Payment & CMS Policy


List of PCP Quality Measures for 2018


For 2018, reporting through the Quality Payment Program (QPP) starts with the selection of measures for the year. CMS has a set of 30 Primary Care Measures and you will select 6 of the 30 for the reporting year 2018. Select measures which are pertinent to the Medicare base of your practice. Also, consider measures which you can improve on during the year.

Need help? Contact MIPSPRO and set up a free live session with a MIPS expert and let them know you are with ACOFP.

CMS Simplifies Reporting with New Website 
Description: CMS has designed and launched a more user-friendly Quality Payment Program (QPP) website for 2017. Eligible Clinicians (EC’s) can now report all 3 categories of data on one site. There is no charge and users can see their score immediately. For 2017 QPP data, the reporting deadline is March 31, 2018. Learn more about how to access and use the new website.

Navigating MIPS in 2018 and Beyond
There are significant changes to MIPS from 2017 to 2018. Physicians and other eligible clinicians (EC’s) will want to learn about these early in the year so that they can plan their measures for the year. This is the first year that Cost will be part of the MIPS Composite Score and will affect your payment adjustment. Learn about the 4 areas of reporting for MIPS.

This webinar is brought to you by Healthmonix and MIPSPRO. Sign-up with MIPSPRO to monitor your measures quarterly and report at the end of the year. ACOFP members get a $20.00 discount with code ACOFP2018.

Physician Fee Schedule Changes for 2018 – Summary
This document contains the top seven changes to the 2018 Physician Fee Schedule. Links to key documents are included for further detail. Some of the news is good news, like the expansion of telehealth payments, especially for rural providers. A new, and much needed program for those with pre-diabetes will start April 1, 2018 – the CMS Diabetes Prevention Program (DPP). “Cost” is being phased in to the Quality Payment Program (QPP) and is worth 10% of your total score for 2018. Incentives payments for those with top scores in Quality, Cost, Advancing Care Information, and Practice Improvement Activities will start at 5% to a high of 10%. For not reporting, or for lower total scores, there is up to a negative 5% penalty which is taken off your Medicare payments. 

Medicare Diabetes Prevention Program - New Payment Model
Diabetes impacts more than 25 percent of Americans age 65 or older. Diabetes is expected to increase two-fold for all US adults – age 18-79 – if current trends continue. CMS has tested and will launch a Diabetes Prevention Program on January 1, 2018. The prevention program targets those with pre-diabetes using a health behavior change methodology. Physicians are awarded payment bonuses, in addition to payment for HCPCS G-codes, based on patient success of weight loss combined with number of educational meetings attended. View the CMS Fact Sheet for more information.

ACOFP Comment Letter to CMS on New Payment Models
This letter from ACOFP to Seema Verma, Administrator for CMS, describes the top priorities for any new payment models proposed by CMS. 

Get America Covered
Get America Covered is an independent initiative to help get the word out to consumers/patients about Open Enrollment for Exchange insurance policies. This year is different than previous years for several major reasons. First, the enrollment time period is cut in half, it runs from November 1 to December 15, 2017. Also, the monies allotted for the Department of Health and Human Services to market this direct to consumers was cut by 90% this year! In person, or phone assistance to help answer consumer questions has been cut by 40%.

Offered here is a free Tool Kit for Physicians, including flyers, social media assets and state specific health insurance marketplace, which you can print and display for your patients. Please help Get America Covered by utilizing these these resources and help spread the word.

2018 Chronic Care Management (CCM) Toolkit &Teaching Materials from CMS: 
Chronic care management (CCM) is a critical component of primary care that contributes to better outcomes and higher satisfaction for patients.  On January 1, 2017, CMS established separate payment under billing codes for the additional time and resources you spend to provide appointment and between-appointment help for many of your Medicare and dual eligible (Medicare and Medicaid) patients need to stay on track with their treatments and plan for better health. CCM payments can be made for services furnished to patients with two or more chronic conditions who are at significant risk of death, acute exacerbation/decompensation, or functional decline. CMS data show that two thirds of people on Medicare have two or more chronic conditions, which means many of your patients may benefit from a CCM program, including the help provided between visits. This toolkit includes information for health care professionals, including tips for getting started, fact sheets on the requirements for implementing a CCM program, and educational materials to share with patients.

Learn more >>

MIPSPRO™: CMS Approved Registry – Quality Tracking and Reporting
Succeeding in Value-Based healthcare involves selecting, improving, and reporting your quality measures. ACOFP and MIPSPRO™ have partnered to bring you access to a CMS qualified registry – With MIPSPRO you are able to select your quality measures and complete your quality reporting to CMS, while avoiding negative payment adjustments. Enroll now and you will be able to see your quality measure score for Q1 2017. This will help you set treatment strategies for the rest of the year. ACOFP Members receive a discount when signing-up for MIPSPRO. Use discount code ACOFP2017 for exclusive discounts for ACOFP members.

Learn more >>

Advancing Care Information, ACI, is a set of requirements dealing with the use of your EMR. ACI is worth 25% of your total Payment Score which then determines your penalty of incentive payment for Medicare Part B patients. There is a “Base Score” which is worth half of this category. The first requirement is a “Security Risk Analysis.” While there are companies which can provide this, you can complete this yourself at no cost using tools on the CMS website. There are 156 questions to answer, and depending on your answer(s), the program will tell you if you have a potential risk. This covers not just your EMR, but other devices in your office which store HIPPA information. The tools can be downloaded free from the CMS website in various formats which can help you complete the assessment. If you have identified a risk, consultation with an your EMR or IT provider may be required to correct it. Access Tools >>


Family Medicine to Have More Support for Identifying & Treating Mental Health

Mental disorders top the list of the most costly conditions in the U.S., accounting for $201 billion in healthcare spending in 2013, far more than was spent on heart disease or cancer, according to federal data. An estimated 8.1 million adults have schizophrenia or bipolar disorder, and 3.9 million go untreated in any given year, according to data from the National Institute for Mental Health.

The Helping Families in Mental Health Crisis Act 2016  steps-up the requirement for insurers to cover mental healthcare on the same level as physical health. Additional support for screenings, programs to provide early intervention for children, and initiatives to prevent suicide are included in the Act.