Physician Center

Spotlights

• CMS-1693-F: CY 2019 Physician Fee Schedule Final Rule - Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2019. For more information, see the Press Release or Fact Sheet.

• CMS-1693-P: CY 2019 Physician Fee Schedule Proposed Rule - Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2019. For more information, see the Press Release or Fact Sheet.

• CMS-1676-F: CY 2018 Physician Fee Schedule Final Rule - Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2018. For more information, see the Press Release or Fact Sheet.

• CMS-1676-P: CY 2018 Physician Fee Schedule Proposed Rule - Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2018. For more information, see the Press Release or Fact Sheet.

• Clinical Laboratory Data  Reporting: Enforcement Discretion

  On March 30, CMS announced that it will exercise enforcement discretion until May 30, 2017, with respect to the data reporting period for reporting applicable information under the Clinical Laboratory fee Schedule (CLFS) and the application of the Secretary’s potential assessment of civil monetary penalties for failure to report applicable information. 

  View the announcement and PAMA regulations page.

• CMS is Accepting Suggestions for PQRS Measures

  CMS is accepting quality measure suggestions for potential inclusion in the proposed set of quality measures in the Physician Quality Reporting System (PQRS) for future rule-making years. Quality measures submitted in this Call for Measures also will be considered for use in other quality programs for physicians and other eligible professionals (e.g. Value Based Modifier, Physician Compare, Medicare Shared Savings Program, etc.).

  Beginning this year, the Call for Measures will be conducted in an ongoing open format. Unlike previous years, where the annual Call for Measures closed after a specified period of time, starting in 2014, the Call for Measures will remain open indefinitely. The month that a measure is submitted for consideration will determine when it can be included on the Measures Under Consideration (MUC) list. Measures submitted from May 1, 2014 to June 30, 2014 may be considered for inclusion on the 2014 MUC list for implementation in PQRS as early as 2016.

  Each measure submitted for consideration must include all required supporting documentation. Documentation requirements and the submission timeline are posted on the Measures Management System Call for Measures web page.

  When submitting measures for consideration, please ensure that your submission is not duplicative of another existing or proposed measure. Additionally, CMS is not accepting claims-based only reporting measures in this process. CMS will give priority to measures that are outcome-based, answer a measure gap and address the most up-to-date clinical guidelines. Measures submitted for consideration will be assessed to ensure that they meet the needs of the PQRS. As time permits, feedback will be provided to measure submitters upon review of their submission.

  Note: Suggesting individual measures or measures for a new or existing measures group does not guarantee the measure(s) will be included in the proposed or final sets of measures of any Proposed or Final Rules that address the PQRS. Additionally, measures submitted for consideration are not guaranteed to be put forth on the MUC list for MAP review. CMS will determine which individual measures and measures group(s) to include in the proposed set of quality measures, and after a period of public comment, the agency will make the final determination with regard to the final set of quality measures for the PQRS.

• Additional Clarification of Guidance on the Physician Order and Physician Certification for Hospital Inpatient Admissions
  On August 19, 2013, in the FY2014 IPPS/LTCH final rule CMS clarified and revised the conditions of payment for hospital inpatient services under Medicare Part A related to patient status. On September 5, 2013, CMS released guidance that discussed the provisions of the final rule regarding the physician order and physician certification of hospital inpatient services. This document includes further clarification of issues addressed in the previous guidance.
• Prior Guidance on the Physician Order and Physician Certification for Hospital Inpatient Admissions
  The guidance provided in this document has been further clarified in Additional Clarification of Guidance on the Physician Order and Physician Certification for Hospital Inpatient Admissions. This version of the guidance document will remain online for comparison purposes.
• Physician Groups of 100 or More: The Registration Period to Avoid a -1% Payment Adjustment Extended to Friday, October 18 - The Physician Value-Physician Quality Reporting System (PV-PQRS) Registration System is open through October 18, 2013. Representatives of group practices can select their group’s PQRS reporting mechanism for CY 2013, and groups with 100 or more eligible professionals (EPs), can elect quality tiering to calculate the Value Modifier for CY 2015.

• The PV-PQRS Registration System can be accessed at https://portal.cms.gov using a valid IACS User ID and password. For additional information regarding registration and obtaining or modifying an IACS account, please see the Quick Reference Guide on the Self Nomination/Registration web page.

• Frequently Asked Questions Regarding Change Request 7631 (Transmittal 2679)--Revised and Clarified Place of Service (POS) Coding Instructions.

• Revised Fact Sheet for Referral Agents - Where are the Round 2 areas? What if a beneficiary travels? What do you need to know before prescribing a DMEPOS item or referring the beneficiary to a DMEPOS supplier? Want more information on the national mail-order program for diabetic testing supplies?

  For answers to these questions and more, see the revised “Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program: Referral Agents” Fact Sheet (ICN 900927), which is now available in downloadable format.

• Blood Clotting Factor Furnishing Fee
• Medicare FFS Physician Feedback Program/Value-Based Payment Modifier

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