Deadline Extension for PQRS and Meaningful Use

CMS has Extended the reporting deadline for 2016 PQRS and EHR Meaningful Use reporting. The original date of February 28, 2017 now varies from March 13th through March 31st depending on your data submission method.   Full update from CMS below:

CMS Extends Deadline for 2016 Physician Quality Reporting System (PQRS) Electronic Health Record (EHR) Submission

CMS is extending the submission deadline for 2016 Quality Reporting Document Architecture (QRDA) data submission for the EHR reporting mechanism. Individual eligible professionals (EPs), PQRS group practices, qualified clinical data registries (QCDRs), and qualified EHR data submission vendors (DSVs) now have until March 13, 2017 to submit 2016 EHR data via QRDA. The original submission deadline was February 28, 2017.

A complete list of 2016 data submission timeframes is below:

March 13, 2017 deadlines:

• EHR Direct or Data Submission Vendor (QRDA I or III) – 1/3/17 - 3/13/17
• Qualified Clinical Data Registries (QRDA III) – 1/3/17 - 3/13/17

March 17, 2017 deadline:

• Web Interface – 1/16/17 - 3/17/17

March 31, 2017 deadlines:

• Qualified Registries (Registry XML) – 1/3/17 - 3/31/17
• QCDRs (QCDR XML) – 1/3/17 - 3/31/17

Submission ends at 8:00 p.m. Eastern Time (ET) on the end date listed. An Enterprise Identity Management (EIDM) account with the “Submitter Role” is required for these PQRS data submission methods. Please see the EIDM System Toolkit for additional information.

EPs who do not satisfactorily report 2016 quality measure data to meet the PQRS requirements will be subject to a downward PQRS payment adjustment on all Medicare Part B Physician Fee Schedule (PFS) services rendered in 2018. For questions, please contact the QualityNet Help Desk at 1-866-288-8912 or via email at Qnetsupport@hcqis.org from 7:00 a.m. - 7:00 p.m. Central Time. Complete information about PQRS is available at https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html.

Dosimetry is Back! CMS to delete 77295/77300 NCCI Edit

Some hard work by ASTRO and ACR, along with the American Association of Physicists in Medicine( AAPM), has paid off as CMS  has agreed to delete the NCCI Edit which ruled that Basic Dosimetry Calculations ,77300, was bundled with 3D Plan 77295.  

The correction will become official on July 1st 2016 and will be retroactive to January 1st 2016. UHN will continue to track all dosimetry calculations which would have been affected by the previous bundling and submit the retroactive charges upon official release of the NCCI Edits on July 1st.

Radiation Oncology Pay Freeze

On December 28th President Obama signed the Patient Access and Medicare Protection Act. The big headline grabber from this law has been the Meaningful Use Hardship Legislation, which expands eligibility for hardship exemptions for Stage 2.

Bigger news for Freestanding Radiation Oncology Centers is found when digging a little deeper into bill S.2425: Payment for treatment delivery and image guidance codes in 2017 and 2018 will remain at the same levels set for 2016.  

This law removes the looming threat of removing the vault as a direct expense when calculating reimbursement, as well as increases in equipment utilization rates, which would have lead to major reductions in payment.  Radiation Oncologist can rest easy knowing that reimbursement will remain steady, at least for a few years.  The Bill also sets 2019 as the target for a transition to an episodic alternative payment model.

The Battle for Dosimetry

CMS has again bundled basic dosimetry calculations (77300) into other charges for 2016.  

Last year 77300 was bundled into isodose planning, this year it is 3D planning (77295) absorbing the dosimetry code.   However there is a big difference this year, the reimbursement for 77295 was not increased to reflect the work associated with dosimetry calculations.  

Despite strong opposition from ASTRO, this rule goes into effect January 1st, 2016 and 77300 can no longer be billed with 77295.

Read more on ASTRO's opposition to this change here: 

https://www.astro.org/Practice-Management/Reimbursement/Medicare/News/2015/ASTRO-Opposes-New-Edit-Prohibiting-the-Reporting-of-77300-with-77295.aspx

CMS Extends Due Date for Meaningful Use Reporting & EHR Incentives

o some of you, it might feel like April 13th and you haven’t yet started to file your taxes, with the CMS Meaningful Use attestation deadline looming at the end of this month. Well, we have good news for you! CMS announced this week that the new deadline for submitting your 2014 Meaningful Use reports will be March 20th, 2015.  This doesn’t mean you should push this to the back burner for another couple of weeks however; they are just being nice and giving you a little extra time so you’re not so stressed.

What does this mean? CMS is giving Medicare EPs (Eligible Physicians) a little extra time to submit, qualifying them to receive their EHR incentive payments and avoid Medicare payment adjustments, which will occur on January 1, 2016.

The extension will also enable eligible professionals, who haven’t yet used their free pass to switch from Medicare to Medicaid, or vice versa. By March 20, 2015, if they have not yet made the switch, they’ll be stuck with their original program. 

This delay will also impact EHR reporting for PQRS (Physician Quality Reporting System), which is the reporting program for physicians that combines incentive payment and payment adjustments, where they cut payments as a way to promote improved reporting of quality information.

Stay informed about the latest PQRS news by subscribing to the PQRS Listserv.

Giving EPs this extra time shows how dedicated CMS is to their commitment to make changes to the HER incentive programs, making it more flexible for providers. So keep in mind what is due on March 20th and make sure that you are getting out ahead of it at your practice.

Submission Deadline is March 20, 2015 at 8:00 PM EST for the following reporting:

• EHR Direct or Data Submission Vendor that is certified EHR technology (CEHRT)
• Qualified clinical data registries (QCDRs) (using QRDA III format) reporting for PQRS and the clinical quality measure (CQM) component of meaningful use for the Medicare Electronic Health Record (EHR) Incentive Program

(Provided by: HER Incentive Programs, a program of the Centers for Medicare & Medicaid Services)

Message from AHIMA on ICD-10

SUCCESS: ICD-10 NOT INCLUDED IN SPENDING BILL

The Twitter Rally on December 10 in support of the October 1, 2015, ICD-10 implementation date let Congress know that #ICD10Matters, with approximately 5,000 tweets using the hashtag in one hour.

COMMITTEE ISSUES STATEMENT ON ICD-10

The United States House of Representatives Energy and Commerce Committee issued a statement last week assuring stakeholders of their commitment to ICD-10's implementation on October 1, 2015, saying the committee had "heard from a number of interested parties concerned about falling behind or halting progress." The committee says it will continue "close communication with the Centers for Medicare and Medicaid Services to ensure that the deadline can successfully be met."

In the upcoming 114th Congress, the committee's chairman, Representative Fred Upton (R-MI), and House Rules Committee Chairman Representative Pete Sessions (R-TX) are expected to ask both supporters and opponents of the code sets for information about ICD-10 readiness.

http://energycommerce.house.gov/press-release/house-chairmen-upton-sessions-statement-icd-10

Medicare Announces Delayed Decision on Vaults and New Codes Until 2016

Yell hallelujah, hell yeah or wahoo, whatever your chosen exclamation might be because Medicare just made your month!  The Centers for Medicare and Medicaid Services (CMS) have granted the wishes of everyone in the radiation oncology industry with their release of the final 2015 Medicare Physician Fee Schedule.

The decision not to remove the cost of the vault as a direct practice expense when calculating reimbursement rates for 2015 is a money saving (read: life saving) move for radiation oncologists. Additionally, CMS has decided to continue to pay for some of the eliminated treatment codes from 2014. They will do this by creating g-codes for those eliminated codes and continuing to reimburse physicians at the same, previous rate.

These two updates will result in a 0% reduction for radiation oncology providers, which is great news compared to the 8% reduction rate we were facing!

So who is to blame for those celebratory high-fives you’re all giving right about now? We can all give a huge thanks the American Society for Radiation Oncology (ASTRO) as they led an advocacy campaign designed to keep the payment cuts CMS proposed in July from going through.  Over 160 bipartisan members of Congress, along with several radiation oncology industry stakeholders, wrote letters to CMS discussing the impact of the reimbursement cuts, begging them to reconsider. Thankfully these efforts did not go without notice and the MPFS final rule states that CMS will be delaying its decision regarding these hot button issues for one more year.

In addition to this, CMS released their 2015 Hospital Outpatient Prospective Payment System (HOPPS) final rule, though this week they will be issuing the final rules, so stay tuned!

Medical Billing Questions to Ask - Radiation Oncology

Are you asking yourself the right questions?

Revenue cycle management can be a cumbersome component of running your practice and managers often become so comfortable with current protocols that they don’t recognize how industry changes are impacting their business.  Once it becomes apparent that something needs to be done to improve collections, where do you start? The questions and concerns can become overwhelming, but the worst thing you can do is avoid change and remain at a standstill. How are practices supposed to know what questions to ask themselves and the companies they are considering outsourcing to?

We sat down with Universal Health Network’s (UHN) CEO Peter Wall last week at ASTRO 2014 in San Francisco and discussed the questions he advises potential new clients to ask themselves.

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• With extensive coding changes on the horizon, who is going to train your staff?
• How much will that training cost you?
• How much time will that training take up?
• Who is acting on your behalf with local representatives to fight increased reimbursement cuts proposed by CMS?
• How will you make up for the revenue lost with these inevitable cuts?
• How do you measure and improve the efficiency of your revenue cycle management process?
• Can your billing protocols be simplified?
• How much money each month could you be losing due to ineffective processes?
• If you decide to outsource, how will the cash flow transition work?
• Do you have anyone fostering relationships with payers across the board? Ex: Insurance Providers, Medicare, Medicaid etc.
• Can you provide cost estimates for all kinds of payers if a patient requests it?
• What is your biggest fear regarding outsourcing your billing?  Is it fear of the unknown, fear of losing control or fear of wasted revenue?

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Coding changes and reimbursement cuts account for just the first round of adjustments radiation oncology practices and organizations will need to make in order to remain successful.  The team at UHN has been working to stay ahead of the curve in regards to industry changes, urging practices to see that they can do better. 

Wall commented saying, “We tell our clients, don’t settle for your current income. Don’t you want to be making more? You could be collecting up to $10,000 more each month, we want to help make that happen.”

UHN’s goal is to be a resource powerhouse for radiation oncology practices, giving them the tools to increase revenue and improve their processes. To discuss the customized answers to the aforementioned questions that UHN can provide to your practice, simply fill out the form below.