Heads Ups: New and Notable From Medicare

Here are some Medicare updates to keep on your radar for 2017 and into 2019. 

Most notable: The Centers for Medicare & Medicaid Services (CMS) has made Medicare Access and CHIP Reauthorization Act (MACRA) reporting easy for 2017 so you won’t earn a penalty. 

MACRA penalty reprieve: For 2017 only, CMS has eased up on MACRA reporting requirements. Next year, you can report on one measure for one MACRA category (quality, improvement activities, advancing care information) to avoid a penalty in 2019. You also have other options:

  • Report on measures for the full year to maximize chances for an incentive.
  • Choose a 90-day performance period to avoid a 2019 penalty and possibly receive an incentive. 
  • Do not report anything in 2017 and receive the full 4-percent penalty in 2019.  

Visit the TMA MACRA Resource Center to learn more about your options under MACRA. And find out the latest information about just-released MACRA final rules at TMA’s seminar, MACRA and Medicare: Get Clarity and Direction, at a city near you, or via webcast on Nov. 30. TMA experts combed through the nearly 2,400 pages of rules to help you get MACRA-ready. Register today.

Reminder: Review your PQRS feedback reports, QRURs: If you submitted data to Medicare’s Physician Quality Reporting System (PQRS) for the 2015 program year, now is the time to review your quality reports: 2015 PQRS feedback report and Quality Use and Resource Report (QRUR). The reports include information about your quality and cost performance and whether you’ll get hit with penalties or receive bonus payments next year. Access and review your reports now as the deadline to appeal any errors is Nov. 30, 2016.

Annual update for HPSA bonus payments: Be sure to check the CMS Physician Bonuses webpage before the end of the year. CMS soon will post its annual Health Professional Shortage Area (HPSA) bonus payment file for 2017. Check whether you need to add modifier AQ to your claim to receive the bonus payment, if applicable, or to see if the ZIP code in which you rendered services will receive the HPSA bonus payment automatically. 

Social Security Number Removal Initiative: MACRA requires CMS to remove Social Security numbers (SSNs) from all Medicare cards by April 2019. A new, randomly generated Medicare Beneficiary Identifier (MBI) will replace the SSN-based health insurance claim number on the new Medicare cards for Medicare transactions like billing, eligibility status, and claim status.

CMS has created a webpage for physicians and providers about the initiative. Look at your practice management systems and business processes and determine what changes you need to make to use the new randomly generated MBI. You’ll need to make those changes and test them by April 2018, before CMS sends out new Medicare cards.

CMS info worth your while:

  • CMS has updated its FAQs about its Provider Enrollment, Chain and Ownership System (PECOS). The FAQs cover enrollment and revalidation.
  • Check out the various newsletters from CMS that you can sign up to receive in your inbox. Don’t want email overload? TMA’s Payment Advocacy staff recommends you subscribe to at least this one: the weekly electronic newsletter, the MLN Connects Provider eNews.

Published Oct. 28, 2016

TMA Practice E-Tips main page

Last Updated On

December 05, 2016

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