Due to the Thanksgiving holiday, the next edition of the Washington Watch will be on December 3, 2020. Wishing you and your families a very safe and Happy Thanksgiving!
ASCRS and ASOA Joins the Alliance of Specialty Medicine in an All-Day Virtual Legislative Fly-in; Key Members of Congress Discuss Priority Issues, Including Medicare Physician Payment and the Pending Cuts
This year, fifteen ASCRS and ASOA members joined over 100 specialty physicians from around the country representing the 14 members of the Alliance of Specialty Medicine in a Virtual Legislative Fly-in, which was held on November 19. Key senators and representatives focused on the key healthcare priority issues for the Alliance, followed by a Q&A session. The members of Congress were provided and briefed on the key priority issues and possible solutions, including pending legislation prior to the Fly-in. The pending Medicare Physician Payment Cuts and possible legislation solutions was a key issue for ASCRS and ASOA. The issues we discussed were: Medicare physician fee schedule payment cuts; COVID-19 Relief; Patient Access/Utilization Management, including Prior Authorization, and Surprise Medical Bills.
We met with the following key members of Congress:
Senator Bill Cassidy, MD (R-LA)
Representative Michael Burgess, MD (R-TX)
Senator Rand Paul, MD (R-KY)
Representative John Joyce, MD (R-PA)
Representative Cathy McMorris Rodgers (R-WA)
Representative Roger Marshall, MD (R-KS)
Representative Brad Wenstrup, DPM (R-OH)
Representative Raja Krishnamoorthi (D-IL)
Senator Tom Carper (D-DE)
Representative Ami Bera, MD (D-CA)
Representative Kim Schrier, MD (D-WA)
The timing of this Fly-in is key – because members of Congress are now back for the “lame duck” session where they are beginning to work on an end of the year spending package, which could be the vehicle to stop the Medicare physician payment cuts scheduled to take effect on January 1, 2021.
Use the ASCRS Grassroots Action Center and Urge Your Representatives to Co-Sponsor H.R. 8702, the “Holding Providers Harmless from Medicare Cuts During COVID-19 Act of 2020,” Bipartisan Legislation to Prevent Medicare Physician Payment Cuts from Going into Effect on January 1, 2021
We need your help now in urging members of the House of Representatives to co-sponsor H.R. 8702, the “Holding Providers Harmless from Medicare Cuts During COVID-19 Act of 2020.” This bipartisan legislation introduced by Ami Bera, MD, and Larry Bucshon, MD, would prevent the pending Medicare physician payment cuts from going into effect for two years. Specifically, the legislation gives an additional “hold harmless relief” payment to those codes where the 2021 total payment is less than the 2020 total payment so that all codes facing a reduction are held harmless – and are paid at the 2020 payment levels.
Please go to the ASCRS Grassroots Action Center and send a letter to your representative asking them to co-sponsor H.R. 8702. We are working to get the same 229 representatives who signed onto the Bera/Bucshon letter urging Congress to address this issue to co-sponsor this legislation. To date, the bill has 43 co-sponsors. Background information, along with a copy of the legislation and a letter for you to send are all provided in the Grassroots Action Center. In addition, we have created a Myths and Facts document regarding the legislation, since primary care opponents are mischaracterizing the bill and its impact.
If you have any questions, please contact Nancey McCann, ASCRS Director of Government Relations at [email protected].
Proposed Palmetto LCD and LCA – Glaucoma Surgical Intervention Retired
As we previously reported, on November 2, the ASCRS Glaucoma Clinical Committee, on behalf of ASCRS, submitted a position statement to Palmetto GBA opposing their Proposed LCD Glaucoma Surgical Interventions (DL38759) and Article (DA583354). The American Academy of Ophthalmology and the American Glaucoma Society also opposed proposed changes to the DL38759 by Palmetto, and ASCRS supported their position statements as well. The ASCRS Glaucoma Clinical Committee expressed significant concern that the LCD DL38759 would limit glaucoma surgical care in a manner that would represent a significant threat to the vision of patients with glaucoma. In addition, the rationale provided for the coverage limitations is inconsistent with current care standards and the published literature.
As a result of our opposition, and that of the entire ophthalmic community, Palmetto has retired the proposed LCD and LCA for Glaucoma Surgical Intervention.
HHS Updates Provider Relief Fund FAQs.
Once again, the Department of Health and Human Services (HHS) has updated the Provider Relief Fund Frequently Asked Questions (FAQs). The new questions are:
Will the Provider Relief Fund limit qualifying expenses for capital equipment purchases to 1.5 years of depreciation, or can providers fully expense capital equipment purchases? (Added 11/18/2020)
Expenses for capital equipment and inventory may be fully expensed only in cases where the purchase was directly related to prevent, prepare for and respond to the coronavirus. Examples of these types of equipment and inventory expenses include:
- Ventilators, computerized tomography scanners, and other intensive care unit- (ICU) related equipment put into immediate use or held in inventory
- Masks, face shields, gloves, gowns
- Biohazard suits
- General personal protective equipment
- Disinfectant supplies
Can providers include the entire cost of capital facilities projects as eligible expenses, or will eligible expenses be limited to the depreciation expense for the period? (Added 11/18/2020)
Expenses for capital facilities may be fully expensed only in cases where the purchase was directly related to preventing, preparing for and responding to the coronavirus. Examples of these types of facilities projects include:
- Upgrading a heating, ventilation, and air conditioning (HVAC) system to support negative pressure units
- Retrofitting a COVID-19 unit
- Enhancing or reconfiguring ICU capabilities
- Leasing or purchasing a temporary structure to screen and/or treat patients
- Leasing a permanent facility to increase hospital or nursing home capacity
Providers may have significant fluctuations in year-over-year net patient revenues due to settlements or payments made to third parties relating to care delivered outside the reporting period (2019-2020). Should Provider Relief Fund recipients exclude from the reporting of net patient revenue payments received for care not provided in 2019 or 2020? (Added 11/18/2020)
Provider Relief Fund recipients shall exclude from the reporting of net patient revenue payments received or payments made to third parties relating to care not provided in 2019 or 2020.
Reminder - 2020 Extreme and Uncontrollable Circumstances Exception and Promoting Interoperability Hardship Exception Applications are Due December 31
Extreme and Uncontrollable Circumstances Application & COVID-19
For the 2020 performance year, CMS will be using their Extreme and Uncontrollable Circumstances policy to allow MIPS eligible clinicians, groups, and virtual groups to submit an application requesting reweighting of one or more MIPS performance categories to 0% due to the current COVID-19 public health emergency.
If you have any concerns about the effect of the COVID-19 pandemic on your performance data, including cost measures, for the 2020 performance period, submit an application now and be sure to cite COVID-19 as the reason for your application.
If you have an approved application, you can still receive scores for the Quality, Improvement Activities and Promoting Interoperability performance categories if you submit data. If the cost performance category is included in your approved application, you will not be scored on cost measures even if other data are submitted.
Learn more in the 2020 Exceptions Applications Fact Sheet.
Note: CMS has proposed to allow APM Entities to submit an application to reweight MIPS performance categories as a result of extreme and uncontrollable circumstances, such as the public health emergency resulting from the COVID-19 pandemic. Learn more in the 2021 Quality Payment Program Proposed Rule Overview Fact Sheet.
MIPS Promoting Interoperability Hardship Exceptions
MIPS eligible clinicians, groups, and virtual groups may qualify for a re-weighting of the Promoting Interoperability performance category to 0% if they:
- Are a small practice;
- Have decertified EHR technology;
- Have insufficient Internet connectivity;
- Face extreme and uncontrollable circumstances such as disaster, practice closure, severe financial distress, or vendor issues; or
- Lack control over the availability of CEHRT.
Note: If you’re already exempt from reporting Promoting Interoperability data, you don’t need to apply.
How do I Apply?
New for 2020: You must have a HCQIS Access Roles and Profile (HARP) account to complete and submit an exception application on behalf of yourself, or another MIPS eligible clinician, group, virtual group, or APM Entity. For more information on HARP accounts, please refer to the Register for a HARP Account document in the QPP Access User Guide.
Once you register for a HARP account, sign in to qpp.cms.gov, select ‘Exceptions Applications’ on the left-hand navigation, select ‘Add New Exception,’ and select ‘Extreme and Uncontrollable Circumstances Exception’ or ‘Promoting Interoperability Hardship Exception.’
How do I Know if I’m Approved?
If you submit an application for either of the exceptions, you will be notified by email if your request was approved or denied. If approved, this will also be added to your eligibility profile on the QPP Participation Status Tool, but may not appear in the tool until the submission window is open in 2021.
For More Information
- Visit the Promoting Interoperability Hardship Exception and Extreme and Uncontrollable Circumstances Exception QPP webpages for more information and links to each application.
- Check out the Exceptions Application Fact Sheet to learn more about these exceptions.
Questions?
Contact the Quality Payment Program at 1-866-288-8292 or by e-mail at: [email protected]. To receive assistance more quickly, please consider calling during non-peak hours—before 10:00 a.m. and after 2:00 p.m. ET.
- Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant
Reminder: CMS Proposes to Allow APM Entities to Submit Applications for the Extreme and Uncontrollable Circumstances Exception; Applications are Due December 31
In the 2021 Medicare Physician Fee Schedule (PFS) Notice of Proposed Rulemaking (NPRM), the Centers for Medicare & Medicaid Services (CMS) proposed to allow APM Entities to submit an application to reweight Merit-based Incentive Payment System (MIPS) performance categories as a result of extreme and uncontrollable circumstances. CMS intends to allow APM Entities to submit applications now, but CMS will not be able to make final determinations on applications until and unless the policy proposal is finalized.
If the policy is finalized and an APM Entity’s application is approved, that APM Entity would receive a final score equal to the performance threshold for the 2020 MIPS performance year, and the MIPS eligible clinicians in the APM Entity group would receive a neutral payment adjustment in 2022.
Who is Eligible to Submit an Application?
If the policy is finalized, then APM Entities affected by extreme and uncontrollable circumstances in the following models would be able to submit an application:
- Medicare Shared Saving Program
- Next Generation ACO Model
- Vermont Medicare ACO Model
- Comprehensive Primary Care Plus (CPC+)
- Comprehensive ESRD Care (CEC)
- Bundled Payments for Care Improvement (BPCI)
- Oncology Care Model (OCM)
- Maryland Primary Care Program
- Independence at Home Demonstration
What are the Application Requirements?
Unlike those who choose to apply as individual clinicians, groups, or virtual groups, APM Entities must apply to reweight all MIPS performance categories to 0%. Additionally, 75% of the MIPS eligible clinicians in the APM Entity must qualify for reweighting in the MIPS Promoting Interoperability performance category. They may qualify automatically or through a MIPS Promoting Interoperability Hardship Exception Application.
CMS does not require APM Entities to submit documentation with their applications. However, APM Entities should retain documentation of the circumstances supporting their application for their own records in the event they are selected by CMS for data validation or an audit.
When are Applications Due?
Applications are due to CMS by Thursday, December 31, 2020 at 8:00 p.m. ET.
How do I Apply?
New for 2020: You must have a HCQIS Access Roles and Profile (HARP) account to complete and submit an exception application. For more information on HARP accounts, please refer to the Register for a HARP Account document in the QPP Access User Guide.
Once you register for a HARP account, sign in to qpp.cms.gov, select ‘Exceptions Applications’ on the left-hand navigation, select ‘Add New Exception,’ and select ‘Extreme and Uncontrollable Circumstances Exception.’
How do I Know if I’m Approved?
If you submit an application and this policy is finalized to allow APM Entities to apply, then you will be notified by email if your request was approved or denied. If approved, this will also be added to your eligibility profile on the QPP Participation Status Tool, but it may not appear in the tool until the submission window is open in 2021.
Will Submitting Data Void the Exception?
Data submitted for an APM Entity will not override performance category reweighting from an approved application. This differs from the policy for individual, group, and virtual group applications.
Will an Approved Application Affect Model-Specific Reporting Requirements?
If the policy is finalized and an APM Entity’s application is approved, the approval would only affect MIPS reporting, and that APM Entity would still be required to meet its model-specific reporting requirements.
For More Information
- Visit the Extreme and Uncontrollable Circumstances Exception QPP webpage for more information and links to each application.
- Check out the Exceptions Application Fact Sheet to learn more about this exception.
Questions?
Contact the Quality Payment Program at 1-866-288-8292 or by e-mail at: [email protected]. To receive assistance more quickly, please consider calling during non-peak hours—before 10:00 a.m. and after 2:00 p.m. ET.
- Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.
Plan to Attend the ASOA 2021 Medicare Physician Fee Schedule and Coding Update Webinar, Wednesday, December 9, 2020, 2:00 – 3:00 PM
Nancey McCann, ASCRS Director of Government Relations, and Kirk Mack, Senior Consultant with BSM Consulting, will provide an overview of the key provisions in the 2021 Medicare Physician Fee Schedule that are contributing to the significant reduction in reimbursement for ophthalmologists and other specialists. The overview will discuss what ASCRS and the physician community are doing to prevent the cuts scheduled to take effect on January 1, 2021, and key coding changes to E/M office visits, ICD-10, and other important updates.
Speakers:
- Nancey McCann, ASCRS Director of Government Relations
- Kirk Mack, COE, COMT, CPC, Senior Consultant, BSM Consulting
ASOA members receive discounted registration for the webinar, "2021 Medicare Fee Schedule and Coding Update" on Wednesday, December 9, 2020. Please make sure you are logged in using your ASOA.org credentials before registering for this event so that your discount can correctly be applied.
Can't make this webinar on the scheduled date and time? Register and we will send you a link to the recording and slides after the session concludes.
Attendance at this webinar provides 1 Category A COE credit
Extended Deadline to Update Your Billing Info by December 13 for Your APM Incentive Payment
Extended Deadline: Certain Clinicians Need to Update Their Billing Information by December 13 to Receive Their APM Incentive Payment
The Centers for Medicare & Medicaid Services (CMS) Quality Payment Program website includes 2020 Alternative Payment Model (APM) Incentive Payment details. To access information on the incentive amount and organization paid, clinicians and surrogates can log in to the QPP website using their HARP credentials. In order to receive payments, certain clinicians will need to verify their Medicare billing information by December 13, 2020.
Many eligible clinicians who were Qualifying APM Participants (QPs) based on their 2018 performance began receiving their 2020 5% APM Incentive Payments last month. If you have already received your payment, you do not need to do anything.
CMS also posted a new 2020 APM Incentive Payment Fact Sheet to explain:
- Who is eligible to receive an APM incentive payment in 2020
- How CMS determines your 2020 APM Incentive Payment
- Frequently asked questions and answers
Who Needs to Verify Their Medicare Billing Information?
If you have not received a payment and find your name on this public notice, you will need to verify your Medicare billing information.
NOTE: If you do not verify your Medicare billing information by December 13, 2020, CMS will not be able to issue your APM Incentive Payment.
For more information, review the QP Public Notice File for Payment Year 2020 Excel Spreadsheet and supporting forms in the 2020 QP Notice for APM Incentive Payment zip file. The spreadsheet will indicate which form you need to submit—the IP Form and/or 588 Form—in order to verify your Medicare billing information.
Questions?
Contact the Quality Payment Program at [email protected] or 1-866-288-8292. To receive assistance more quickly, consider calling during non-peak hours—before 10 a.m. and after 2 p.m. ET.
Alliance of Specialty Medicine Participates in Listening Session on the CMS Quality Action Plan
On Monday, November 16, the Alliance of Specialty Medicine participated in a listening session to provide feedback on the CMS Quality Action Plan, which is an ongoing, multi-year strategy that aims to advance the CMS vision for the future of quality.
The session included updates from Lee Fleisher, MD, Chief Medical Officer and Director of the Center for Clinical Standards and Quality (CCSQ) at CMS and Michelle Schreiber, MD, Deputy Director for Quality and Value of CCSQ at CMS, who provided an overview of CMS’s key goals for improving quality measurement and value-based programs, which are to:
- Prioritize and Align Quality Measurement to Ensure Impact Yet Parsimony
- Modernize Value-based Programs and Ensure Quality is Integral to the Value Equation, Supporting a Transition to Full Value-Based Payment
- Harness the Power of Data by Ensuring Seamless Communication through Interoperability, Digital Measures, and Fostering Innovation in Predictive Quality Data Analytics
- Design Customer-Centered Systems with Broad Stakeholder Engagement and Transparency
Throughout and following this overview, there was an open discussion between participants and CMS.
