CMS is reviewing claims and letting practices know which clinicians need to take part in the Merit-based Incentive Payment System https://qpp.cms.gov/learn/qpp (MIPS), an important part of the new Quality Payment Program (QPP). In late April through May, you will get a letter from your Medicare Administrative Contractor https://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/MedicareAdministrativeContractors.html that processes Medicare Part B claims, providing the participation status of each MIPS clinician associated with your Taxpayer Identification Number (TIN).
* Bill more than $30,000 in Medicare Part B allowed charges a year and
* Provide care for more than 100 Part B-enrolled Medicare beneficiaries a year
QPP intends to shift reimbursement from the volume of services provided toward a payment system that rewards clinicians for their overall work in delivering the best care for patients. It replaces the Sustainable Growth Rate formula and streamlines the "Legacy Programs" - Physician Quality Reporting System, the Value-based Payment Modifier, and the Medicare Electronic Health Records Incentive Program. During this first year of the program, CMS is committed to working with you to streamline the process as much as possible. Our goal is to further reduce burdensome requirements so that you can deliver the best possible care to patients. Learn more about the Quality Payment Program https://qpp.cms.gov/
Percentage Arrangements With Billing Companies
By Ellen F. Kessler
The New York State Medicaid Fraud Control Unit (“MFCU”) has recently embarked on a campaign to recover thousands of dollars of Medicaid payments plus interest from various health care providers who pay billing companies a percentage of collections for their billing services.
MFCU has been sending letters to Medicaid providers in New York State demanding the return of payments where Medicaid discovered that the providers used billing companies who were paid on a “percentage of collections” basis. This demand by Medicaid is not based on a claim of overpayment or improper billing methodology by the provider. Rather, Medicaid relies on an arcane provision found in the Medicaid rules1 which states that:
“A provider of medical care services or supplies may employ a business agent, such as a billing service or an accounting firm. Such agent may prepare and send bills and receive MA payments in the name of the provider only if the compensation paid to the agent is:
1. Reasonably related to the cost of the services;
2. Unrelated, directly or indirectly to the dollar amounts billed and collected; and
3. Not dependent on actual collection of payments.”
2017 Medicare Electronic Health Record (EHR) Incentive Program Payment Adjustment Fact Sheet for Eligible Professionals
Overview of the Program
As part of the American Recovery and Reinvestment Act of 2009 (ARRA), Congress established payment adjustments under Medicare for eligible professionals that are not meaningful users of Certified Electronic Health Record (EHR) Technology. Eligible professional (EP) that do not successfully demonstrate meaningful use for an EHR reporting period associated with a payment adjustment year will receive reduced Medicare payments for that year. The Medicare payment adjustments began on January 1, 2015 for EP and sunset in 2018 per the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
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