CMS-Update Email issued by CMS on May 1


nurse practitioner logoThe Nurse Practitioners Modernization Act will become law as part of the 2014-2015 enacted budget. The NPMA takes effect on January 1, 2015.

Independent-Physician-content Source:


Source: Rich Daly, HFM Senior Writer/Editor. To view the original article click here

Two-thirds of the office-based specialist care provided to accountable care organization (ACO) enrollees was done outside of the comprehensive care entity, a new study found.

CMS logoAre you an eligible professional or part of a group practice participating in PQRS this year? If so, you must satisfactorily report data on quality measures during 2014 to avoid the 2016 payment adjustment.

 CMS logoOn April 1, 2014, President Obama signed legislation that delays the scheduled Sustainable Growth Rate (SGR) cut to physician payments for one year (and delay ICD-10 implemetation!).

While fee-for-service is not going away anytime soon that we can see, many alternative payment models are in play impacting how physicians manage their patients, document the patient encounter and manage re-visits. Many factors are now being considered to determine the amount of reimbursement the provider receives as we see the shift to determine payment moving from volume to value.

The transition to ICD-10 is the biggest change to face our industry in decades. Essentially everything associated with coding a patient encounter and submitting that encounter for payment is going to have to change.  There is the potential for major disruption in operations, payment streams and productivity for those that don’t adequately prepare. So, how do you survive? For many practices, the best option will be to engage with a revenue cycle partner that has already made the investment in the tools, systems and training and can provide a turnkey solution for your practice.

The passage of the Affordable Care Act empowered CMS to encourage new payment models by changing reimbursement structures driving an evolution from pay for volume to pay for outcome.

If you thought it was difficult for your practice to field patient questions that start with “Do you accept?” in the past, health exchange plans have just made it more difficult to answer. Each plan participating in a state exchange has identified or created a network to service members and they vary widely. Look at the exchanges as another plan type as you would Medicare Advantage or a Managed Medicaid and improve the patient experience by having information available to answer their questions.