Archive | July 2014

Sunshine Act Update: Open Payments Registration and Review/Dispute Process Began July 14

Registering in the Open Payments system is voluntary, however, it is a mandatory process if physicians want to review and dispute the data submitted by manufacturers and group purchasing organizations (the Industry) before the data is posted to the public on September 30, 2014. Any data disputes must be filed on or before August 27, 2014, in order to be reviewed and possibly corrected by the Industry which before going public, will be able to submit dispute corrections beginning August 28 through September 11. Please Note: Registration is a two-step process. Physicians must first register for the Enterprise Portal before registering for the Open Payments System. View MSNJ’s archived webinar regarding the complicated Enterprise Portal registration process. Read more on how to prepare for the review and dispute process. View AMA’s Sunshine Act resources.

CMS’ MLN Connects™ will host a National Provider Call on July 22 on this topic. Listen to a brief introductory presentation about Open Payments and an overview of the registration and review and dispute process. Register.

Register for MSNJ’s upcoming webinar that will provide an in depth look into: The Sunshine Act – Financial Interest Data Disclosure: Refuting Open Payments Data
Wednesday, July 30, 2014 from 12:00pm-1:00pm
Register online.

Key Provisions of Proposed Medicare Physician Fee Schedule for 2015

CMS published its proposed rule on Medicare’s payment schedule and policies on July 11. Comments on the proposal are due on September 2. Key changes in the proposal include:
• Doubling the value-based modifier (VBM) penalties to 4% and subjecting all physicians to 2017 VBM adjustments based on performance in 2015;
• Extending the VBM to ACOs and other alternate payment models;
• Eliminating global surgical services by 2018;
• Reducing the opportunity for comment, review time, and implementation for changes in local coverage determinations (LCDs) for clinical laboratory tests;
• Expanding reimbursement for telehealth services under certain circumstances to include psychotherapy services, prolonged services, and annual wellness visits in 2016;
• Reimbursing for chronic care management services on a per patient per month basis when certain conditions are met; among other things, beneficiaries must have two or more serious chronic conditions;
• Expanding public reporting of group-level measures in Physician Compare in 2016 and, if feasible, expanding measures for individuals making all 2015 PQRS individual measure collected via registries, EHR, or claims available on Physician compare in late 2016;
• Increasing the requirements for successful PQRS reporting and imposing a 2% penalty in 2017 for those eligible professionals who do not report satisfactorily in 2015. Read more details in AMA’s Summary of Key Provisions.

Note that CMS supports legislation to permanently address the SGR, but rates are only protected from payment cuts through March 2015 at which time payments will be reduced by over 20% if Congress does not act.