Connect Archives

October 2016

Monday, October 31, 2016


On October 14, CMS issued a 2,400 page final regulation implementing MACRA’s (The Medicare Access and CHIP Reauthorization Act of 2015) Quality Payment Program. Many of you may be familiar with this regulation, others likely are not. This is representative of trends across the country, as a recent report from Deloitte indicated that 50% of physicians have never heard of MACRA, while another 32% of physicians know of it, but by name only. This concerns us greatly because like many others in the industry, we believe this regulation proposes the most significant changes to physician reimbursement we've seen in decades. We are clearly facing a tipping point as MACRA, other government reforms, and market forces are set to make value-based reimbursement in effect mandatory for not only Medicare, but also Medicaid and commercial payers. As a result, physician groups are being forced to do more with less: to deliver high-quality, cost-effective care with fewer dollars and more risk.

In response to these challenges and acknowledging the sense of urgency MACRA’s now finalized January 1, 2017 start date has created, we have partnered with ParrCare Solutions to host a FREE dinner event Tuesday, November 1st at 6:00 p.m. at the Hilton Garden Inn, 1144 Airport Blvd., Pensacola, FL.

The two-hour event will feature keynote remarks summarizing the details of the MACRA regulation from our friend and colleague, Chris Emper, Government Affairs Advisor to ParrCare Solutions. Additionally, we will be highlighting some proven solutions (including some exciting new self-sustaining fee-for-service revenue opportunities) that can help you be one of the “winners” under MACRA’s zero-sum game reimbursement system.

We urge you to join us next Tuesday evening! Please RSVP to as soon as possible.


WellCare has increased the bonus incentive to providers who use RxEffect® to identify and take action for Star Ratings medication therapy areas: Blood Pressure, Cholesterol and Diabetes.

Now earn $100 per qualifying member therapy between October 1, 2016 and December 31, 2016.

Related Links


To ensure that WellCare Medicare members receive important medical services by the end of 2016, WellCare of Florida is offering additional reimbursement to providers who submit detailed claims or encounters related to the following Centers for Medicare & Medicaid Services (CMS) Star measure at the time of each visit:

• Annual Flu Vaccine

WellCare is offering an Enhanced Payment of $20 per code for select codes (including CPT Category II codes) with dates of service between October 1, 2016 and December 31, 2016. Only physicians who submit on a CMS-1500 (paper form) or an electronic 837P form are eligible for this Enhanced Payment.

Related Links


On October 14, 2016, the Centers for Medicare & Medicaid Services (CMS) released a final rule implementing a new Medicare physician payment system, which replaces the flawed sustainable growth rate formula and marks the most significant change to Medicare physician reimbursement in 20 years. Beginning in 2017, physician practices can choose between two payment tracks – the Merit-Based Incentive Payment System (MIPS) and risk-based alternative payment models (APMs). At the outset, there are relatively few APM opportunities, and CMS estimates that more than 90% of physicians will participate in MIPS, making it the default track.

MIPS increases or decreases physician Medicare reimbursement rates based on performance on measures in four categories: quality, cost, EHR use, and clinical practice improvement activities. Payments in 2019 will be adjusted based on 2017 performance, and the cost category will not be counted in 2017.

2017 will be a transition year and physician practices will have four options for engaging in MIPS:
1. Report all required measures for at least 90 consecutive days and be eligible for a bonus payment;
2. Report more than one quality measure, more than one improvement activity, and the required EHR measures for at least 90 consecutive days and be eligible for a small bonus payment;
3. Report one quality measure, one improvement activity, or the required EHR measures and avoid a penalty; or
4. Do nothing and receive a 4% payment penalty in 2019.

Related Links


The Office of the National Coordinator for Health Information Technology (ONC) issued a final rule on its Health IT Certification Program which focuses on three broad topics: direct review, oversight authority, and transparency. In terms of direct review, the rule provides a regulatory framework for ONC to review certified health IT products independent of the current accredited testing laboratories and "take necessary action" should there exist risks to public health or complications with the current certification. It also includes a vendor appeals process and permits ONC to demand vendor corrective action plans. Second, the rule outlines a process for ONC to authorize and oversee accredited testing laboratories. Finally, the rule establishes a process to encourage and support increased transparency and public availability of information related to certified health IT. According to the ONC, vendor accountability will be improved by making surveillance results of certified products, both positive and negative, available to physician practices and other technology purchasers.

Related Links


On October 17, 2016, CMS made available the 2015 Supplemental Quality and Resource Use Reports (QRURs). Supplemental QRURs are for informational purposes only and complement the per capita cost and quality information provided in the 2015 Annual QRURs. The information contained in the Supplemental QRURs is not used to calculate payment adjustments.

The Supplemental QRURs are available to every medical group practice and solo practitioner nationwide, including those who participated in the Medicare Shared Savings Program, the Pioneer ACO Model, or the Comprehensive Primary Care initiative in 2015, and those consisting only of non-physician eligible professional (EPs). Medical group practices and solo practitioners are identified in the Supplemental QRURs by their Taxpayer Identification Number (TIN).

The 2015 Supplemental QRURs provide information to TINs on the management of their Medicare fee-for-service (FFS) patients based on resource use measures that consist of episodes of care (“episodes”). An episode includes the set of services provided to treat, manage, diagnose, and follow-up on a clinical condition or treatment.

Authorized representatives of group and solo practitioners can access the 2015 Supplemental QRURs on the CMS Enterprise Portal using an Enterprise Identify Data Management (EIDM) account with the correct role. Only TINs with at least one attributed episode will receive a full 2015 Supplemental QRUR. For more information on how to access the 2015 Supplemental QRURs, please follow the link below.

Related Links


Health First Network, Inc. (HFNI) has formed the HFNI Professional Liability Insurance Program, a program designed to enhance the professional liability coverage of our members with available discounts of up to 50% for qualified members.

Related Links


Did you receive money back on your Workers’ Comp Premium last year? Now you are eligible through the Health First Network Workers’ Compensation Program.

Related Links

Financial Focus for Young Physicians: “First, Build Your Foundation”

As advisors to young physicians across the country, we are often asked the question: “What is the most important thing I should be doing financially in the first years of practice?” Our answer is simple: “You need to build a solid foundation” – yet, the application of this concept (Foundation) is different for each physician. As with patients, we often see very common symptoms and can make some generalizations about what is involved in creating a ”financial foundation” for many young doctors. We will do that here in this article.

Related Links

Featured Advisor

Dr. Brian J. McAulay
President, Argosy University Dallas

Dr. Brian J. McAulay is currently serving as President of the Argosy University Dallas campus; it is his third university presidency. He is an American Council on Education Fellow, chairs site visits for the Southern Association of Colleges and Schools Commission on Colleges, and has served as chief academic officer at several healthcare-centered institutions in addition to his chief executive experience. He owned and operated his own private health care practice for 14 years in suburban Philadelphia. He earned his Ph.D. in management from Temple University, and his doctor of chiropractic degree from Pennsylvania College.

Related Links

Featured Partner

The HFNI Office Depot/OfficeMax Discount Program

HFNI Members, get custom-discounted pricing and more with your Store Purchasing Card. When you shop at any Office Depot or Office Max store, you’ll always get the lower of the retail store price or your custom-discounted price.

Plus, get deep discounts on black & white copies, color copies, binding, folding and cutting at our Copy and Print Center.

Related Links

Register to Access the HFNI Member Benefit Portal

We are pleased to announce the launch of your new and improved web based Exclusive Member Resource Center. As a Health First Network member, you now have 24/7 access to discounted partner rates, business advisors and educational CME content.

Register today to schedule your Complementary Benefit Review.

Related Links