Medicare Compliance & Reimbursement

The feds need QPs’ information ASAP.

Quality reporting is tricky, and the policies change from one year to the next. Ensure you’re getting the reimbursement you deserve by reviewing these recent updates.

1. QP payment problems: On Dec. 30, the Centers for Medicare & Medicaid Services (CMS) published an advisory in the Federal Register concerning qualifying APM participants’ (QPs) reimbursement issues for the 2017 performance year/2019 payment year under the Advanced Alternative Payment Model (APM) part of the Quality Payment Program (QPP).

The gist of the advisory is to “notify the QPs who are eligible for a 2019 APM incentive payment” that CMS lacks many eligible clinicians’ (ECs) current banking information to disburse the payments, notes the agency. The notice links to a list of QPs, who received the 5 percent incentive, that the agency is having trouble contacting due to missing data.

CMS asks affected providers to update their information or contact the QPP by Feb. 28 to ensure payment.

Review the specifics and see if you’re on the QP list at  www.govinfo.gov/content/pkg/FR-2019-12-30/pdf/2019-28010.pdf.

2. Resource library additions: Over the last month, CMS has added several new tools to its QPP resource library. Some of the highlights include guidance on wrapping up your 2019 measures submissions and reviews, 2020 eligibility and participation guidance, and categories and benchmarks deep dives.

Plus: CMS offers a handy new guide explaining the intersection of the Merit-Based Incentive Payment System (MIPS) and Part B claims. The resource targets small practices struggling with MIPS measures as the QPP heads into its fourth performance year.

Find helpful updates and tools at  https://qpp.cms.gov/about/resource-library. 

3. PY 2019 inconsistencies: After updating 2019 MIPS eligibility data last month, CMS uncovered inconsistencies. The problems stem from two different Part B claims reviews that determined 2019 MIPS eligibility, CMS suggests in a release.

Initially, the agency reviewed Part B claims and PECOS data from Oct. 1, 2017, to Sept. 30, 2018, and your 2019 MIPS eligibility was based on this information originally. However, a second review may have changed your status as it looked at Part B claims and PECOS details from Oct. 1, 2018, to Sept. 30, 2019, CMS stresses.

“If you checked your eligibility following the December 4th listserv announcing final MIPS eligibility, your status may have been affected by the data inconsistencies,” CMS advises. “We encourage you to use the QPP participation status tool to re-check and confirm your final 2019 MIPS eligibility.”

The 2019 MIPS data submission period is now open through March 31, 2020.

Check your 2019 MIPS participation status at  https://qpp.cms.gov/participation-lookup/.