Plans for the Quality Payment Program in 2017: Pick Your Pace

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ASE Comments on the 2017 PFS and HOPPS Proposed Rules

Read copies of ASE’s comment letters on the 2017 PFS and HOPPS Proposed Rules here.

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U.S. Physicians… Just a Few Minutes of Your Time!

CPT codes that describe stress echocardiography are currently under review. Your participation is key in the assessment of the time, complexity, and physician work value for these procedures. This is your opportunity to participate in the Relative Value Update Committee (RUC) process to ensure fair and adequate code valuation. If you were randomly selected with the subject line, “Help ACC and ASE with RUC Physician Work Survey for Stress Echo,” please take a few minutes to complete this new survey.

The information you provide is critical to ensuring appropriate valuation for these services. We greatly appreciate your time, input, and expertise. For more information, please visit here.

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EHR Meaningful Use, What’s Next?

Last week acting administrator of the Centers for Medicare and Medicaid Services, Andy Slavitt, stated he intends to replace the Meaningful Use program in 2016. For more detail, read the following articles: EHR Meaningful Use to End in 2016, CMS Leader Says and Andy Slavitt puts meaningful use on ice; Read his J.P. Morgan speech transcript. Our Advocacy team had previously worked with the Alliance of Specialty Medicine and the AMA to advocate on behalf of echo practitioners that the original program needed improvement as physicians were unduly penalized for failure to meet requirements and measures not in their control.

A recent blog post from the CMS Blog provides more insight into the future of Meaningful Use.

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Modest Changes in Echo Professional Fees But Significant Changes in Hospital Outpatient Echo Payment Proposed by Medicare for 2016 (7/10/15)

The Centers for Medicare and Medicaid Services (CMS) recently released proposed changes to the Medicare allowances for physicians’ services paid under the Physician Fee Schedule (PFS) and services provided by hospital outpatient departments paid under the Hospital Outpatient Prospective Payment System (HOPPS). If the changes are adopted as proposed, the amounts paid for physicians services (Professional and Technical Components) under the PFS would remain relatively unchanged in 2016, but hospitals would experience significant changes in the amounts paid by Medicare for the overhead, supplies, equipment, and non-physician personnel costs associated with outpatient echos. Read more here.

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CMS Medicare Physician Payment Schedule Proposed Rule Released

The Centers for Medicare and Medicaid Services (CMS) released the 2016 Medicare Physician Payment Schedule Proposed Rule proposed rule. View it here.

The CMS Fact Sheet can be found here.  ASE is analyzing these recommendations and will share a more detailed and targeted analysis soon.

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CMS and AMA announce efforts to help get ready for ICD-10

The American Medical Association and CMS jointly announced that an agreement has been reached on important elements of a “grace period” for the October 1, 2015, implementation of the ICD-10 diagnosis code set.

In guidance that is being transmitted, CMS announced that:

  • For a one year period starting October 1, Medicare claims will not be denied solely on the specificity of the ICD-10 diagnosis codes provided, as long as the physician submitted an ICD-10 code from an appropriate family of codes. In addition, Medicare claims will not be audited based on the specificity of the diagnosis codes as long as they are from the appropriate family of codes. This policy will be followed by Medicare Administrative Contractors and Recovery Audit Contractors.
  • To avoid potential problems with mid-year coding changes in CMS quality programs (PQRS, VBM and MU) for the 2015 reporting year, physicians using the appropriate family of diagnosis codes will not be penalized if CMS experiences difficulties in accurately calculating quality scores (i.e., for PQRS, VBM, or Meaningful Use). CMS will continue to monitor implementation and adjust the duration if needed.
  • CMS will establish an ICD-10 Ombudsman to help receive and triage physician and provider problems that need to be resolved during the transition.
  • CMS will authorize advanced payments if Medicare contractors are unable to process claims within established time limits due to problems with ICD-10 implementation.

The October 1 deadline for implementation of the ICD-10 code set is fast approaching, and time is running out for physician practices to complete their preparation. The AMA has a broad range of materials available on its web site to help physicians prepare for the October 1 deadline. For additional information please visit here.

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CMS releases the proposed HOPPS rule

The Centers for Medicare and Medicaid Services (CMS) released the proposed rule to the Hospital Outpatient Prospective and Ambulatory Surgical Center Payment Systems.The proposed rule also includes important proposed changes to the Two Midnight Rule for CY 2016. See this related fact sheet for detailed information on this rule and click here to view the full detailed fact sheet on CMS changes. ASE is analyzing these recommendations and will share a more detailed and targeted analysis soon.

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New Category III codes announced July 1, 2015

On July 1, 2015 the American Medical Association (AMA) released its semi-annual update to its list of CPT Category III codes. The AMA identified 34 new Category III codes; these codes all are scheduled to become effective as of January 1, 2016.  Of particular interest to Echocardiographers is 0399T – Myocardial strain imaging as described below:

  • 0399T: Myocardial strain imaging (quantitative assessment of myocardial mechanics using image-based analysis of local myocardial dynamics)
    ►(Use 0399T in conjunction with 93303, 93304, 93306, 93307, 93308, 93312, 93314, 93315, 93317, 93350, 93351, 93355)◄
    ►(Report 0399T once per session)◄

Reminders for your practice

  1. Typically Category III codes replace unlisted codes that were previously used for new procedures or services.   Prepare to update your charge sheets.
  2. If a Category III code describes the procedure or service performed, it must be reported. An unlisted code or less specific Category I cannot be reported in place of an active Category III code.
  3. Reimbursement of Category III codes is at the discretion of payers.  During the six months between announcement of new Category III code and active date, practices interested in utilizing new code should begin working with local payers to obtain coverage and payment.
  4. Category III codes are released on a semi-annual basis in January and July and are published on the AMA’s website.  Please reference the AMA website for a complete listing of all recently approved Category III codes

Also, with the passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACA) Congress permanently repealed and replaced the Sustainable Growth Rate Formula and a providing to increase the Medicare conversation faction by .05%. This increase will go into effect today, July 1.

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CMS released provider information on Parts A and B Providers, Costs, Services, and Trends

This week, US CMS has published the third annual release of the Medicare hospital utilization and payment data (both inpatient and outpatient) and the second annual release of the physician and other supplier utilization and payment data. As they did last year, state and national media outlets are expected to publish names and details of top billers in forthcoming coverage of this year’s data.

CMS files can be searched by specialty or by state which allows you to compare yourselves to your peers. For more information please visit here.

As always, ASE will monitor press coverage of this data release in the coming weeks, and will continue to alert our members if any articles emerge that are particularly concerning for echocardiography.

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