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Second Opinion

Learn about policy issues important to medical schools and teaching hospitals, with Executive Vice President Atul Grover, M.D., Ph.D.

Washington Highlights

CMS Announces New Initiative to Increase Clinician Engagement

October 14, 2016—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.

Contact:

Tanvi Mehta
Physician Payment & Quality Specialist, HCA
Telephone: 202-909-2020
Email: tmehta@aamc.org

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Washington Highlights, a weekly electronic newsletter, features brief updates on the latest legislative and regulatory activities affecting medical schools and teaching hospitals.


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For More Information

Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806
Email: jkleinman@aamc.org