This Week – February 17, 2018

This Week in Washington, D.C.

  • MIPS-eligible Clinicians Can Now View Performance Scores for 2017 Claims Data
  • CMS Actuary Office releases projections on U.S. healthcare spending
  • MACRA Tidbit for the Week: Do I even have to participate in the QPP in 2018?

From ACG Practice Management Committee Chair, Louis J. Wilson, MD, FACG

MIPS-eligible Clinicians Can Now View Performance Scores for 2017 Claims Data

According to a recent release from the Centers from Medicare and Medicaid Services (CMS), ACG members who submitted 2017 Quality performance data for MIPS via reimbursement claims forms are now able to view MIPS performance scores through the Quality Payment Program’s data submission website.

  • To sign in to QPP, you need to use your Enterprise Identity Management (EIDM) credentials, and you must have an appropriate user role associated with your organization.
  • You may have used these credentials in the past to login to the CMS Enterprise Portal and/or to submit data to the Physician Quality Reporting System (PQRS).

Please note that claims data submission is only an option if you’re participating in MIPS as an individual (not as part of a group).

More information on submitting Quality Performance data via claims
Claims-based quality measures are calculated automatically by CMS based on the Quality Data Codes (G-codes) submitted on your 2017 claims.  If you’ve already submitted MIPS quality data via your reimbursement claims, you don’t have to take any additional action.

ACG members using the claims data submission option should note that your scores are subject to change monthly due to CMS processing additional 2017 claims and adjustments until March 31st, 2018 (90 days past the end of 2017).  It is also possible that claims or adjustments that were submitted towards the end of 2017 have not yet been processed.  CMS encourages ACG members to check back after March 31st, 2018 to get an accurate result of their score.

Reminder: Still Time to Submit Claims for 2017
If you still have 2017 claims you’d like to submit for the MIPS’ Quality performance category, make sure to submit them now. Claims, which are processed by Medicare Administrative Contractors (MACs) (including claims adjustments, re-openings, or appeals), must arrive at the national Medicare claims system data warehouse (National Claims History file) by March 1, 2018 in order to be analyzed.  Your MACs can provide you with specific instructions on how to bill.

ACG is here to help.  Check out ACG’s infographic, the “GI Small Practices Crash Cart,” and follow the 4 easy steps to avoid a Medicare reimbursement cut.  This infographic guides you through the process, by first determining whether or not you even have to participate in MIPS in 2017 (being a small practice may come in handy!), to selecting measures, to showing you a measure that you may be able to report, and where to report the quality measure’s identifying code on a Medicare claims form.

It only requires a one-time effort to avoid a cut – don’t miss your chance!

View the infographic here.

From ACG Legislative and Public Policy Council Chair, Whitfield L. Knapple, MD, FACG

CMS Actuary Office releases projections on U.S. healthcare spending

On Wednesday, the CMS Actuary Office stated that U.S. health care spending is projected to grow from 4% in 2016 to 5% this year, and 5.7 % by 2021; on track to spend about one in every five dollars on health care by 2026, or $5.7 trillion (up from $3.3 trillion in 2016).

According to CMS, the aging baby boomers will cause Medicare spending to increase by almost 8% a year by the end of the decade, and a general increase in prices will spur spending.  Among the major payers of health care, “spending growth for Medicare and Medicaid is anticipated to continue to outpace that for private health insurance, mainly because of faster enrollment growth associated with the aging of the population.”

Here are some more highlights from the report, “National Health Expenditure Projections, 2017–26: Despite Uncertainty, Fundamentals Primarily Drive Spending Growth.”

Medicare: Medicare spending growth is projected to have accelerated to 5% in 2017 (from 3% in 2016), largely because of faster projected growth in spending per beneficiary. Recent slow growth in Medicare spending through 2016 was influenced by both low utilization (particularly of hospital services) and slow growth in payment rates (partly the result of modest inflation and ACA-related payment adjustments).  In 2017, however, growth in the use of services and increases in payment updates are projected to have begun to contribute to faster overall Medicare spending growth. Medicare enrollment growth is also expected to have contributed to the acceleration, with a projected rate of 3.2% in 2017 after a rate of 2.8% in 2016. Compared to 2018, Medicare spending is projected to grow 2 percentage points more rapidly on average during 2019–20, at 8%.  Of note for ACG, according to the report, “one factor contributing to this acceleration is incentive payments made to physicians under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.”

Commercial insurance & more: read the full blog here.

Do I even have to participate in the QPP in 2018?

Who has to participate in MACRA?
You do, if you are a:

  1. physician
  2. physician assistant
  3. nurse practitioner
  4. clinical nurse specialist; or
  5. a certified registered nurse anesthetist (CRNA)

Those Not Subject to the QPP in 2018
You may be exempt from the QPP if you are:

  • a newly Medicare-enrolled eligible clinician during the reporting period, i.e. those in the FIRST year of Medicare Part B participation in CY 2018
  • or practice below the 2018 “low volume threshold” of Medicare Part B allowed charges that are less than or equal to $90,000 or see less than or equal 200 Medicare Part B patients in a year.

Impact on Smaller and Rural GI Practices- 15 or fewer eligible clinicians in your practice

This is where being a solo practitioner or practicing in a small practice (15 or fewer QPP-eligible clinicians) may help you.  You may be excluded from the QPP and not have to do anything.  According to CMS, many small practices did not have to participate in MIPS during the 2017 transition year due to this low-volume threshold. For the CY 2017 performance period, the agency set this threshold at less than or equal to $30,000 in Medicare fee-for-service allowed charges, or less than or equal to 100 Medicare fee-for-service patients.  CMS increases this threshold (thus excluding more providers) in CY 2018The low-volume threshold in 2018 is less than or equal to $90,000 in Medicare fee-for-service allowed charges, or less than or equal to 200 Medicare fee-for-service patients.

Your first step: Check eligibility

Visit the Medicare Quality Payment Program website to check your “eligibility” by entering your national provider identifier (NPI) number.

Your next step (if you must participate): Pick your payment track

The next step requires you to decide what reimbursement system or “track” you want to participate in for your Medicare fee-for-services patients.  These 2 tracks include:

  1. A modified fee-for-service reimbursement system called the Merit-Based Incentive payment System (MIPS); or
  2. An alternative way to get paid, like participating in a bundled payment or accountable care organization (ACO) payment model.

Stay tuned for more next week.  Also please check out ACG’s “MAKING $ENSE OF MACRA”

ACG Hopes to Keep This Simple.   We compiled a detailed overview for you that seeks to make some sense out of this alphabet soup – but hopefully in a simplified fashion and in plain English.  Read the summary and potential impact to GI.  Dissecting MACRA:

Year 1

Year 2