2021 is now here and, with it, comes changes to how physicians must document for and code patient office and outpatient visits. For the first time since the implementation of office/outpatient visit E/M CPT code set in 1992, the Centers for Medicaid and Medicare Services (CMS) has instituted extensive changes to the coding criteria.
Have you had difficulties finding a referring provider's direct address? You are not alone! The NPPES system now supports updating your providers' NPI registration with their direct address. This will contribute to a national directory that should improve the use of direct messaging. While there is no requirement in MIPS to update your registration at the time of publication, CMS will post a list of providers without direct messaging capabilities in the second half of this year.
Telehealth (or telemedicine) is highly regulated, and as a result, has been difficult to fully adopt. Over the past week, CMS has made changes to broaden access to telehealth services.
Implementing Medicare Telehealth visits allows providers to get reimbursed at the same rate as an E/M visit.
Using a combination of the 2020 Final Rule and the 2020 Measure Benchmarks released on 12/31, we have compiled a list of the most important measure changes for this year. This doesn't cover all possible measures for an Ophthalmologist to report on, but these are the ones that are most specific that a majority of our clients will use.
While there are many measures under review, the one that effects a majority of our clients is the Total Cost per Capita measure (TPCC). Our thoughts after reviewing these reports is that if these changes are implemented, specialists will continue to get attributed in the TPCC measure. Here are some notes on what we have found so far:
Follow these steps to create an EIDM account. This will give you access to portal.cms.gov for feedback for 2016 and prior, and qpp.cms.gov for feedback for 2017 and beyond.
The purpose of this guide is to provide you a high-level overview of the HIPAA requirements of MIPS, and an attempt to simplify a very complex concept. MIPS
The CMS Portal (EIDM) is where you can access all reports on how you performed on your 2016 PQRS and VM programs, and the QPP site, which shares a login with the EIDM is where you view everything related to the MIPS and APM tracks.
While these programs will be replaced with MIPS going forward, get use to this portal as it is where all feedback reports will be accessed. In order to access the CMS portal, you must have an Enterprise Identity Management (EIDM) Account.
- Go to https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Carrier-Specific-Files.html
- Click on the latest year, All States
- Extract the files, then open the PDF
- Starting on page 6, look for your locality
- In the Carrier field, note down the last 2 digits of the Carrier number
- Go back to the folder, and look for your State File (It will be PF + State Abbreviation + Year + Revision), so for Louisiana it would be PFLA17A.
- Look at the 2 digit value in the 3rd set of the file, this will match the number in Step 5
- Delete all other rows that have different locality IDs
- Save this file
In order for someone other than yourself to submit data to CMS, you need to add them as a surrogate. If you received a request for access, click on the link in the e-mail or visit the Identity and Access Management System.
1. Login to the I&A Management System by using your username and password. This is the same username and password that you would use to access NPPES and PECOS. If you don't have a login, check with your billing staff or the provider.