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  • Washington Highlights

    CMS Releases Update on Patient Relationship Categories and Codes under MACRA

    Len Marquez, Senior Director, Government Relations

    The Centers for Medicare and Medicaid Services (CMS) released an update on the Patient Relationship Categories and Codes. The codes, which are required by the Medicare Access and CHIP Reauthorization Act (MACRA, P.L. 114-10), would be used as a tool to more accurately attribute patients to the physicians responsible for particular services and the overall cost of care.

    These categories are intended to help CMS more effectively measure cost, a major performance category under the Merit-based Incentive Payment System (MIPS). CMS posted a draft list of patient relationship categories in April. The agency received over 75 public comments, including comments from the AAMC, and has decided to modify the categories. CMS continues to seek comments on the updated categories below:

    • Continuous/broad: Clinicians who provide principal care for a patient, where there is no planned endpoint of the relationship;

    • Continuous/focused: Specialist whose expertise is needed for ongoing management of a chronic disease or a condition;

    • Episodic/broad: Clinicians that have broad responsibility for comprehensive needs of the patients but for only a defined period of time;

    • Episodic/focused: Specialist focused on particular types of time-limited treatment; and

    • Only as ordered by another clinician: Clinician who furnishes care to the patient only as ordered by another clinician.

    Furthermore, CMS is considering several options for codes that must be included on claims submitted for items and services furnished by applicable clinicians on or after Jan. 1, 2018, to identify patient relationship categories. In the update, CMS has identified Healthcare Common Procedure Coding System (HCPCS) modifiers to be the most appropriate option because clinicians are already familiar with how these codes operate and will thereby allow more precise analysis of attribution.

    AAMC will be submitting comments, which are due by Jan. 6, 2017.