The Centers for Medicare & Medicaid Services (CMS) recognizes the impact of the COVID-19 pandemic public health emergency (PHE) on clinicians across the country and continues to offer flexibilities to provide relief where possible. Under § 414.1350(d)(3), the Merit-based Incentive Payment System (MIPS) cost performance category weight is 15% of the final score for the 2020 … [Read more...] about CMS reweighting 2020 MIPS cost performance category
Health care reform
2018 performance info now available on Medicare Care Compare and in Provider Data Catalog
The Centers for Medicare & Medicaid Services (CMS) has added new performance information to the Doctors & Clinicians section of Medicare Care Compare and in the Provider Data Catalog (PDC), the successor websites to Physician Compare and the Physician Compare Downloadable Database. Medicare patients and caregivers can use the Care Compare website to search for and … [Read more...] about 2018 performance info now available on Medicare Care Compare and in Provider Data Catalog
Resource ready for next year’s QRDA Implementation
The Centers for Medicare & Medicaid Services (CMS) has published the Quality Reporting Document Architecture (QRDA) Category III Implementation Guide (IG), Schematron, and Sample Files for Eligible Clinicians and Eligible Professionals Programs. The 2021 CMS QRDA III IG outlines requirements for eligible clinicians and eligible professionals to report electronic clinical … [Read more...] about Resource ready for next year’s QRDA Implementation
Prevent losing your patients by focusing on these 4 areas
By Nick Hernandez bio The changes to the healthcare industry are increasingly focused on addressing patients as consumers. Such a change means that providers must, of course, emphasize quality and work toward price transparency, but they must also seek to determine what patients desire most. It is this last effort that is transforming the healthcare sector more like businesses … [Read more...] about Prevent losing your patients by focusing on these 4 areas
Feds Take Down $2.1 Billion Medicare Genetic Test Fraud Scheme
You know that a branch of lab testing has gone from fad to mainstream when it becomes the subject of a major federal enforcement takedown. Accordingly, the newly announced breakup of a $2.1 billion genetic billing fraud scam, one of the largest Medicare frauds ever undertaken, signifies that genetic testing has officially arrived. Operation Double Helix Known as Operation … [Read more...] about Feds Take Down $2.1 Billion Medicare Genetic Test Fraud Scheme
HIPAA enforcement takes a dramatic new direction
Historically, HIPAA enforcement has focused predominantly on the failure of covered entities to keep protected health information (PHI) private and secure; but now the scope is broadening to encompass keeping PHI too private and too secure. The HHS Office for Civil Rights (OCR), the agency that enforces HIPAA rules, has broken new ground by fining a Florida hospital for failing … [Read more...] about HIPAA enforcement takes a dramatic new direction
Compliance officers must establish credibility with consistent, well-documented decision-making
One of the tougher issues a non-lawyer compliance officer faces is a challenge to their decisions and recommendations by other members of the management team. This happens more often when the person is new to the company or the position. In a large proportion of these challenges, the challenger cites a lawyer's comments or an interpretation they saw in a newsletter or on the … [Read more...] about Compliance officers must establish credibility with consistent, well-documented decision-making
What every medical office manager needs to know about the Sunshine Law
Another product of the Affordable Care Act, the Sunshine Law (also called Open Payments) begins implementation this year. The law requires manufacturers and group purchasing organizations publicly report certain transfers to or transactions with physicians. The goal is transparency and avoiding improper influence of physician's prescribing practices. Physicians should make sure … [Read more...] about What every medical office manager needs to know about the Sunshine Law
What makes a successful practice manager
By Shane Carter bio Being a practice manager in today's health care environment is a very tough job. Disruptive and transformational change is underway in health care delivery. The modernization of health care has created a complex, changing environment that requires a successful practice to employ technology, advanced systems, and an educated and dedicated staff. Because … [Read more...] about What makes a successful practice manager
New Quality Payment Program resources are now available
The Centers for Medicare & Medicaid Services (CMS) has recently posted the following new and updated resources on the Quality Payment Program website: 2018 Self-Nomination Toolkit for QCDRs & Registries:Offers step-by-step instructions for potential Qualified Registry and Qualified Clinical Data Registry (QCDR) vendors to self-nominate to qualify for the 2018 … [Read more...] about New Quality Payment Program resources are now available