HHSIn a meeting with nearly two dozen leaders representing consumers, insurers, providers, and business leaders, Health and Human Services Secretary Sylvia M. Burwell today announced measurable goals and a timeline to move the Medicare program, and the healthcare system at large, toward paying providers based on the quality, rather than the quantity of care they give patients.

negotiatingNothing is more important in any negotiation than preparation, preparation, preparation. It is no coincidence that the party that is better prepared for a negotiation is much more likely to walk out with the best outcome. Preparation includes understanding the standing, the perspective and the goals of the payor as well as that of your physician practice.

congressThe Medicare Sustainable Growth (SGR) formula was enacted by Congress as part of the Balanced Budget Act of 1997. The intent of the formula was to control the growth of Medicare spending for physician services by tying Medicare payment for services to physicians to the overall status of the economy. Basically, if the U.S.

microscopeOnce you have obtained a copy of the signed and executed contract from the payor, review the document carefully to ensure that it is signed and executed by both parties. As you review the contract you may wish to summarize key information on a cover sheet that includes all major terms.

contractThe first step to assessing your payor contracts is to obtain a copy of the signed and executed contract from each contracted payor. If you do not have a copy on file, you can request a copy from the payor.

docatdeskMost physician practices know the plans in which they participate.  They know they have a contract in place that covers payment terms and rates.  They just don't know where that contract is or what it includes.  They vaguely remember signing something a long time ago and have left it at that.

In an bulletin issued January 16, 2014, CMS announced the submission timeframes for 2014 PQRS data.

PQRS provides an incentive payment to individual eligible professionals (EPs) and group practices that satisfactorily participate or satisfactorily report data on quality measures for covered Medicare Physician Fee Schedule (PFS) services. Additionally, those who do not meet the 2014 PQRS reporting requirements will be subject to a negative payment adjustment on all Medicare Part B PFS services rendered in 2016.

CMSIn a last minute move, CMS released newly-updated national Medicare RVU files for 2015 on December 30, 2014.

CMSEligible professionals (EPs) and Group practices (GPs) who believe they have been inappropriately penalized for the PQRS reporting period of January 1, 2013 – December 31, 2013 may appeal their results via an informal review process to CMS during the time period of January 1, 2015 through February 28, 2015.

Starting in January 2015, Medicare payments will be determined by the 2015 Medicare Physician Fee Schedule. The rule brings a number of changes that are critical for doctors and practice managers to understand.

Join us as we review the key highlights of the CMS ruling, including: