MIPS Value Pathways Framework

CMS has published a brand-new term, the “MIPS Value Pathways Framework” (MVPs). As part of the proposed rules, CMS is seeking feedback on its new MVPs, which aims to move MIPS toward a new set of measures that are more clinically relevant for each provider.

CMS proposes that a clinician or group has the choice to opt into an MVP associated with their specialty or opt into a clinical condition. Providers would be reporting on the same measures and activities as other clinicians and groups in the MVP that the provider has opted into. Each MVP “track” would connect measures and activities across the various MIPS performance categories and could rely on a mix of specialty-specific measures as well as population-based administrative claims-based measures automatically calculated by CMS. MVPs would also include more robust and timely performance feedback to better prepare clinicians for transitioning to risk-based alternative payment models. MVPs could begin to apply as early as the 2021 performance year.

A more detailed fact sheet on proposed changes to the quality payment program can be found here.

Hospital Price Transparency

As part of the proposed OPPS rule, CMS published a series of proposals that collectively aim to increase the transparency of hospital charges. Notably, CMS is proposing requirements that would force hospitals to make their private-payer negotiated (contracted) rates (for “shoppable” services) available to the public.

Hospital Clinic, Emergency Department, and Critical Care Payments

CMS proposed no major changes for hospital-based clinics and emergency department facility payments as well as facility critical care services and trauma activation services. The policies for these services would also remain generally unchanged.

A more detailed fact sheet regarding both the payment and quality proposals in the OPPS rule can be found here.

Need More Help?

Resources for these and other topics can be found on the reimbursement section of the ACEP website, www.acep.org/administration/reimbursement. ACEP Director of Reimbursement David McKenzie, CAE, can field questions at 800-708-1822, ext. 3233. Finally, ACEP offers well-attended and highly recommended coding and reimbursement educational conferences annually, with the next conference scheduled for Jan. 27–31 in Austin, Texas. Visit www.acep.org/rc for details.

Dr. Granovsky is president of LogixHealth, an ED coding and billing company, and currently serves as the course director of ACEP’s Coding and Reimbursement courses. He may be reached at mgranovsky@logixhealth.com.

Mr. McKenzie is ACEP director of reimbursement.