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CMS Announces New Initiative to Increase Clinician Engagement

October 14, 2016

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PRESS CONTACTS
Len Marquez, Senior Director, Government Relations

The Centers for Medicare and Medicaid Services (CMS) Oct. 13 announced a new initiative to increase clinician engagement and improve clinician satisfaction. This new, long-term effort aims to reshape physician experience by reviewing regulations and policies to minimize administrative burden.

The Medical Review Reduction initiative is an 18-month pilot program to reduce medical review for certain physicians practicing within specific Advanced Alternative Payment Models (APMs). Medical review is the process by which CMS reviews claims and payment for accuracy. While some reviews are automatically assessed through claims data, other issues may call for the provider to submit additional medical record documentation to support the claims selected for review.

Specific Advanced APMs were identified for this pilot because participating providers share financial risk with the Medicare program. These include: Next Generation Accountable Care Organizations (ACOs), Medicare Shared Savings Program Track 2 and 3 participants, Pioneer ACOs, and Oncology Care 2-Sided Risk Model participants.

As a part of Phase 1 (Jan. 1, 2017 – June 1, 2018), CMS will direct Medicare Administrative Contractors (MACs), Recovery Audit Contractors (RACs), and the Supplemental Medical Review Contractor to consider as a low priority for post-payment medical record review claims for providers participating in the aforementioned Advanced APMs. In Phase 2 (April 1, 2017 – June 1, 2018), providers in these Advanced APMs will also be considered as low priority for prepayment medical review by MACs.

During the 18-month pilot, CMS will continue to monitor and assess the progress of the program to determine whether to continue or expand it based on results.

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