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CMS Updates

CMS Updates

Scoring well in quality has just become more difficult.

by Michael L. Brody, DPM

Think of it as being graded on the curve. If you score a 95 on a test you think you have a good grade, but if class average on that test was a 98 you will get a poor grade. Scoring for quality measures is similar to that type of grading.
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CMS Updates

CMS Grants Blanket Exemptions for MIPS for 2020.

by Michael Brody

They are stating that these exemptions are Automatic.  But what does that really mean?
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CMS Updates

The Public Health Emergency has been extended through April 20.

by Michael Brody

This means that the CMS 1135 Waivers have been extended through April 20. Some of the waivers may impact your practice while most of the waivers are related to hospital care.
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CMS Updates

Deadline to File for MIPS Extreme and Uncontrollable Circumstances Exception extended to February 1, 2021.

by Michael Brody

For the 2020 performance period, CMS is using the Extreme and Uncontrollable Circumstances policy to allow clinicians, groups, and virtual groups to submit an application requesting reweighting of one or more MIPS performance categories due to the COVID-19 pandemic. As an additional flexibility, CMS has extended the deadline to submit a COVID-19 related 2020 extreme and uncontrollable circumstances application to February 1, 2021.
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CMS Updates

2% Payment Adjustment (Sequestration) Suspended Through March 31, 2021

by Michael Brody

The Coronavirus Aid, Relief, and Economic Security (CARES) Act suspended the payment adjustment percentage of 2% applied to all Medicare Fee-For-Service (FFS) claims from May 1 through December 31. The Consolidated Appropriations Act, 2021, signed into law on December 27, extends the suspension period to March 31, 2021
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CMS Updates

Therapeutic Shoe Update:

by Paul Kesselman DPM

Recently Medicare expanded their definition of the health care provider who can certify the patient as being diabetic. This brief article will answer some questions, but many others remain unquestioned.
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CMS Updates

Breaking News Regarding the Therapeutic Shoe Program!

by Veronica Mennella

On November 5th, 2020, the DME MACs released two joint publications detailing expansion of the roles of Nurse Practitioners (NP) and Physician Assistants (PA) in certifying therapeutic shoes and inserts for beneficiaries. CMS is utilizing its authority under the soon-to-be-launched Primary Care First (PCF) model to waive Social Security Act 1861(s)(12), the section which requires that an MD or DO only, is permitted to certify therapeutic shoes and inserts for beneficiaries.
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CMS Updates

November DME Updates

by Paul Kesselman DPM

Arizona has apparently received some changes to its HCPCS validation which is reflected in this announcement by CGS. This has some far reaching implications beyond the Arizona brand name.
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CMS Updates

CMS Announces New Repayment Terms for Medicare Loans Made to Providers During COVID-19

by Dr. Michael Brody, DPM, CEO TLD Systems

CMS announced amended terms for payments issued under the Accelerated and Advance Payment (AAP) Program as required by recent action by President Trump and Congress. This Medicare loan program allows CMS to make advance payments to providers, which are typically used in emergency situations. Under the Continuing Appropriations Act, 2021 and Other Extensions Act, repayment will now begin one year from the issuance date of each provider or supplier’s accelerated or advance payment. CMS issued $106 billion in payments to providers and suppliers in order to alleviate the financial burden health care providers faced while experiencing cash flow issues in the early stages of combating the Coronavirus Disease 2019 (COVID-19) public health emergency.
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CMS Updates

CGS announces Widespread Post-Pay Service Specific Review

by Dr. Michael Brody, DPM, CEO TLD Systems

CGS's Medical Review staff will be conducting a complex post-pay service-specific medical review of HCPCS Codes L1902; L1906; L1971; L4396; L4397 (Ankle-Foot Orthosis). This review will be conducted because data analysis revealed that Jurisdiction B's allowed dollars for HCPCS Codes L1902; L1906; L1971; L4396; and L4397 were significantly above expected amounts. Additionally, the Orthotics policy group ranked #1 in total CERT errors.
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