What’s the Problem?
Sequestration underpayments have been improperly withheld from provider payments by many Medicare Advantage Organizations [MAO] in violation of CMS guidelines that were issued on May 1, 2013.
Now that hospitals are required to post chargemaster data online for patients to access, the Centers for Medicare & Medicaid Services is exploring the most effective ways to make sure providers comply with the rules.
The CMS saw a sharp decrease in the number of providers opting out of Medicare in 2017, after several years where thousands indicated that they did not want to participate in the program.
2018 is the second year of transition in the Merit-Based Incentive Payment System (MIPS). If you are required to report data for 2018 and fail to do so, you’ll receive a 5% reduction in Medicare payments in 2020. In fact, unless you are participating in a Medicare Alternative Payment Model, the only way to receive any payment increase between 2019 and 2020 is to score more than 15 points in the MIPS Program. Unlike the first program year, you’ll need to get started early in the year to ensure success. Here are the key changes that will influence your score in 2018:
In the past several years, the Center for Medicare & Medicaid Innovation (CMMI), part of the Centers for Medicare & Medicaid Services (CMS), has designed and implemented demonstration projects and models to try new ways of paying providers to deliver health care to people with Medicare. These tests of new designs attempt to see if there are ways providers can be paid that will increase the quality of care people receive while either keeping costs stable or, ideally, lowering them.
Medicare overpaid physicians $6.7 billion in 2010 for evaluation and management services, HHS’ Office of Inspector General said in a study released Thursday. The overpayments, which allegedly stemmed from incorrect coding and poor documentation, accounted for more than one-fifth of the $32.3 billion the CMS paid for E/M services that year. E/M services are basic patient health assessments performed at a physician’s office or clinic.
Accountable care organizations under the Medicare Shared Savings Program show promise in both quality improvement and cost reduction, according to a new report.
If you have received a request from Medicare to revalidate your provider information, please complete all steps immediately to avoid interruption of your Medicare payments or cancellation of your contract. All changes can be updated through the Medicare PECOS website: