CMS begins disbursing 2018 performance year advanced APM incentive payments

Group practices that participated in an advanced alternative payment model (APM) in 2018 should be receiving their bonus payments this week if participating clinicians achieved qualifying participant (QP) status by meeting patient or payment thresholds in 2018. Bonuses may have been transmitted as early as Friday, Sept. 11, and electronic deposits may be labeled as “CMMI QPP MEDICARE.” Payments are generally made to the tax identification number (TIN) associated with the QP’s participation in the advanced APM. The Centers for Medicare & Medicaid Services (CMS) announced that it was unable to verify current Medicare billing information for some QPs and therefore was unable to issue payments. If you expected to receive a payment but have not, please take note of the CMS’ regulatory filing providing instructions for updating billing information. Updated information must be submitted by Nov. 13 (note that early versions of CMS’ instructional document list an incorrect deadline of Nov. 10; MGMA reached out to CMS and confirmed that the correct deadline is Nov. 13). The bonus is 5% of aggregate payments for covered professional services billed by QPs across all TINs associated with the QP in the calendar year immediately preceding the payment year (in this case, 2019).

DOL issues new regulations modifying employee leave rules

Following a New York federal court decision that vacated several aspects of the Department of Labor’s (DOL) regulations under the Families First Coronavirus Response Act (FFCRA), DOL issued new regulations addressing employee leave eligibility and entitlement. Specifically, DOL narrowed its definition of who a “healthcare provider” is for purposes of being excluded by their employer from receiving FFCRA paid leave. In a departure from its previous definition, DOL stated that a person is not a healthcare provider merely because his or her employer provides healthcare services. Therefore, IT professionals, HR personnel, billers, building maintenance staff, and others are not considered healthcare providers within the meaning of the regulations and therefore are not eligible for exclusion from FFCRA leave. For more information on the revised regulations, reference DOL’s updated FAQ and MGMA’s updated FFCRA resource.

2019 MSSP ACO results announced

The 541 accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) generated nearly $1.2 billion in net savings in 2019, the highest number to date for the program. ACOs saved $739 million in 2018 and $313 million in 2017. CMS Administrator Seema Verma announced the results in a blog post on Health Affairs, which includes links to more comprehensive data files. MSSP ACOs share in any savings generated for Medicare if they meet certain spending and quality metrics. The MSSP is the largest Medicare APM and began in 2012.