3.26.19 MIPS Year 2 (2018) Data for the Quality Payment Program Must Be Submitted
by April 2
The data submission deadline for Merit-based Incentive Payment System (MIPS) is two weeks away for eligible clinicians who participated in Year 2 (2018) of the Quality Payment Program. Data can be submitted and updated any time until 8:00 p.m. ET on Tuesday, April 2, 2019.
CMS Web Interface users need to report their Quality performance category data by 8:00 p.m. EST on March 22, 2019. Physicians who reported Quality measures via Medicare Part B claims can sign in to qpp.cms.gov to view current performance based on claims that have been processed by your Medicare Administrative Contractor.
If you are working with a third-party intermediary to submit data on your behalf, we encourage you to sign in to the Quality Payment Program website during the submission period and review the submission for accuracy. Data cannot be resubmitted after the submission period closes.
For More Information
To learn more about how to submit data, please review the 2018 MIPS data submission FAQs, User Guide and video series available in the QPP Resource Library.
If you have questions about how to submit your 2018 MIPS data, contact:
- The Quality Payment Program by phone: 1-866-288-8292/TTY: 1-877-715-6222; or email: QPP@cms.hhs.gov
Your local technical assistance organization
3.26.19 NY Department of Health Influenza Surveillance
The New York State Department of Health (NYSDOH) collects, compiles, and analyzes information on influenza and produces a weekly report during the influenza season (October through the following May).
During the week ending March 9, 2019:
- There were 6,493 laboratory-confirmed influenza reports, a 6% decrease over the previous week.
- Of the 2,933 specimens submitted to NYS WHO/NREVSS laboratories, 651 (22.20%) were positive for influenza. 645 were for influenza A, and 6 were influenza B.
- Of the 101 specimens submitted to the Wadsworth Center, 94 were positve for influenza. 34 were influenza A (H1), 51 were influenza A (H3), 8 were influenza A (Not Subtyped), and 1 was influenza B (Victoria).
- Reports of percent of patient visits or influenza-like illness (ILI3) from ILINet providers was 2.93%, which is above the regional baseline of 3.10%.
- The number of patients hospitalized with laboratory-confirmed influenza was 1,037, a 17% decrease over last week.
- There were no influenza-associated pediatric death reported this week, and four influenza-related pediatric deaths so far this season.
Read the entire report here.
1.17.19: Drug Take Back Program Begins in New York State
From NY Assemblymember John T. McDonald III
The New York State Drug Take Back Act went into effect January 6, creating a statewide drug takeback program – paid for by drug manufacturers, not taxpayers (Ch. 120 of 2018). The program requires participation by all chain and mail-order pharmacies doing business in the state and is part of the Assembly Majority’s continued efforts to fight the opioid epidemic and save lives. The Assembly previously led the push for “I-STOP,” creating the first real-time prescription-drug database in the country.
Opioid overdoses took the lives of more than 42,000 Americans in 2016. In New York, the rate of opioid overdose deaths doubled between 2010 and 2015. The nationwide crisis has reached such epidemic proportions that life expectancy in the U.S. has decreased for the second time in three years.
The new law requires all drug manufacturers to implement a takeback program in which both chain and mail-order pharmacies offer on-site collection or prepaid envelopes for New Yorkers to dispose of unused medication. Opioid addiction often begins with the use of prescription painkillers, whether obtained legitimately through a doctor or illegally from someone else’s medicine cabinet, and that the program will help cut off supply. The program will also help ensure that these drugs are not improperly disposed of by flushing down the toilet or throwing them in the trash, which can cause them to seep into the water supply.
To learn more please read Assembymember McDonald's full blog piece here
11.9.18: Extortion Scam Targeting DEA Registrants, Including Physicians
DEA is aware that registrants are receiving telephone calls and emails by criminals identifying themselves as DEA employees or other law enforcement personnel. The criminals have masked their telephone number on caller id by showing the DEA Registration Support 800 number. Please be aware that a DEA employee would not contact a registrant and demand money or threaten to suspend a registrant’s DEA registration.
If you are contacted by a person purporting to work for DEA and seeking money or threatening to suspend your DEA registration, submit the information through “Extortion Scam Online Reporting” posted on the DEA Diversion Control Division’s website, www.DEADiversion.usdoj.gov.
Extortion Scam Online Reporting
For more information contact:
Locate DEA Field Office for your area - https://apps.deadiversion.usdoj.gov/contactDea/spring/fullSearch
Registration Service Center - 1-800-882-9539
Email - DEA.Registration.Help@usdoj.gov
11.9.18: New: ACP Practice Advisor® Opioid Risk Management Module*
This online tool can help your practice enhance patient care and office efficiency. The Opioid Risk Management module (ACP Practice Advisor log-in required) has resources to help mitigate risk and improve outcomes for patients and medical practices. It includes tools to address the major components of the Blueprint for Prescriber Education for Extended Release and Long-Acting Opioid (ER/LA) Analgesics.
On-Demand Webinars: Chronic Pain/Opioid Prescribing
Safer Opioid Prescribing (recorded August 2018)
Learn more about safer opioid prescribing–including agreements and monitoring for benefits and harms.
Managing Patients Not Benefiting From (or Being Harmed by) Opioids (recorded September 2018)
Experts in opioid management and weaning discuss how to assess patients on opioids for lack of benefit and implement a patient-centered opioid taper and treatment plan with alternative therapies, as well as how to assess for and treat opioid use disorder
These webinars are supported by Funding Opportunity 1L1CMS331476-03-00 from the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the presenters and do not necessarily represent the official views of HHS or any of its agencies
*Free access is available through 12/31/18.
More Opioid Treatment Resources can be found here
11.9.18: Influenza Resource Sheet
The National Governmental Resources Contractor Advisory Committee (NGS CAC) recently released a helpful information sheet for this year's influenza season. It covers Medicare reimbursement rates and coding guidelines, as well as educational products for all health care providers. It also contains helpful links immunization-related websites, like the Food and Drug Administration, National Vaccine Program, Immunization Action Coalition, and more!
These resources were recently reviewed with the NGS Contractor Advisory Committee (CAC). The Chapter is well represented on the CAC with two NYACP Masters, John Maese, MD, MACP, and Ed Stehlik, MD, MACP serving.
You can view the fact sheet here.
11.9.18: CMS Releases Letter on Reducing Administrative Burdens
On Thursday, November 8, CMS released a letter to physicians outlining how the agency is reducing burden through reform of documentation and coding requirements. An excerpt:
"CMS has been hard at work to address the burden placed on clinicians by federal health care regulations. Through [CMS'] “Patients over Paperwork” initiative [they] are collecting feedback and updating policies in Medicare and Medicaid that are outdated, duplicative, or overly burdensome.
One key initiative that [CMS has] launched involves streamlining the measures that clinicians report; a recent Health Affairs study found that U.S. medical practices in four common specialties on average spend, per physician, a striking 15.1 hours per week and over $40,000 per year reporting quality metrics. The litany of regulations in healthcare contributes to the consolidation we’re seeing in the system. According to a survey by the American Medical Association, the percent of clinicians with ownership status in their practice declined from 53 percent in 2012 to 47 percent in 2016, with younger physicians more than three times as likely as older physicians to be employed by hospitals."
You can read the full letter here.
11.9.18: Promoting Interoperability: Attestation and Financial Support with NyeC
The New York eHealth Collaborative's Medicaid Eligible Professional Program (EP2) provides free assistance and a hands-on approach to help your practice successfully achieve Promoting Interoperability (formerly Meaningful Use) objectives.
FREE Services include:
- Readiness assessment
- Promoting Interoperability (formerly Meaningful Use) Support
- Education and Training
- Audit Readiness and Preparation
- HIE Connectivity
Eligible practices can receive up to $34,000 in incentive payments through New York Medicaid EHR Incentive Program. The EP2 Program is only open to providers who started participating in the New York Medicaid EHR Incentive Program in 2016.
You can find out more here.
9.18.18: ACP Comments on Medicare Payment Proposal, Offers Alternate Way Forward
The Centers for Medicare & Medicaid Services (CMS) released the proposed rule for the 2019 Medicare physician fee schedule and Quality Payment Program on July 12, 2018, which would change documentation requirements and how physicians are paid for office visits. Since that time, ACP has been reviewing the proposed rule in detail and evaluating potential short- and long-term effects on Internal Medicine specialists, subspecialists, and their patients.
ACP strongly supports CMS easing documentation of E/M services. As ACP has long advocated and asserted, the proposed changes can and should be implemented starting next year, without resulting in reductions in pay for the most complex visits.
The College strongly opposes the proposed change to pay the same for complex cognitive care as more basic care, which would adversely affect internal medicine specialists, subspecialists, and their patients and urges CMS to test alternatives to their proposed flat fee structure.
ACP observed in a 2015 position paper on clinical documentation, “In place of a thoughtfully written review of systems that listed pertinent positive or negative findings, clinically meaningless terms such as ‘ten point review of systems was negative’ were introduced into the record to satisfy E&M guidelines ... [an] imbalance of values has been created, with compliance, coding, and security trumping patient care, clinical well-being, and efficiency.”
ACP's comments offer an alternative way forward for CMS to immediately implement changes that will address the adverse impacts of documentation on patient care while preserving the principle that more complex cognitive care must be valued more than less complex care. If CMS eases documentation of E/M services without devaluing complex cognitive care, it would be a big step forward for ACP members and ACP's Patients Before Paperwork initiative.
In its official comment letter to CMS last week addressing the proposed rules, ACP detailed concerns and made recommendations for change. You can read the letter here.
9.18.18: Make Your Voice Heard: Take this Survey on Reducing Administrative from ACP
ACP is continuously working on your behalf to reduce administrative burdens and improve the Medicare payment system, as well as press legislators and regulators for changes that can successfully improve your daily work experience and patient care.
As part of that work, ACP is looking for members to complete this survey on Administrative Tasks and Best Practices. This survey will better assist the College in advocating for reform.
8.15.18: 2017 MIPS Performance Feedback and Payment Adjustment Update
If you submitted 2017 Merit-based Incentive Payment System (MIPS) data through the Quality Payment Program website, you can now view your performance feedback and MIPS final score.
CMS originally displayed a single payment adjustment amount, which included an additional adjustment for exceptional performance available to MIPS eligible clinicians and groups with a final score of 70 or greater. However, based on feedback from various clinicians and groups, CMS has updated the system so that the MIPS payment adjustment, and additional adjustment for exceptional performance (if applicable) are now displayed separately. The system will continue to display the total MIPS payment adjustment, which is a sum of MIPS performance and exceptional performance.
How to Access Your Final Score and Feedback
You can access 2017 MIPS performance feedback and final score by:
Upcoming Office Hours
CMS will be hosting an office hours session on August 14 to provide a brief overview of MIPS 2017 performance feedback and targeted review and to answer frequently asked questions.
8.3.18: FDA Approves Cannabis-Derived Drug
Excerpt Courtesy of Nixon-Peabody
On June 25, the Food and Drug Administration (FDA) approved Epidiolex, the first drug derived from cannabis in the United States. Epidiolex, produced by GW Pharmaceuticals (in the United Kingdom), is derived from cannabidiol (CBD), a non-psychoactive part of cannabis, which is intended to treat patients with Dravet and Lennox-Gastaut syndromes, two rare forms of epilepsy. Clinical trials have demonstrated that patients taking Epidiolex experience 40% less seizures.
Having been approved by the FDA, Epidiolex will now have to be approved by the Drug Enforcement Administration (DEA) before becoming available in jurisdictions that have legalized medical cannabis use. While legislation has been and is being introduced to change cannabis’s current classification as a Schedule I drug with no medical value, CBD, like cannabis, requires DEA reclassification, which is expected to occur within the next 90 days.
While other drugs have been approved to treat Lennox-Gastaut syndrome, Epidiolex is the first also specifically approved for Dravet syndrome. Analysts anticipate that Epidiolex will also be prescribed off-label (for purposes it has not been officially approved for) to treat many epileptic diseases besides Dravet and Lennox-Gastaut syndromes. Additionally, experts believe that Epidiolex’s approval will increase patient safety because it provides a regulated medication with standard dosing and supply to patients who were previously being treated with CBD at home, some without dosage guidance.
8.3.18: In Case You Missed It - Recording of Panel Discussion on E/M Coding Reform
In case you missed it last week, see below for a link to the webcast of the panel discussion on Evaluation & Management Coding:
- Title: CMS Panel Discussion on E/M Coding Reform
CMS Administrator Seema Verma, Dr. Rucker, National Coordinator for Health Information Technology, Dr. Kate Goodrich, CMS Chief Medical Officer and Director of CCSQ, Dr. Anand Shah, CMMI Chief Medical Officer, and Dr. Thomas Mason, ONC Chief Medical Officer host an informative live telecast on E/M Coding Reform. Many stakeholders maintain that current CMS evaluation and management documentation guidelines are outdated, complex, ambiguous, and that they fail to distinguish meaningful differences among code levels. CMS has acknowledged that the current guidelines create an administrative burden and increased audit risk for some providers. In response, CMS announced its intention to undertake a multi-year effort—with the input of providers and other stakeholders—to revise the current E/M documentation guidelines.
8.3.18: ACP Publishes Paper on Social Determinants of Health
ACP has published a paper in the Annals of Internal Medicine that examines ways to reduce health care disparities. Addressing Social Determinants to Improve Patient Care and Promote Health Equity provides a set of recommendations aimed at improving patient care and health outcomes, and overcoming the special challenges associated with adverse conditions in which people are born, grow, work, and live. The Chapter's Council reviewed this paper in a lively discussion led by Maria Carney, MD, FACP, NYACP Long Island Governor.
Social determinants of health are non-medical factors that can impact an individual’s overall health and health outcomes. These include conditions that shape a patient’s daily life, such as income, social status and education, their physical environment including access to safe water and clean air; the safety and conditions of their workplace and home; employment opportunities and social support networks; and access to health services. The Council has made several suggestions to ACP to create meaningful resources for our physician members.
You can read the entire report here.
7.3.2018: The Sunshine Act: CMS Posts 2017 Financial Data
The Centers for Medicare & Medicaid Services (CMS) has made available the Open Payments Program Year 2017 data, along with newly submitted and updated payment records for previous program years. The data is accessible here.
Open Payments is a national disclosure program that promotes transparency and accountability by making information about the financial relationships between applicable manufacturers and group purchasing organizations (GPOs) and physicians and teaching hospitals available to the public. Through this program, health care consumers have access to a more transparent healthcare system.
In Program Year 2017, applicable manufacturers and GPOs reported $8.40 billion in payments and ownership and investment interests to physicians and teaching hospitals. This amount is comprised of 11.54 million total records attributable to 628,214 physicians and 1,158 teaching hospitals.
Payments are reported in three payment categories: general payments, research payments, and ownership or investment interests. Payments in the three major reporting categories for Program Year 2017 are:
- $2.82 billion in general (i.e., non-research related) payments
- $4.66 billion in research payments
- $927 million of ownership or investment interests held by physicians or their immediate family members
Over the course of the Open Payments program, CMS has published 53 million records, accounting for $33.42 billion in payments and ownership and investment interests. For more information, please visit: https://www.cms.gov/openPayments/
7.3.2018: What's the Fastest and Easiest Way to Correct a Claim or Request an Appeal?
Recently, National Government Services (NGS) created a chart to assist the provider community in knowing the differences between an appeal Reopening and a Redetermination.
Understanding the differences and the process are very important for quick reimbursement.
- A reopening is a reprocessing of a claim to fix minor mistakes.
- A redetermination is an examination of a claim that includes analysis of documentation.
There is a substantial difference between a reopening and a redetermination and this guide will assist Part B providers in determining which to use. Please refer to the Reopening versus Redetermination guide to learn the fastest and easiest methods.
4.26.2018: Worker's Compensation Board Announces Proposals to Improve Medical Care for Injured Workers
To increase provider participation in the workers' compensation system and improve injured workers' access to timely, quality medical care, the Workers' Compensation Board (Board) is proposing an increase to provider fees and adoption of the universal CMS-1500 form to reduce administrative burden, among other measures. Access to quality medical care for injured workers is of utmost importance for a healthy workers' compensation system. When an injured worker has ready access to medical treatment, the worker heals and is restored to function more quickly and completely. This benefits not only the worker, but the employer as well.
On April 17, the Board announced a multipronged approach to address provider concerns around participating in the workers' compensation system and expand injured workers' access to medical care.
Proposal to Increase Medical Fees for All Medical Providers
The Board's current medical fee schedule has remained relatively unchanged since 1996 and remains a significant obstacle to attracting new providers and retaining existing ones. Therefore, the Board will be advancing a regulatory proposal in June to raise provider fees; this will be effective for services provided on or after October 1, 2018. The proposal will include an overall statewide fee increase for all provider types, with additional increases for certain specialty provider groups that have an extreme shortage of authorized providers. These new fees will ensure providers in New York are receiving fair and reasonable reimbursement for prompt, quality treatment to our injured workers.
Proposal to Reduce Paperwork
Providers have indicated that the unique paperwork requirements in the workers' compensation system result in significant additional administrative costs. Therefore, the Board will be consolidating and eliminating forms, including converting to the use of the CMS-1500 form. The CMS-1500 is the universal claim form used by medical providers to bill health insurers. Careful review and discussion with different stakeholders confirms that the CMS-1500 is easy to use and provides the necessary information. The Board proposes replacing the current Board treatment forms (C-4 and C-4.2, and equivalent OT/PT and PS forms) with the CMS-1500. As the CMS-1500 is already used by medical providers and insurance carriers to process claims, the Board anticipates an easy transition to the CMS-1500 and will be working towards a January 1, 2019, implementation date.
Other Enhancements to Improve Access to Quality Medical Care
The Board is also committed to other improvements that will increase access to quality medical care and reduce administrative burdens:
- Medical Portal: The first phase of the Medical Portal, an important Business Process Re-engineering initiative, will be coming this year. This electronic medical portal will allow providers to quickly and easily identify whether their course of treatment is consistent with the Board's medical treatment guidelines and, if not, advise them that a variance is needed. The Medical Portal is an important step toward an easy-to-use, paperless system.
- Access to Different Medical Providers Types: The Board is also exploring options that will increase access to medical care providers. This will afford injured workers access to expanded provider types and medical providers flexibility in the delivery of medical care.
Governor Cuomo continues to support a comprehensive legislative solution that expands the types of providers that may treat injured workers. Currently only physicians, chiropractors, podiatrists, and psychologists can be authorized. The proposed legislation would amend the Workers' Compensation law to conform with the Education law by permitting medical providers who are licensed in New York State to become authorized, opening participation to nurse practitioners, physician's assistants, licensed clinical social workers, and other providers. In most instances, injured workers would be able to seek treatment for their workers' compensation illness and injuries with the same providers they use for non-work related illness and injuries.
1.12.18: ADA Releases Updated Standards of Diabetes Care Recommendations
The American Diabetes Association (ADA)'s 2018 update to its Standards of Medical Care in Diabetes makes several notable new recommendations, including a target blood pressure below 140/90 mm Hg for most patients with hypertension, integration of continuous glucose monitoring into care, and routine screening for type 2 diabetes in high-risk youth.
The standards of care were published online Dec. 8 and are available as a supplement to the January 2018 Diabetes Care.
Important changes and updates for patients with diabetes and cardiovascular disease include the following:
- A new recommendation for adults with type 2 diabetes and heart disease that after lifestyle management and metformin, a medication proven to improve heart health should be added.
- Most adults with diabetes and hypertension should have a target blood pressure below 140/90 mm Hg, and risk-based individualization to lower targets, such as 130/80 mm Hg, may be appropriate for some patients, as summarized and outlined in a new table of four major, randomized controlled trials.
- A new algorithm illustrates the recommended antihypertensive treatment approach for adults with diabetes and confirmed hypertension, defined as blood pressure of 140/90 mm Hg or greater. The algorithm suggests selecting specific classes in certain clinical situations.
- All hypertensive patients with diabetes should monitor their blood pressure at home to help identify potential discrepancies between office and home blood pressure and to improve their medication-taking behavior.
To read the rest of the report, please click here.
12.22.17: Reporting Patients Who Should Not Drive: An FAQ
Laurie Cohen, Esq. of Nixon-Peabody, NYACP's Legal Counsel has developed as list of Frequently Asked Questions updating members on how to handle patients who should not be driving due to temporary or permanent impairment.
The New York State Department of Motor Vehicles (DMV) may suspend or place restrictions upon an individual’s driver license or learner permit if it has reason to believe the individual has a medical condition that may interfere with his or her ability to safely operate a motor vehicle. To that end, the DMV solicits reports by individuals, including police officers, licensed physicians and others, of individuals with medical conditions that may affect his or her driving. Before making such a report, you should review this guidance to ensure that doing so does not violate your patient’s privacy rights, including those pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Forms for such cases are available through the DMV and can be accessed here.
Below is a sample of the frequently asked questions:
Q: Do I have a duty to report to the DMV when I have a patient whose medical condition could affect his or her driving?
A: No. In New York State, a physician is not required to report to the DMV any patient’s medical condition and should not do so in the absence of the patient’s written consent or unless otherwise permitted or compelled to do so, for example, pursuant to a court order.
Q: Am I permitted to make a report to the DMV if I have a patient whose medical condition could affect his or her driving?
A: It depends. If your patient consents in writing, you may disclose his or her protected health information. This circumstance could arise if your patient is involved in a motor vehicle accident, after which time he or she is asked to supply medical documentation to demonstrate his or her fitness to drive. Without your patient’s written consent, and in the absence of one or more circumstances for which disclosure without patient consent is expressly permitted, you may not disclose his or her protected health information.
12.22.17: New York State Department of Health Announces New Medical Marijuana Regulations
On December 8, 2017, the New York State Department of Health announced the filing of regulations that will improve the state's Medical Marijuana Program for patients, practitioners and registered organizations. These regulations, which will go into effect on December 27, 2017, allow for the sale of additional medical marijuana products, an improved experience for patients and visitors at dispensing facilities and the ability for the Department to approve new courses that will allow prospective practitioners to complete their training in a shorter amount of time.
Under the new regulations, registered organizations (ROs) are allowed to manufacture and distribute additional products including topicals such as ointments, lotions and patches; solid and semi-solid products, including chewable and effervescent tablets and lozenges; and certain non-smokable forms of ground plant material. All products are subject to rigorous testing, and the Department reserves the right to exclude inappropriate products or those which pose a threat to public health.
The new regulations also allow prospective patients and practitioners to enter dispensing facilities to speak directly with RO representatives, learn about products and get information about the medical marijuana program. In addition, people other than designated caregivers may accompany patients to dispensing facilities.
Physicians will soon be able to take a shortened version of the currently available four-hour courses required to certify patients for medical marijuana. The Department will work with course providers to offer a two-hour course, which is a typical length for other medical education courses.
The regulations also streamline the manufacturing requirements for medical marijuana products, broaden the capability of registered organizations to advertise, amend security requirements and clarify laboratory testing methods.
Other recent enhancements to New York's Medical Marijuana Program include authorizing five additional registered organizations to manufacture and dispense medical marijuana, adding post-traumatic stress disorder and chronic pain as qualifying conditions, empowering nurse practitioners and physician assistants to certify patients and permitting home delivery.
As of December 8, 2017, there are 38,642 certified patients and 1,358 registered practitioners participating in the program.
For more information on New York's Medical Marijuana Program, please click here.
CDC Online STEADI Training:
To engage your older patients in interventions to reduce fall risk, CDC developed the STEADI (Stopping Elderly Accidents, Deaths, and Injuries) Initiative to help providers incorporate fall prevention into clinical practice. CDC created this training to give you the tools you need to make fall risk screening, risk factor assessment, and falls interventions part of your clinical practice.
The content is based on established clinical guidelines. You will learn:
- Two easy screening methods to determine a patient’s fall risk
- Three rapid standardized gait, strength and balance assessment tests
- To apply the STEADI algorithm to determine a patient's fall risk level
- To select appropriate evidence-based interventions based on risk level
- You can take the CDC’s new STEADI Online Training for Providers at: https://www.cdc.gov/steadi/index.html. All you need to do is create a free account on CDC TRAIN, Log in, and search “STEADI”.
Resources for Patients:
7.20.17: Acronym List
Below is an acronym list detailing various acronyms in the medical field.
Click here for the acronym list
Last Updated 3.26.19
Practice Management Topics
Alternative Payment Models (APMS)
End of Life Care/
Advance Care Planning
Health Information Technology
Legal Counsel's Forum
Medicare & Medicaid
Opioid Prescription Education
Practice Management Tools