Given the enormous impact of the 2019 Novel Coronavirus (COVID-19) on the healthcare system, the American Society of Nephrology (ASN) and other members of the kidney community have requested regulatory relief for clinicians and facilities on multiple fronts over the past few weeks. The Centers for Medicare & Medicaid Services (CMS) and other agencies within the Department of Health and Human Services are responding in kind. The following is an update for ASN members on several major steps of importance to nephrologists and their patients that CMS has taken, particularly:
Department of Health and Human Services (HHS) officials from the office of the Secretary, office of the Chief Technology Officer (OTC), Centers for Medicare and Medicaid Services (CMS), and the Innovation Center at CMS, came together for an HHS-wide Forum on the Executive Order on Advancing American Kidney Health (AAKH), especially the Kidney Care Choices (KCC) model on Thursday, November 7, at Kidney Week 2019. The session was standing room only with a very engaged audience.
Thursday afternoon, November 1, Medicare released the final Physician Fee Schedule (PFS) rule containing some revisions to evaluation and management (E&M) codes in terms of documentation requirements but no changes in reimbursement levels for the next two years – but year three is another matter.
The desire to reduce the documentation burden in E&M coding led CMS in July to propose a system that collapsed levels 2-5 of E&M into one reimbursement payment. This move had negative implications for nephrologists and pretty much any physician practicing cognitive care with complex patients. So, where did we end up and what do you need to know?
A new CPT® code, 87635, has been released for immediate use for novel coronavirus testing offered by hospitals, health systems, and laboratories in the United States. The code became effective Friday, March 13, 2020, for reporting of novel coronavirus tests across the entire healthcare system. Because of the immediate release and use of the code, clinicians will need to manually upload this code descriptor into their electronic health record (EHR) system. This CPT code will arrive as part of the complete CPT code set in the data file for 2021 later this year in the Microbiology subsection of the Pathology and Laboratory section.
Recently, we informed you that the Centers for Medicare and Medicaid Services (CMS) released a status tool on the Quality Payment Program (QPP) website for performance feedback for clinicians included in the Merit-based Incentive Payment System (MIPS) during the 2017 performance year. This status tool allows clinicians to check to see if their payment adjustment for 2019 (based on the 2017 data) will be positive, neutral, or negative. In conjunction with the status tool, there was an open period to request a targeted review of your data until October 1, 2018.
The American Society of Nephrology (ASN) organized the fourth Kidney Community Advocacy Day (KCAD) on Capitol Hill in Washington, DC, bringing together 13 organizations in the kidney community to raise the profile of kidney diseases with lawmakers. A total of 75 advocates representing a broad intersection of patient and provider perspectives from the kidney and transplant community met with nearly 100 members of Congress and their staff, commending them for investing in kidney research and asking for their support of the Living Donor Protection Act and increased innovation in kidney care through programs like KidneyX.
Advocates from the American Society of Nephrology (ASN) and the American Association of Kidney Patients (AAKP) are meeting with representatives, senators, and their respective staffs today, March 20th, to urge Congress to support KidneyX, a public-private partnership to accelerate innovation in the prevention, diagnosis, and treatment of kidney diseases.
The American Society of Nephrology (ASN) was honored to participate recently in the third annual Nephrology Business Leadership University 2018 in Dallas, TX, at the headquarters of U.S. Renal Care (USRC) and hosted by USRC, the Dallas Renal Group, and UC San Diego. The NBLU unique weeklong program for second year nephrology fellows allows them to drill down with a diverse faculty of practicing nephrologists from private practices and academia, hospital and dialysis executives, and other professionals who will share their insights on leadership, the business of nephrology, and the evolving healthcare landscape.
Focusing on the intensity of the executive branch’s sweeping proposals to radically change kidney care – and the transformational implications therein – the plenary session on November 9 at Kidney Week was far from ordinary. The State-of-the Art Lecture, “Perspectives on Innovation and Transformation in Kidney Care,” served as a crucible to distill down what should, and must, happen at this point to deliver a brighter future for people with kidney diseases.
Right now, you are probably thinking that you do not want to hear another thing about MACRA (the Medicare Access & CHIP Reauthorization Act) either until the details are final or until there are some helpful steps you can take. The details will be final very soon – before November 1 – and there are steps to take now. As most of you know, MACRA replaced the old Sustainable Growth Rate (SGR) reimbursement formula with the Quality Payment Program (QPP) and the new reimbursement formula is going to focus heavily on quality of care. While the payment adjustments do not begin until 2019, the reporting period begins January 1, 2017, so let’s get started with three facts to help you prepare.