Medicare Compliance & Reimbursement
Small Physician Practices--Get Ready For P4P Programs
Encouraged by early results showing improvement in care quality from the Premier Hospital Quality Incentive Demonstration, the Centers for Medicare & Medicaid Services (CMS) is launching a new pay-for-performance demonstration for small-to-medium-sized physician practices serving Medicare patients.
The Medicare Care Management Performance (MCMP) Demonstration will launch in 2007 in four states: Arkansas, Utah, California and Massachusetts, CMS announced in an Oct. 17 release. These same four states are already participating in the Doctor's Office Quality--Information Technology project, which also targets small-to-medium-sized group practices.
CMS will recruit approximately 800 practices in the four states to participate in the MCMP demonstration, which will continue for three years, the agency says. "In order to be eligible to participate, physicians must be the main provider of primary care to at least 50 fee-for-service Medicare beneficiaries in a solo or small to medium-sized group practice," CMS explains.
"Under this demonstration, physician groups will continue to be paid on a fee-for-service basis," the agency notes. "Participating physicians will submit data annually on up to 26 quality measures related to the care of patients with diabetes, congestive heart failure and coronary artery disease, as well as the provision of preventive health services such as immunizations and cancer screenings to high risk patients with a range of chronic diseases," CMS adds.
Payoff: After the demonstration's first year, practices can earn up to $10,000 per physician each year and $50,000 per practice year, CMS notes.
"We know that most patients receive care in smaller medical practices," CMS administrator Mark McClellan comments in the announcement, "Which is why it's so important to have an approach that works for making the link between payment and quality of care in these settings."
For more information on this and other Medicare P4P demonstrations, visit www.cms.hhs.gov/DemoProjectsEvalRpts/MD/list.asp.
Medicare Compliance & Reimbursement
- P4P:
Small Physician Practices--Get Ready For P4P Programs
CMS targets 800 practices in 4 states for its new demo.
Encouraged by early results showing [...] - PHYSICIANS:
Your Payment System Doesn't Account For Drug Discounts You Never See, MedPAC Says
You could receive pay boosts of up to 3-percent per year.
If you took away all [...] - PART B:
Check Secondary Coverage Before Charging Patient For Preventive Services
Tip: Obtain a denial from Medicare so the claim can cross over.
Myth: You can't bill [...] - PART D:
CMS Wants Your Opinion On Sharing Part D Claims Data
Proposed reg would release Part D claims data to federal agencies and researchers.
A new proposed [...] - NPPs:
Don't Take Denials Lying Down--Contact CMS Now
Manual misprint leads to missed reimbursement for NPs.
If you're seeing denials for nurse practitioners (NPs) [...] - COMPLIANCE:
Watch Out--OIG Zeroes In On Incident-To Billing
Federal watchdog agency's work plan will keep it busy next year.
The HHS Office of Inspector [...] - GENERAL SURGERY CODING:
You Can Stop Using An Unlisted Code For Gastric Electro Stimulation
But rectal mucosectomy may have become harder to bill.
It looks as though surgeons can't bill [...] - INDUSTRY NOTES:
CMS Looks To Continue Decreases In Improper Medicare Payments With Tough Oversight
Plus: CPT 2007 has new codes for Moh's surgery.
Medicare's detailed reviews of fee-for-service (FFS) claims [...]
