Medical Billing and Coding Healthcare Blog

The Centers for Medicare & Medicaid Services has announced it will allow providers to "pick your pace" of participation in the Quality Payment Program included in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

Understanding Your Options

The options identified by CMS are as follows:

1. Test the Quality Payment Program. With this option, as long as you submit some data to the Quality Payment Program, including data from after January 1, 2017, you will avoid a negative payment adjustment. This first option is designed to ensure that your system is working and that you are prepared for broader participation in 2018 and 2019 as you learn more.

2. Participate for part of the calendar year. You may choose to submit Quality Payment Program information for a reduced number of days. This means your first performance period could begin later than January 1, 2017 and your practice could still qualify for a small positive payment adjustment. For example, if you submit information for part of the calendar year for quality measures, how your practice uses technology, and what improvement activities your practice is undertaking, you could qualify for a small positive payment adjustment. You could select from the list of quality measures and improvement activities available under the Quality Payment Program.

3. Participate for the full calendar year. For practices that are ready to go on January 1, 2017, you may choose to submit Quality Payment Program information for a full calendar year. This means your first performance period would begin on January 1, 2017. For example, if you submit information for the entire year on quality measures, how your practice uses technology, and what improvement activities your practice is undertaking, you could qualify for a modest positive payment adjustment. We’ve seen physician practices of all sizes successfully submit a full year’s quality data, and expect many will be ready to do so.

4. Participate in an advanced alternative payment model in 2017. Instead of reporting quality data and other information, the law allows you to participate in the Quality Payment Program by joining an advanced alternative payment model, such as Medicare Shared Savings Track 2 or 3 in 2017. If you receive enough of your Medicare billing payments or see enough of your Medicare patients through the advanced alternative payment model in 2017, then you would qualify for a 5 percent incentive payment in 2019.

Analysis

As long as providers choose one of the participation options, they would not receive a negative payment adjustment in 2019.

The decision by CMS to offer these options came after thousands of physicians and other clinicians shared their feedback on an April proposal for implementation of the Program, with many requesting flexibility.

The Centers for Medicare & Medicaid Services (CMS) has published a video on provider compliance relating to psychotherapy and psychiatry medical billing.

The video includes pointers to properly submit documentation for these services, more specifically the use of add-on codes when billing for same day evaluation and management and psychotherapy services, and three factors needed for sufficient documentation.

The video is part of an going series intended to help providers improve in areas identified with a high degree of noncompliance.

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