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CMG NEWS
Volume 49| November 2020
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From the President's Desk |
I want to invite each of you to CMG’s first “virtual” Annual Meeting to be held on Thursday, December 3rd at 6:30 PM via zoom. When we canceled the regularly scheduled meeting in the spring, we had hoped to reconvene this year, but that is no longer possible. However, we still wanted to take the opportunity to meet and provide an overview of the last year.
Our presentation will be concise and will focus on the following topics:
- Clinical Integration and Contracting Update
- ACO performance and Shared Savings
- CMG Strategic Partnership Opportunities and Strategy
- Practice Support Activities
I would encourage as many of you to attend as possible, but at least one person from each practice should attend. Attendance at this meeting will earn credit for participating in Clinical Integration educational activities for you and your practice. Please click here for a link to the invitation. I look forward to seeing you on December 3rd.
Best,
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Joseph L. Quaranta, MD, President
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NGS has noticed claims being billed for the 2020-2021 flu season with the incorrect CPT codes for influenza flu vaccines. Click here to review the article and coding guidelines.
OIG Examines billing for Advanced Care Planning Services
The OIG will be reviewing Advanced Care Planning Services (CPT 99497 and 99498) to determine if the documentation supports a face to face encounter occurred and the time spent performing care planning services. Click here for more information.
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EXTRA! EXTRA! Read all about it..
Check out the interesting round-up below.
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Cigna sends mailers to patients |
CMG and Cigna partnered to send educational mailers to parents of adolescents to encourage preventive care follow up. The mailer was sent to patients attributed to your practice by Cigna, and include the name of the patient’s practice as well as the phone number.
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COVID-19 Impacting Risk Adjustment |
Because diagnoses from the 2020 claims are used to determine 2021 risk scores, fewer claims in 2020 could mean lower risk scores and, consequently, lower shared savings opportunities in CMG‘s Medicare Advantage (MA) ACO contracts.
CMS uses diagnoses data based on inpatient, outpatient, and physician services to calculate an MA plan enrollee’s risk score. For 2021, risk scores will be based on member demographics and diagnoses from services that occur in 2020. Patient risk scores impact the monthly payments received by MA plans, which in turn impacts the Medical Loss Ratio, or MLR. In many ACO contracts, the MLR acts a budget for patients’ medical cost. If the CMG attributed patients’ expenses are below the MLR, a shared savings opportunity exists.
CMS announced that diagnoses recorded using real-time audio video telehealth visits will support risk adjustment activities. Please ensure that your patients’ chronic conditions are coded to the highest level of specificity during in-person and telehealth visits, and that those chronic conditions have been monitored, evaluated, assessed and/or treated during the visit.
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Weitzman Institute and Sacred Heart University Institute for Public Policy Release Poll Examining Views on Telehealth |
Telehealth has taken off during the COVID-19 pandemic. Community Health Center, Inc. and its research arm, the Weitzman Institute, commissioned Sacred Heart University’s Institute for Public Policy to survey 1,000 Connecticut residents on their views about this emerging, and now essential, technology.
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MIPS Exception Applications Due by 12/31/2020 |
CMS’ Quality Payment Program (QPP) recognizes that there may be circumstances that impact clinicians participation in MIPS reporting requirements.
To reduce this burden, practices are encouraged to review two exceptions available for the 2020 performance year:
- Extreme and Uncontrollable Circumstances Exception- includes impact from COVID-19
- MIPS Promoting Interoperability Performance Category Hardship Exception
Visit their website to evaluate your eligibility. If you have questions on your practice eligibility, please contact Sharon Wood.
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Post-COVID-19 Practice Recovery Survey Results. |
This past July, CMG member practices were invited to complete a survey on the challenges facing their clinicians, employees and offices. Those results provided meaningful data on a wide range of issues. Your responses facilitated frank discussions with insurance carriers and helped guide decisions on how best to serve the needs of our members.
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CAHPS Survey Data: An Important Component of Medicare Shared Savings Programs Quality |
Each November, CMG contracts with Press-Ganey to administer the mandated Consumer Assessment of Healthcare Providers & Systems (CAHPS) for ACOs survey of Medicare recipients. The survey data collection includes two identical mailed questionnaires and follow-up phone calls when beneficiaries do not respond to one of the mailed questionnaires. The survey includes questions about timely access to care, utilization of primary and specialist care, evaluation of care coordination, patient involvement in decision-making, experiences with a health care team, health promotion and patient education, and patient self-assessment of functional status and general health.
To help improve patient recollection of their health care experience when completing the CAHPS survey, please consider the following tactics to help patients recall conversations:
- Give patients reading materials and educational handouts
- Ask your patients to repeat important follow up and teachings
- Ask patients about concerns and feelings, specifically why they may or may not want a medication or procedure
- Ask the patient about the ability to afford a new medication
- Engage your office staff or CMG‘s care management team to help find resources when there is a need
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Kraig Gland, Director, Medical Economics & Clinical Outcomes
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Can't find or missed out on our previous issue? Visit your MyCMG to view all archived newsletters and much more.
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