Important Policies Affecting Your Practice
Coding and Reimbursement
STS held a VAD coding webinar on Dec. 13. To view the slides from this presentation, click here.
CMS Quality Reporting Initiatives
Electronic Prescribing (eRx) Incentive Program
Established in 2009, the eRx Incentive Program seeks to encourage the use of electronic prescribing by providing incentives and payment adjustments based on whether eligible professionals meet the criteria for being successful electronic prescribers.
For more information on the eRx Incentive Program, please review this slide presentation from the Centers for Medicare and Medicaid Services (CMS).
Additional resources are available on the CMS website for the eRx Incentive Program.
Significant Hardship Exemptions are available to eligible professionals or group practices if:
- The eligible professional or group practice practices in a rural area with limited high-speed Internet access
- The eligible professional or group practice practices in an area with limited available pharmacies for electronic prescribing
- The eligible professional or group practice is unable to electronically prescribe due to local, state, or federal law or regulation
- The eligible professional who prescribes fewer than 100 prescriptions during a 6-month, payment adjustment reporting period.
Deadline to submit requests for significant hardship exemptions:
- 2012: The deadline for applying for a significant hardship exemption for 2012 eRx payment adjustments has passed. CMS has said that every provider who would have been subject to a penalty was notified in advance of this date. If you are experiencing any problems, please contact the Government Relations office at (202) 787-1230 or email@example.com.
- 2013: Payment Adjustment: June 30, 2012
- 2014: Payment Adjustment: June 30, 2013
Method of Submission:
The Communication Support Page will be available to accept requests for significant hardship exemptions in spring 2012.
Physicians should contact the QualityNet Help Desk if they have issues relating to the e-prescribing penalty. If a physician has previously contacted the QualityNet Help Desk and their case has been resolved to their satisfaction, the physician does not need to contact the QualityNet Help Desk again.
The QualityNet Help Desk can be reached M-F; 7:00 am – 7:00 pm CMT at 866-288-8912 or via email at firstname.lastname@example.org.
If a physician continues to experience problems with the Help Desk, CMS is encouraging physicians to email their concerns directly to Medicare at eRx_hardship@cms.hhs.gov.
EHR Incentive Program
The Medicare Electronic Health Record (EHR) Incentive Program provides incentive payment to eligible professionals, eligible hospitals, and critical access hospitals (CAHs) participating in the Medicare and Medicaid programs that successfully adopt, implement, upgrade, or demonstrate meaningful used of certified EHR technology.
In May 2012, STS sent two comment letters to CMS regarding the proposed rules:
- Surgical Organizations Comments to CMS on Electronic Health Record Incentive Program-Stage 2
- Medical Organizations Comments to CMS on Electronic Health Record Incentive Program-Stage 2
CMS held a EHR Incentive Programs National Provider Call on March 12. Click here for details from this event.
For more information on the EHR Incentive Program, please review this slide presentation from CMS.
Additional resources are available on the CMS website for the EHR Incentive Program.
STS has also made available an overview of the Final Rule for Stage 2 of the Electronic Health Record Incentive Program.
If you have additional questions, please contact the EHR Information Center:
1-888-734-6433 (TTY 888-734-6563) (7:30am-6:30pm CST M-F)
Physician Quality Reporting System
Established in 2007, the Physician Quality Reporting System (PQRS) is a pay-for-reporting program that provides a combination of incentives and payment adjustments to eligible professionals and group practices who satisfactorily report data on PQRS quality measures. Currently, STS members can participate in PQRS through the STS National Database.
A presentation was held on March 20, 2012. The slides are available here.
For more information on PQRS, please review this slide presentation from CMS.
Additional resources are available on the CMS website for PQRS.
CMS Contact information:
- CMS QualityNet Help Desk at 1-866-288-8912 (TTY 877-715-6222) (7:00am – 7:00PM CST M-F) or
Section 3007 of the Affordable Care Act requires CMS to apply a value modifier (VM), which compares the quality of care furnished to the cost of that care to physician payment rates under the physician fee schedule (PFS). Application of the VM states with specific physicians and physician groups in 2015 and expands to all physicians by 2017.
CMS held a VBP National Provider Call on March 14. Click here for details from this event.
CMS recently held a presentation titled: Physician VBPM: Experience from Private Sector Physician Pay-for-Performance Programs. The presentation is available here.
For more information on Value-Based Purchasing, please review this slide presentation from CMS.
Additional resources are available on the CMS website for physician feedback programs.
CMS Contact Information:
Lung Cancer Awareness
Please take a moment to ask your members of Congress to co-sponsor the Lung Cancer Mortality Reduction Act of 2011, introduced in the Senate by Sens. Dianne Feinstein (D-CA), John Kerry (D-MA), and Johnny Isakson (R-GA), and in the House of Representatives by Reps. Donna Christensen (D-VI) and Frank LoBiondo (R-NJ).
STS has drafted a sample letter and provided contact information for your representatives. The letter may be edited to provide examples of your personal experience as a cardiothoracic surgeon. If you have any questions, please contact the STS Government Relations staff at (202) 787-1230 or email@example.com.
Help Your Patients Quit Smoking, Get Reimbursed by Medicare Help your patients quit smoking now and improve their chances of a healthier life after surgery by immediately distributing our Stop Smoking for Surgery brochures and wallet cards.
Medicare now reimburses for tobacco-use cessation counseling services. Medicare provides coverage of smoking and tobacco use cessation counseling services for outpatient and hospitalized beneficiaries who:
- use tobacco and have been diagnosed with a recognized tobacco-related disease or who exhibit symptoms consistent with tobacco-related disease; or use tobacco regardless of whether they have signs or symptoms of tobacco-related disease.
There are two CPT codes you may use for billing purposes:
- 99406 – Smoking and tobacco use cessation counseling visit; intermediate, greater than three minutes up to 10 minutes.
- 99407 – Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes.
For more information, please visit https://www.cms.gov/mlnproducts/downloads/smoking.pdf.
Court Rules Against New Cigarette Labels Educating your patients about smoking cessation is more important than ever. A preliminary injunction has been issued against new cigarette warning labels. A federal district court judge has ruled that the FDA will not be allowed to implement the warning label requirement unless the lawsuit is overturned.
For more information on the FDA’s cigarette health warning label program, please visit http://www.fda.gov/TobaccoProducts/Labeling/CigaretteWarningLabels/default.htm.