The Medical Management Institute - MMI
The Medical Management Institute - MMI
The Medical Management Institute - MMI

MMI Updates & Announcements

  • CMS Issues Guidance to States and Manufacturers Regarding Value Based Purchasing (VBP) Arrangements

    Posted: Jul 14 2016

    The Centers for Medicare & Medicaid Services (CMS) released guidance to states and manufacturers regarding participation in value based purchasing (VBP) arrangements.  The guidance also encourages states to participate in such arrangements as a means to address, as well as offset, higher cost drug treatments.  This guidance has been released through State Release #176 and Manufacturer Release #99, which are available for download by clicking here. If you have any questions regarding the states and/or drug manufacturer releases, email MDROperations@cms.hhs.gov.

  • Proposed Rules for Calendar Year 2017 Released by CMS

    Posted: Jul 07 2016

    On July 7, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that updates payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2017. This year, CMS is proposing a number of new physician fee schedule policies that will improve Medicare payment for those services provided by primary care physicians for patients with multiple chronic conditions, mental and behavioral health issues, and cognitive impairment or mobility-related disabilities. CMS is proposing to expand the Diabetes Prevention Program model starting January 1, 2018.  This is the second CMS Innovation Center – and first preventive services – model that has been certified for expansion.  Expansion of this model will enhance access to these important services for Medicare beneficiaries who are at risk for developing diabetes.  In addition CMS is also: • Proposing modifications to the Medicare...

  • [Announcement] Effective July 1st, 77295 and 77300 Can Be Reported Together

    Posted: Jul 01 2016

    In March 2016, CMS and the NCCI announced that they would remove the current edit prohibiting the reporting of CPT codes 77295 and 77300. The change will take effect today, July 1, 2016 (retroactive to January 1, 2016) and will be finalized in the July version of the NCCI Manual. Reporting requirements may vary by payer. Providers (hospitals, physicians and freestanding cancer centers) should continue to track and capture the supported work of code 77300 during the 3D planning process. When the transmittal is released, providers will be able to submit those charges, along with the retroactive charges, for payment and in accordance with documentation guidelines and published Medically Unlikely Edits (MUEs). Background: CMS originally implemented the prohibition of reporting these codes together (implemented January 1, 2016) because they believed the work of 77300 was integral to the work of 77295. Therefore, it should not be considered a separately reportable procedure. Opponents believed that this NCCI edit...

  • [Announcement] Helping Small Practices Prepare for the Quality Payment Program

    Posted: Jun 25 2016

    The Quality Payment Program is proposed to implement the new, bipartisan law changing how Medicare pays clinicians, known as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). On June 20, HHS announced $20 million to fund on-the-ground training and education for Medicare clinicians in individual or small group practices of 15 clinicians or fewer. These funds will help provide hands-on training tailored to small practices, especially those that practice in historically under-resourced areas including rural areas, health professional shortage areas, and medically underserved areas. As required by MACRA, HHS will continue to award $20 million each year over the next five years, providing $100 million in total to help small practices successfully participate in the Quality Payment Program. In order to receive funding, organizations must demonstrate their ability to strategically provide customized training to clinicians. And, most importantly, these organizations will provide education and consultation about the Quality...

  • [Announcement] Private Payor Prices Will Be Used By Medicare to Set Payment Rates for Clinical Diagnostic Laboratory Tests Beginning in 2018

    Posted: Jun 25 2016

    Clinical Lab Tests

    On June 17, CMS released a final rule implementing Section 216(a) of the Protecting Access to Medicare Act of 2014 (PAMA), requiring laboratories performing clinical diagnostic laboratory tests to report the amounts paid by private insurers for laboratory tests. Medicare will use these private insurer rates to calculate Medicare payment rates for laboratory tests paid under the Clinical Laboratory Fee Schedule (CLFS) beginning January 1, 2018. The final rule includes provisions to ease administrative burdens for physician office laboratories and smaller independent laboratories. The final rule will generally require reporting entities to report private payor rates and test volumes for laboratory tests if an applicable laboratory receives at least $12,500 in Medicare revenues from laboratory services paid under the CLFS and more than 50 percent of its Medicare revenues from laboratory and/or physician services. For the system’s first year, laboratories will collect private payor data from January 1, 2016, through...