Attached is a guide on how to submit for mid-levels via the Provider Maintenance Form for BCBSGA. If submission is done as an “Organization” a roster can be uploaded so it won’t be as tedious as completing a form per mid-level. You will also find attached a list of BCBS reps for the different regions around the state that you will be able to follow up with for confirmation that these updates have been made. We recommend you request the effective date of 9/1, even though there is no guarantee that you will receive that date.
News You Can Use
SHP Lunch ‘n’ Learn – Tomorrow, Sept 16th @ 12pm
As a reminder, the SHP Fall Lunch ‘n’ Learn series are continuing on with sessions scheduled over the next two weeks.
Please join us at 12:00 p.m. tomorrow, September 16, 2021, for an update on Georgia’s Managed Care market and developments; from what’s coming in 2021 from Medicare Advantage expansions to new Healthcare Exchange offerings to the conclusion of the PSHP/WellCare merger. As the market continues to shift and narrow based on payer mergers; we’ll also talk longer-term strategy considerations to encourage competition in the market.
For the best experience, please join us using the link below:
https://www.gotomeet.me/Strategic-Healthcare/shp-fall-series-ga-managed-care-update
And next week, September 22, 2020, we are thrilled to be joined by Department of Community Health Commissioner Frank Berry and Deputy Commissioner Blake Fulenwider. To join us for the physician session that will begin at 12:45 p.m. and will run approximately 45 minutes.
2021 is shaping up to be a big year for DCH, and we encourage you to join and hear from Commissioner Berry and Deputy Commissioner Fulenwider updates including the following topics:
- PSHP will officially take over WellCare’s Medicaid population in May 2021.
- DCH will re-procure the carriers for State Health Benefit Plan…..it is crucial in light of BCBSGA’s recent actions regarding physician contracts that DCH hears from physicians around the State how critical it will be to have additional options outside of BCBSGA & UHC.
- DCH will continue to pursue their Medicaid/Exchange plan waivers to expand Medicaid coverage in the State.
For the best experience, please join via the link below:
https://www.gotomeet.me/Strategic-Healthcare/shp-fall-series-ga-dch-practices
We look forward to talking with you then!
Hospital Pricing Transparency Webinar
Strategic Healthcare Partners in conjunction with Michele Madison at Morris, Manning & Martin present a review of the recent final rule issued by CMS requiring hospitals to release and publish pricing information BEFORE providing services. We have heard many questions from providers looking for clarity and guidance. We look to provide such education during an interactive lunch and learn session on September 30th at 12pEST.
Please join us by using this link:
https://www.gotomeet.me/Strategic-Healthcare/shp-fall-series-hospital-pricing-transparency
SHP Fall Webinar Series
SHP, in collaboration with various partners and legislative representatives, presents our Fall webinar series, which focuses on a variety of current and bottom line-impactful topics.
These webinars serve as a tool to educate and provide actionable takeaways for healthcare providers on real time COVID updates, QPP 2021 Rules, and Revenue Cycle best practices such as Managed Care and Provider Enrollment. We are also pleased to have the Commissioners for both the Department of Insurance (DOI) and Department of Community Health (DCH). So, please order in lunch as we interactively discuss such topics amongst your peers.
Visit our webinar schedule for more information.
Quality Measures & Telehealth
Just before the 4th of July holiday weekend, CMS released new guidance for which eCQMs can be used during a telehealth visit for Reporting Year 2020. This unexpected update was the result of questions regarding if home-captured data was “good enough” for Quality Measures. Fortunately, out of the 47 eCQMs that exist, a total of 42 are telehealth allowable. As with everything, there is a caveat: some measures may require an in-person element that cannot be achieved fully with just telehealth. So while an eCQM is eligible, there may be an extra step required to complete the measure.
Measure Highlights
While the complete list available here, we do want to highlight the ones that we find most commonly used by practices:
Allowed:
- 50v8 – Receipt of Specialist Report
- 68v9 – Documentation of Current Medications
- 122v8 – Diabetes Hemoglobin A1c Poor Control
- 128v8 – Anti-depressant Medication Management
- 135v8 – Heart Failure Medication Therapy (ACE inhibitor or ARB or ARNI therapy)
- 138v8 – Tobacco Screening & Cessation
- 139v8 – Falls Screening
- 156v8 – Use of High-Risk Medication in the Elderly (inverse measure)
- 159v8 – Depression Remission at 12 months
- 161v8 – MDD Suicide Risk Assessment
- 165v8 – Controlling High Blood Pressure
- 347v3 – Statin Therapy for Treatment of CVD
NOT Allowed:
- 22v8 – Screening for High Blood Pressure & Follow-up
- 69v8 – BMI Screening & Follow-up
- 157v8 – Medication & Radiation Paint Intensity Quantified
- 129v9 – Prostate Cancer Overuse of Bone Scan
- 133v8 – Cataracts 20/40 or Better Within 90-days Following Surgery
What About MIPS CQMs?
eCQMs that have a MIPS CQM equivalent (formerly called Registry Measures) are also telehealth eligible/ineligible! Remember, the difference between the measure sets is: targeted population and (usually minor) differences in their formulas. Generally, however, the MIPS CQMs are identical in nature to their matched eCQMs.
If you have a MIPS CQM (there are 196 of them) you can safely assume it is NOT telehealth eligible if it is not on the list. If you are relying on telehealth visits and have MIPS CQMs not on the list, you will need to adjust your measures.
What About Specialty Registry Measures?
The guidance released only applies to measures that CMS oversees: MIPS CQMs & eCQMs. The onus is on the Qualified Registry to determine if a telehealth visit and their data standards are an equitable match. If you have a specialty registry, that you are using to report MIPS Quality, be sure to consult with them about this.
Going Forward
CMS has said that this list of CQMs for 2020 is final. However, they did also release a list for 2021 which has FEWER (39) measures allowed. Fortunately, those three extra measures are not common. It is important to note that this list is not final and may change between now and Jan 1, 2021.
As the 2021 list is updated we will provide you our analysis if anything significant changes. At this point, however, we do not believe that it will change radically.
Conclusion
The rush to telehealth brought about questions that almost no one was asking: “What Quality Measures can be done outside the clinic?” CMS has responded with a well-crafted list of measures.
As always, CMS reserves the right to change the MIPS program to adapt to the health community’s needs. Though it appears that they are finished changing the program for 2020. Historically, in late July, CMS releases a Proposed Rule that becomes final in late-Oct/early-Nov. Therefore, SHP anticipates additional changes to the MIPS program for 2021, but no further major changes to the program for 2020.
Practices, particularly those who are relying on Telehealth, should re-evaluate their Quality Measures against this list. If you find that you were using a measure that is not eligible, you may want to consider requesting an Extreme & Controllable Circumstances Exception for the Quality Category.
If you are not sure if you should file an ECCE, or if you want assistance with picking your eCQMs, contact your SHP Representative and they will get you in touch with our MIPS expert.
MIPS Reporting Year 2020 Guidance Update
MIPS Reporting Year 2020 Guidance Update
After weeks of waiting, CMS has finally updated its MIPS guidance around the Reporting Year 2020 (RY2020). While CMS may make additional changes, this is the first major change for RY2020 we have seen thus far. For 2020, physicians and groups reporting for MIPS may submit an Extreme & Uncontrollable Circumstances Application to have some or all the MIPS categories reweighted to 0%. You must justify how COVID-19 has harmed your ability to achieve the category (or categories) you are asking to have reweighted.
Unlike the last-minute automatic reweight of RY2019, this will require effort on your organization’s part. You must provide examples showing:
- How the pandemic prevented you from collecting necessary MIPS data for a category (or categories) (such as seeing patients only via telemedicine and no reliable method of collecting Quality Category data)
- How the pandemic will prevent you from scoring a category (such as missing 3 months’ worth of Quality Category data)
- How the pandemic impacted your normal business process that would affect your cost measures or other administrative claims measures (such as unable to send claims due to lack of enough billing staff)
SHP’s Recommendation
We recommend that if you intended to submit for RY2020 and you feel your data is complete enough to score well, continue to move forward with that plan. A reweight request of a category may result in a lower score than desired. A total reweight of MIPS will result in a score of 0, with penalty avoidance, but may harm your score on Physician Compare: https://www.medicare.gov/physiciancompare/
That said, if you do feel like a reweight will help your organization and you feel that you can justify the request to CMS, follow the instructions here: https://qpp.cms.gov/mips/exception-applications#extremeCircumstancesException-2020
As always, SHP is here to help you with your Quality Payment Program participation questions, and we will bring you timely information regarding any changes to the MIPS program for 2020 and beyond.
COVID-19 & MIPS Reporting Year 2020
Despite the on-going health crisis, the Quality Payment Program is still in full swing for Reporting Year 2020. MIPS practices, ACOs, and APMs are all expected to report their 2020 performance in Q1 2021. So far, CMS has only made some minor alterations to the QPP/MIPS program, largely focused on some “housekeeping-type” changes that will give QCDRs a little more breathing room. That said, CMS has indicated there will be changes coming to the MIPS program, but they have not given a clear timeline or any idea on what will change.
What Has Changed?
- The biggest change has already come and gone, the data submission deadline for RY 2019 was moved to April 30. Those who did not submit data by that deadline were given a neutral adjustment instead of a penalty as the pandemic trigged an “Extreme and Uncontrollable Circumstances (E&UC) policy” exemption. Practices and providers that did submit will receive their adjustment accordingly.
- New Improvement Activities (high-weight) for RY2020 were created that promotes participation in COVID-19 treatment clinical trials and reporting on COVID-19 data to a registry or data repository.
- Extended the deadline for the QCDR measure & collection policies from Jan 1, 2021 to Jan 1, 2022. (This will require QCDRs to follow new rules for gathering more measures and sharing “unique” measures with others)
- Extended the Call for Quality Measures & the submission of DVER to June 30
What Will Change?
At this point in time, it would be pure speculation as to what will change. The largest lobby groups have advocated for a 90-day reporting window for all four categories, another automatic trigger of the E&UC policy, a nation-wide “pause” on QPP, and other substantive changes. We won’t know until sometime this summer or even this fall if there will be any changes to this reporting year.
Therefore, it is our recommendation to proceed with your RY2020 plans and do not plan on making any modifications to your QPP behavior. Expect that while CMS will make changes, if you continue on the “there’s no change” path you will likely exceed their modified rules whenever they are released.
When CMS does release their changes, we will be here to post an update and provide education to help you understand and best navigate the rules.
COVID Forum Survey
As part of our bi-weekly COVID forums, we want the discussion and guests dictated by you. We also are asked what others are doing to help ‘get back to the norm.’ Here is a 7 question survey to help direct these conversations and then provided back to you in a summary so that you can see what your peers are doing to tackle the challenges of today.
HHS Announcement – New Relief Funds Distributions for Skilled Nursing Facilities (SNFs)
From the $175 billion provider relief fund, HHS announced this morning that they have allocated an additional $4.9 billion in direct provider relief for Skilled Nursing Facilities (SNFs). HHS has determined the following distribution methodology for SNFs:
- HHS will make relief fund distributions to SNFs with six or more certified beds based on both a fixed basis and variable basis.
- Each SNF will receive a fixed distribution of $50,000 plus a distribution of $2,500 per bed.
Consistent with all HHS distributions to this point, nursing home recipients must attest that they will only use Provider Relief Fund payments for permissible purposes, as set forth in the Terms and Conditions, and agree to comply with future government audit and reporting requirements. For further details, you can find the full press release here: https://www.hhs.gov/about/news/2020/05/22/hhs-announces-nearly-4.9-billion-distribution-to-nursing-facilities-impacted-by-covid19.html.
There are reports that distributions began hitting accounts already. So, be on the lookout and let us know if we can be of any assistance
Have you attested for the Provider Relief Fund?
For those that received funding from the first round of HHS distribution, remember that you have 45 days from receipt of funds in which to attest. NOT returning the funds within that 45 day timeframe will be seen as acceptance of the Terms & Conditions.