Incentive Program Patient Volume Threshold (PVT) Massachusetts Medicaid EHR Incentive Program April 25, 2017 Today s presenters: Thomas Bennett, MeHI Technical Assistance Team Elisabeth Renczkowski, Content Specialist Disclaimer

More information

PARTNERS HEALTH PLAN PHP CARE COMPLETE FIDA-IDD. TRAINING FOR DEVELOPMENTAL DISABILITIES PROVIDER NETWORK June 16, 2017

PARTNERS HEALTH PLAN PHP CARE COMPLETE FIDA-IDD. TRAINING FOR DEVELOPMENTAL DISABILITIES PROVIDER NETWORK June 16, 2017 PARTNERS HEALTH PLAN PHP CARE COMPLETE FIDA-IDD TRAINING FOR DEVELOPMENTAL DISABILITIES PROVIDER NETWORK June 16, 2017 AGENDA Welcome & Introduction Care Management/Interdisciplinary Teams (IDT)/Life Plans

More information