Medicare Working to Improve Quality and Response Times

Recently Medicare offered two key announcements which will improve efficiencies and eliminate confusion in the system. On February 16th Medicare announced the Core Quality Measures Collaborative, and on February 9th they announced plans to improve response times through the Commercial Repayment Center.

On February 16, 2016, the Centers for Medicare & Medicaid Services (CMS) and various industry groups announced they are working together through the Core Quality Measures Collaborative to identify core sets of quality measures that payers have committed to using for reporting as soon as feasible. The participants are developing the future core quality measurements that will be meaningful to patients, consumers, and physicians.

The core measures are in the following seven data sets:

•  Accountable Care Organizations (ACOs), Patient Centered Medical Homes (PCMH), and Primary Care

•  Cardiology

•  Gastroenterology

•  HIV and Hepatitis C

•  Medical Oncology

•  Obstetrics and Gynecology

•  Orthopedics

Medicare is already using many of the quality indicators in their system. For a copy of the full announcement with additional information, please click here >>

Earlier in the month on February 9, 2016, CMS announced an initiative to improve response times for industry participants. Since October 2015, the Centers for Medicare & Medicaid Services’ (CMS) Commercial Repayment Center (CRC) assumed responsibility for the recovery of conditional payments where CMS is pursuing recovery directly from a liability insurer (including a self-insured entity), no-fault insurer or workers’ compensation (WC) entity as the identified debtor. The CRC has issued more than 33,000 Conditional Payment Letters (CPLs) and Conditional Payment Notices (CPNs) from last October. CMS is aware that many insurers and WC entities are awaiting CPLs, CPNs, or demand letters. CMS is actively engaged with the CRC to improve responsiveness to requests for conditional payment information and the handling of correspondence.

For a full reading of this recent announcement and other associated information, please click here >>