The American Society of Nephrology has developed and released the Kidney Care First (KCF) Model Calculator for nephrologists and nephrology practices to help them evaluate how they might perform in the voluntary payment program. The calculator is a guide only and does not calculate every variable that a practice might face; however, it is designed to examine the difference in nephrology practice reimbursement in the status quo versus the KCF Option in the Kidney Care Choices (KCC) Model. This device is intended for practices already considering the KCF Option.
Medicare has proposed changes to the payment rules for dialysis care and physician reimbursement for calendar year 2019. While several proposed changes are positive, one proposed adjustment to the Evaluation and Management (E&M) coding reimbursement structure has created serious concern and will be a priority in the American Society of Nephrology’s (ASN) comments to Medicare.
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.