2016 payment updates
The Academy works closely with the Centers for Medicare & Medicaid Services (CMS) to maintain our visibility and credibility with the Agency by submitting comments every year on proposed and final federal regulatory policies that impact otolaryngology-head and neck surgeons. The Academy’s role is to advocate on behalf of Members and provide resources to educate Members on current and future national payment policies.
Facts you need to know about healthcare system changes
The Academy works closely with the Centers for Medicare & Medicaid Services (CMS) to maintain our visibility and credibility with the Agency by submitting comments every year on proposed and final federal regulatory policies that impact otolaryngology-head and neck surgeons. The Academy’s role is to advocate on behalf of Members and provide resources to educate Members on current and future national payment policies. As part of this effort, we have worked to summarize the following regulations, drafted comments to CMS, and developed fact sheets on specific programs to assist Members as you navigate the changing healthcare system.
Merit-based Incentive Payment System and eligible Alternative Payment Models
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repealed the SGR and created two new payment update tracks effective January 1, 2019: the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). The MIPS program will take components of currently existing CMS quality programs to determine physician payment. Providers participating in qualified APMs will receive bonus payments in addition to regular updates. To learn more about MACRA and how the Academy is advocating for you as Medicare transitions to accommodate the regulatory changes created by the MACRA legislation, visit this page: www.entnet.org/content/regulatory-advocacy.
2016 Medicare Physician Fee Schedule (MPFS)
This program takes into account guidance from the AMA and specialty societies to schedule the broad payment rate across the entire Medicare payment system as well as payment rates for specific procedures. The current CMS quality program rewards and penalties are also established through this rule. The comments address several specific payment policy issues affecting otolaryngology including: practice expense changes; Global Surgical Package valuation; Physician Quality Reporting System and Qualified Clinical Data Registry requirements; Physician Compare; and Value Based Payment Modifier program. To read past comment letters visit this page: www.entnet.org/content/comment-letters. To learn more about how each fee schedule rule has impacted otolaryngologist-head and neck surgeons, please visit this page: www.entnet.org/SummariesofRegulations.
Electronic Health Records (EHR) and Meaningful Use (MU)
This rule establishes the rewards and penalties within the Medicare systems for EHR usage and reporting. In October 2015, CMS released the MU Modifications on Stage 2 and Stage 3 final rule. CMS finalized that Stage 3 Meaningful Use will be optional in 2017 and required for all participants beginning in 2018. It is very likely that the overall EHR MU requirements will be rolled into MIPS and APM requirements.
On December 7, 2015, the Academy submitted comments on the CMS final rule. Comments focused on the need for increased flexibility, interoperability, continuation of 90-day reporting periods, and measure thresholds and requirements. To see the Academy’s comments on EHR MU and read about the Academy’s efforts to modify or delay MU requirements, visit: www.entnet.org/content/electronic-health-records-ehr-and-meaningful-use.
2016 CMS Quality Reporting Initiatives Fact Sheets
This year, physicians will be subject to new requirements for many CMS quality reporting initiatives. To help Members understand the reporting requirements, the Academy’s Health Policy team has once again created one-page fact sheets for each of the CMS initiatives. The fact sheets provide Members with key information, such as reporting deadlines, reporting requirements, changes for 2016, and much more. Members are encouraged to use the factsheets as quick references. For detailed information on all of these programs, visit the Academy’s CMS Quality Initiatives webpage at www.entnet.org/content/cms-quality.
The Academy has updated the following fact sheets for the Physician Quality Reporting System (PQRS), Value Based Payment Modifier (VBM), Physician Compare, and Electronic Health Records (EHR) CMS Quality Reporting programs.
For more information on potential changes to the Electronic Health Records Meaningful Use program, please see “Meaningful Use changes in 2016?” for an update. Please look to the News and HP Update for more details on how these possible changes could affect you.