Medicare Compliance & Reimbursement

Applications and assessments may require mid-year maintenance.

The first of the year usually brings new proposals, plans, and programs. But CMS often updates and reviews its sites and initiatives with deadlines that fall on or around the half-year mark.

Register and pocket the following deadlines that may impact your Medicare pay.

Review Your Data

CMS publishes quality data on a quarterly basis, which allows beneficiaries an informed view into providers’ activities and results. If you find your quality data to be incorrect, the agency allows concerned providers and facilities to request a review of the online materials.

Take a look at these programs and their deadlines:

Hospice: As of June 1, “Hospice provider preview reports and Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS^®) Survey^® provider preview reports have been updated and are now available,” according to CMS. Providers will need to check in their Certification and Survey Provider Enhanced Reports (CASPER) non-validation reports folder for the two separate reports.

“Hospice providers are encouraged to review their Hospice Item Set (HIS) quality measure results from Quarter 4- 2016 to Quarter 3-2017 and their facility-level CAHPS^® survey results from Quarter 4, 2015 to Quarter 3, 2017,” stresses the agency.

Deadline: The HIS and CAHPS^® results preview period ends on June 30, 2018, so Hospice providers must act soon to request their CMS reviews. Review the Hospice Provider Preview guidance at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/Spotlight.html.

IRF: CMS updated the Inpatient Rehabilitation Facility (IRF) Provider Preview Reports on June 1, and providers may look over their performance data on quality measures concerning 2016 Quarter 4 through 2017 Quarter 3 data, “prior to the September 2018 IRF Compare refresh, during which this data will be publicly displayed,” notes the agency guidance.

Deadline: You have until July 1, 2018, to preview your data and request a CMS review. See the IRF Provider details and advice for access and review www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/IRF-Quality-Reporting/IRF-Quality-Public-Reporting.html.

LTCH: Long-term Care Hospital (LTCH) Provider Preview Reports were uploaded a few weeks ago with providers’ quality performance information “based on Quarter 4 -2016 to Quarter 3 - 2017 data,” CMS online materials indicate. Impacted providers are encouraged to sift through the data before its publicly released in the September 2018 LTCH Compare refresh.

Deadline: Be advised, you have until July 1, 2018, to look at your LTCH details and request a CMS review. LTCH preview information with links to the most recent refresh and instructions can be found at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/LTCH-Quality-Reporting/LTCH-Quality-Public-Reporting.html.

SNF: Recently released Skilled Nursing Facility (SNF) Provider Preview Reports cover quality performance data on a variety of issues from discharge rates, beneficiary spending, patients’ medical conditions and treatment over nursing home stays, and readmission rates dating as far back at Quarter 4 of 2015 and up to Quarter 4 of 2017, depending on the criteria being assessed, CMS guidance suggests. The reports have been updated and are now available.

Deadline: The window closes on July 1, 2018, to preview your SNF quality performance data on Nursing Home Compare before it goes public, CMS advises. “Providers can request a CMS review during the preview period if they believe their data scores displayed are inaccurate,” the agency says. You can read about the preview process at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Skilled-Nursing-Facility-Quality-Reporting-Program/ SNF-Quality-Reporting-Program-Spotlights-and-Announcements.html.

Know These Other End Dates

Your should be aware of a few other approaching application due dates for Medicare providers and hospitals.

Promoting Interoperability (PI): Two important deadlines hit in the coming weeks. They include:

1. Hardship exceptions. Eligible hospitals that were unable to meet the Meaningful Use requirement in 2017 for 2019 Medicare payment must file a hardship exception application no later than July 1, 2018. Access the application at www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/HardshipException2019_Hospital_Application.pdf.

2. Annual Call for Measures. CMS asks that stakeholders interested in submitting PI measures to increase interoperability and improve the delivery of care send their ideas by June 29, 2018. The public comments may be considered for the CY 2019 rulemaking, which will be eligible for implementation in CY 2021. You can find the PI measures’ application and submission information at www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/CallForMeasuresForm.pdf.

MIPS: If your Medicare Part B practice or virtual group submitted your 2017 Merit-Based Incentive Payment System (MIPS) measures through the CMS Web Interface, you are good to go for 2018. However, if you didn’t send information through the online portal last year but wish to now, you must apply by June 30, 2018.

“To register your group, you must have a valid Enterprise Identity Management (EIDM) account with a ‘Physician Quality and Value Programs’ role,” emphasizes the MIPS guidance. Ascertain your role and whether you have an EIDM account at www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Enterprise-Identity-Data-Management-EIDM-User-Guide.pdf.

After EIDM confirmation, “register for CMS Web Interface in the [Quality Payment Program] QPP data submission system by clicking Manage User Access in the left-hand navigation,” informs CMS. Get the details on registering before the end date at https://qpp.cms.gov/mips/how-to-register-for-CMS-WI-and-CAHPS.