Archive for April, 2016

CMS Proposes to Not Require MU (Advancing Care Information) for Non-Patient-Facing MIPS Eligible Clinicians

April 28, 2016 Leave a comment

The proposed rule released yesterday by the Centers for Medicare and Medicaid Services (CMS) to establish the foundation of the Merit-based Incentive Payment System (MIPS) includes a proposal to reweight the “Advancing Care Information” performance category the MIPS Composite Performance Score (CPS) to zero for non-patient-facing participants. The Advancing Care Information performance category is essentially a rebranding and simplification for the MIPS era of the prior EHR Incentive Program’s “meaningful use” requirements.

Generally speaking, payment adjustments under MIPS would be determined by the relative CPS of MIPS eligible clinicians. The CPS would be comprised of performance in four categories: quality, resource use, clinical practice improvement activities, and advancing care information.

The Advancing Care Information performance category would, by default, count for up to 25 percent of an eligible clinician’s CPS. However, CMS proposes that non-patient-facing MIPS eligible clinicians would have their Advancing Care Information performance category automatically reweighted to zero, thus basing their CPS on other performance categories (some of which also have reweighting). The end result is that the CPS of non-patient-facing MIPS eligible clinicians would not be influenced by the Advancing Care Information performance category—at least not initially (CMS indicated that they would revisit this issue in future rulemakings).

CMS proposes that “non-patient-facing MIPS eligible clinicians” would be defined as individual MIPS eligible clinicians or groups that bill 25 or fewer patient-facing encounters during a performance period. A “patient-facing encounter” would be an instance in which MIPS eligible clinician or group billed for services such as general office visits, outpatient visits, and surgical procedure codes under the Physician Fee Schedule. CMS plans to publish a proposed list of these patient-facing encounter codes online.

The current assumption (without the aforementioned list of encounter codes to verify) is that most of ACR’s diagnostic radiologists and nuclear medicine physicians would meet the proposed “non-patient-facing” definition, and thus would have their Advancing Care Information performance category automatically reweighted to zero.  At this writing, it is unclear (again, without that list of encounter codes) if interventional radiologists would also meet the proposed “non-patient-facing MIPS eligible clinician” definition.

Categories: EHR, meaningful use, Medicare

MIPS/APMs Proposed Rule Released

April 27, 2016 1 comment

As anticipated, the Centers for Medicare and Medicaid Services publicly released the proposed rule titled,”Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models.”  The proposed rule will be formally published in the Federal Register on May 9.

Categories: EHR, meaningful use, Medicare

OMB Completes Review of APMs/MIPS Proposed Rule; Public Inspection Imminent

April 27, 2016 Leave a comment

On April 26, the White House Office of Management and Budget (OMB) completed its regulatory review of the Centers for Medicare and Medicaid Services’ Notice of Proposed Rulemaking (NPRM) regarding “Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) in Medicare Fee-for-Service.”

OMB Office of Information and Regulatory Affairs review is one of the final steps prior to public availability of the NPRM. Therefore, we expect the NPRM will very soon be placed on the Office of the Federal Register’s (OFR) Public Inspection Desk for future publication in the Federal Register.

As always, the pre-publication version of the NPRM will be accessible to the public soon after CMS submits it to OFR. Availability could be as early as today, sometime this week, or perhaps even next week. Note that CMS traditionally times their submissions to OFR for Friday afternoon releases, although they may choose not to in this particular case.

As a reminder, this is a proposed rule for public comment purposes. CMS plans to promulgate the final rule for MIPS/APMs around Fall 2016. The American College of Radiology’s Economics, Government Relations, and Quality & Safety leadership and staff teams will continue to be heavily involved in this rulemaking advocating on behalf of ACR’s members.

Categories: EHR, meaningful use, Medicare

Legislation Introduced to Allow 90-Day EHR Reporting Periods in 2016

April 20, 2016 Leave a comment

U.S. Senators Rob Portman (R-Ohio) and Michael Bennet (D-Colorado) and U.S. Representatives Renee Ellmers, Tom Price, M.D., Bobby Rush, and Ron Kind announced introduction of the Flexibility in Electronic Health Record (EHR) Reporting Act (bill numbers TBA) on April 20.

The bipartisan, bicameral legislation would allow eligible professionals and hospitals to have ninety-day EHR reporting periods in CY 2016 of the Medicare/Medicaid EHR Incentive Program (“meaningful use”). Currently, program participants beyond their first year of participation are required to have full year-long reporting periods.

The American College of Radiology (ACR) is currently supporting the final draft of this noncontroversial legislation alongside numerous other physician and provider organizations.

Categories: EHR, meaningful use, Medicare

Meaningful Use Attestation Data Update

April 14, 2016 Leave a comment

The Centers for Medicare and Medicaid Services (CMS) and Office of the National Coordinator for Health IT (ONC) recently released an updated public use file containing Medicare/Medicaid EHR Incentive Program attestation and certified product data. Over the years, this de-identified dataset has served as one of the few sources of Meaningful Use (MU) attestation information that allows stratification by specialty.

Importantly, the file only contains MU attestation data through January 2016. Historically, the majority of MU attestations have been completed closer to the deadline, which for CY 2015 reporting periods was March 11, 2016. Therefore, we will not be able to see the final 2015 MU tally until the agencies release a future update containing mid-March 2016 data. This could be available sometime around mid-June at the earliest—the rule of thumb is that public availability of these datasets is approximately three months behind the pull.

So, as of January 2016…

  • 44 unique diagnostic radiologist MU attestations for CY 2015 reporting periods.
  • 2 unique interventional radiologist MU attestations for CY 2015 reporting periods.
  • 1 unique nuclear medicine physician MU attestation for a CY 2015 reporting period.
  • 36 unique radiation oncologist MU attestations for CY 2015 reporting periods.

Again, it is critical to understand that these numbers are not representative of the final attestation totals for 2015. It is likely that most attestations would have been completed closer to the March 11, 2016 deadline.  No attestations from February or March were included in these counts.

Categories: EHR, meaningful use, Medicare

ONC Requests Information on Assessing Interoperability for MACRA

April 7, 2016 1 comment

The Office of the National Coordinator for Health IT (ONC) will soon publish a Request for Information (RFI) on assessing interoperability for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Certain provisions in MACRA directed ONC to establish metrics to determine whether interoperable EHR technology is successfully enabling widespread health information exchange by the end of calendar year (CY) 2018.

The RFI (to be published in the April 8 Federal Register) includes background discussions and specific questions for stakeholders on three subtopics of interest to ONC:

  1. Measurement population (e.g., “meaningful EHR users” and providers they exchange with) and key measurable components of interoperability.
  2. Current data sources and potential metrics that address these issues.
  3. Other data sources and metrics ONC should consider with respect to these issues or interoperability measurement more broadly.

The comment period for ONC’s RFI will close on June 3. American College of Radiology (ACR) members interested in providing input for use in ACR’s future comments to ONC should please contact Michael Peters, ACR Director of Regulatory and Legislative Affairs, and (202)223-1670 ext. 4546 or

Categories: EHR, meaningful use, Medicare