CMS launched a new provider engagement initiative in an effort to help providers prepare for the Medicare Access and CHIP Reauthorization Act, according to RevCycle Intelligence.
Here are nine highlights:
1. The initiative aims to enhance the provider experience by gathering providers' feedback and working to limit administrative burden.
2. CMS Acting Administrator Andy Slavitt said the agency is looking to take a more comprehensive view on provider demands so they can successfully implement MACRA's Quality Payment Program that will benefit physicians.
3. Shantanu Agrawal, MD, CMS deputy administrator and director, is leading the provider engagement initiative. She will spearhead the initiative's effort to address provider documentation requirements as well as the provider experience.
4. CMS' 10 regional offices will take part in the initiative and will conduct meetings within the next six months. Through the meetings, the offices will collect provider feedback, and will hold regular meetings following these local meetings. Dr. Agrawal said, "CMS is turning a new page in assessing not only how to reward for quality, but also to reduce administrative hurdles. I look forward to hearing about what steps we can take to make the practice of medicine in Medicare more efficient and rewarding."
5. CMS is launching an 18-month pilot program in which providers in Advanced Alterative Payment Models will not be subjected to as many medical record views to justify their claims. Currently, CMS uses contractors to review Medicare claims and reimbursement for accuracy, analyzing many of these claims through an automated process. For more complex cases, contracts will request medical records to review the claims.
6. To make this process less of a burden, CMS will classify the following clinicians in APMs as low-priority for medical records reviews:
• Next Generation Accountable Care Organizations
• Medicare Shared Savings Program Track 2 and 3 participants
• Pioneer ACOs
• Oncology Care Model 2-Sided Track participants
7. For the pilot program's first phase, Medicare administrative contractors, recovery audit contractors and supplemental medical review contractors will classify Advanced APM providers as low priority for post-payment medical records if their payments and claims are associated with beneficiaries within the model. CMS expects to launch this first phase in January 2017.
8. CMS will launch the second phase in April 2017, under which Medicare administrative contractors will deem Advanced APM providers as low-priority for pre-payment medical record reviews.
9. CMS will not include durable medical equipment, home health agencies and other providers' claims in the pilot program. Additionally, CMS will hold participating providers responsible for other Medicare review programs. CMS scheduled the pilot program to end in June 2018, but CMS may expand or continue the program based on its progress.
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