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Physician Center

  • CY 2016 Medicare Physician Fee Schedule Proposed Rule with comment period : Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2016.

  • MLN Connects® National Provider Call - Certifying Patients for the Medicare Home Health Benefit (December 16, 2014 at 1:30 pm ET). This MLN Connects™ National Provider Call provides an overview of certifying patient eligibility for the Medicare home health benefit. This includes an overview of a new requirement for HHAs to obtain documentation from the certifying physician's and/or the acute/post-acute care facility's medical record for the patient that served as the basis for the certification of patient eligibility. This new requirement was finalized in the Calendar Year 2015 Home Health Prospective Payment System final rule (CMS-1611-F) effective for home health episodes beginning on or after January 1, 2015. For more information and to register, visit this MLN Connects™ National Provider Call web page.
  • CMS-1612-FC: CY 2015 Physician Fee Schedule Final Rule with Comment Period - Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Medicare Part B.

  • Clarification: 2013 Quality Resource and Use Reports (QRURS) Available Fall 2013
    The MLN ConnectsTM Provider eNews and the eHealth list serve messages provided direction to access your 2013 QRUR .To clarify, the 2013 QRURs are not available at this time but will be available shortly. CMS will make the 2013 QRURs available for all physician group practices and solo practitioners nationwide. Please stay tuned for updates to the Physician Feedback/ Value Modifier website for announcements about the availability of the 2013 QRURs.

  • CMS-1612-P:  CY 2015 Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Medicare Part B

  • CMS is Accepting Suggestions for PQRS Measures

    CMS is accepting quality measure suggestions for potential inclusion in the proposed set of quality measures in the Physician Quality Reporting System (PQRS) for future rule-making years. Quality measures submitted in this Call for Measures also will be considered for use in other quality programs for physicians and other eligible professionals (e.g. Value Based Modifier, Physician Compare, Medicare Shared Savings Program, etc.).

    Beginning this year, the Call for Measures will be conducted in an ongoing open format. Unlike previous years, where the annual Call for Measures closed after a specified period of time, starting in 2014, the Call for Measures will remain open indefinitely. The month that a measure is submitted for consideration will determine when it can be included on the Measures Under Consideration (MUC) list. Measures submitted from May 1, 2014 to June 30, 2014 may be considered for inclusion on the 2014 MUC list for implementation in PQRS as early as 2016.

    Each measure submitted for consideration must include all required supporting documentation. Documentation requirements and the submission timeline are posted on the Measures Management System Call for Measures web page.

    When submitting measures for consideration, please ensure that your submission is not duplicative of another existing or proposed measure. Additionally, CMS is not accepting claims-based only reporting measures in this process. CMS will give priority to measures that are outcome-based, answer a measure gap and address the most up-to-date clinical guidelines. Measures submitted for consideration will be assessed to ensure that they meet the needs of the PQRS. As time permits, feedback will be provided to measure submitters upon review of their submission.

    Note: Suggesting individual measures or measures for a new or existing measures group does not guarantee the measure(s) will be included in the proposed or final sets of measures of any Proposed or Final Rules that address the PQRS. Additionally, measures submitted for consideration are not guaranteed to be put forth on the MUC list for MAP review. CMS will determine which individual measures and measures group(s) to include in the proposed set of quality measures, and after a period of public comment, the agency will make the final determination with regard to the final set of quality measures for the PQRS.

  • Additional Clarification of Guidance on the Physician Order and Physician Certification for Hospital Inpatient Admissions
    On August 19, 2013, in the FY2014 IPPS/LTCH final rule CMS clarified and revised the conditions of payment for hospital inpatient services under Medicare Part A related to patient status. On September 5, 2013, CMS released guidance that discussed the provisions of the final rule regarding the physician order and physician certification of hospital inpatient services. This document includes further clarification of issues addressed in the previous guidance.
  • Prior Guidance on the Physician Order and Physician Certification for Hospital Inpatient Admissions
    The guidance provided in this document has been further clarified in Additional Clarification of Guidance on the Physician Order and Physician Certification for Hospital Inpatient Admissions. This version of the guidance document will remain online for comparison purposes.
  • Physician Groups of 100 or More: The Registration Period to Avoid a -1% Payment Adjustment Extended to Friday, October 18 - The Physician Value-Physician Quality Reporting System (PV-PQRS) Registration System is open through October 18, 2013. Representatives of group practices can select their group’s PQRS reporting mechanism for CY 2013, and groups with 100 or more eligible professionals (EPs), can elect quality tiering to calculate the Value Modifier for CY 2015.
  • The PV-PQRS Registration System can be accessed at using a valid IACS User ID and password. For additional information regarding registration and obtaining or modifying an IACS account, please see the Quick Reference Guide on the Self Nomination/Registration web page.

  • Frequently Asked Questions Regarding Change Request 7631 (Transmittal 2679)--Revised and Clarified Place of Service (POS) Coding Instructions.
  • Revised Fact Sheet for Referral Agents - Where are the Round 2 areas? What if a beneficiary travels? What do you need to know before prescribing a DMEPOS item or referring the beneficiary to a DMEPOS supplier? Want more information on the national mail-order program for diabetic testing supplies?

    For answers to these questions and more, see the revised “Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program: Referral Agents” Fact Sheet (ICN 900927), which is now available in downloadable format.

  • Primary Care Incentive Program Payments for 2011 (posted 05/22/2012)
  • Blood Clotting Factor Furnishing Fee
  • Medicare FFS Physician Feedback Program/Value-Based Payment Modifier

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