CMS Updates

Update from CMS

The net result is a decrease in payments of 3.89%. How does this break down?

Think of it as being graded on the curve. If you score a 95 on a test you think you have a good grade, but if class average on that test was a 98 you will get a poor grade. Scoring for quality measures is similar to that type of grading.

They are stating that these exemptions are Automatic.  But what does that really mean?

This means that the CMS 1135 Waivers have been extended through April 20. Some of the waivers may impact your practice while most of the waivers are related to hospital care.

For the 2020 performance period, CMS is using the Extreme and Uncontrollable Circumstances policy to allow clinicians, groups, and virtual groups to submit an application requesting reweighting of one or more MIPS performance categories due to the COVID-19 pandemic. As an additional flexibility, CMS has extended the deadline to submit a COVID-19 related 2020 extreme and uncontrollable circumstances application to February 1, 2021.

The Coronavirus Aid, Relief, and Economic Security (CARES) Act suspended the payment adjustment percentage of 2% applied to all Medicare Fee-For-Service (FFS) claims from May 1 through December 31. The Consolidated Appropriations Act, 2021, signed into law on December 27, extends the suspension period to March 31, 2021

Recently Medicare expanded their definition of the health care provider who can certify the patient as being diabetic. This brief article will answer some questions, but many others remain unquestioned.

On November 5th, 2020, the DME MACs released two joint publications detailing expansion of the roles of Nurse Practitioners (NP) and Physician Assistants (PA) in certifying therapeutic shoes and inserts for beneficiaries. CMS is utilizing its authority under the soon-to-be-launched Primary Care First (PCF) model to waive Social Security Act 1861(s)(12), the section which requires that an MD or DO only, is permitted to certify therapeutic shoes and inserts for beneficiaries.

Arizona has apparently received some changes to its HCPCS validation which is reflected in this announcement by CGS. This has some far reaching implications beyond the Arizona brand name.