The Centers for Medicare and Medicaid Services (CMS) released a Final Rule freeing more than $10.4 billion to anxious payers to continue the Affordable Care Act’s (ACA) risk adjustment program. The agency had halted payments to payers while a New Mexico ruling was challenged, but in the end the activity unnerved the industry and didn’t change much. Risk Adjustment ...
In Audit
Jul 5th, 2018
Eligible clinicians can now see the results of their 2017 performance in the Merit-based Incentive Payment System (MIPS). Feedback includes performance category scores, final scores, and 2019 MIPS payment adjustments. The Centers for Medicare & Medicaid Services (CMS) is mandated under MACRA to adjust payments for professional services furnished to Medicare patients provided by MIPS ...
In CMS
Jun 11th, 2018
Participation by clinicians in the Merit-based Incentive Payment System (MIPS) exceeded targets, Seema Verma, administrator of the Centers for Medicare & Medicaid Services (CMS) recently crowed in a blog. Verma announced 91 percent of all eligible clinicians participated, topping the health agency’s 90 percent goal. Verma also revealed that 98 percent of Accountable Care Organizations (...
In CMS
Apr 20th, 2018
Quality reporting changes in 2018 for MIPS eligible clinicians who don’t see most of their patients face to face. Clinicians, clinician groups, and virtual groups eligible to participate in the Merit-based Incentive Payment System (MIPS) should know what percentage of their patient encounters are considered non-patient facing. Although self-identification is not required in 2018, the reporting ...
In Billing
Apr 3rd, 2018
Here’s a question to consider when coding and billing for services performed as part of an accountable care organization (ACO):  who pays providers’ standing claims if the ACO dies? If the State of Utah has its way, seven payers will have to pony up $26.6 million in unpaid claims for the Arches Health Plan, which folded ...