Rule2023-16140
Medicare Program; Alternative Payment Model (APM) Incentive Payment Advisory for Clinicians-Request for Current Billing Information for Qualifying APM Participants
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
July 31, 2023
Issuing agencies
Health and Human Services DepartmentCenters for Medicare & Medicaid Services
Abstract
This advisory is to alert certain clinicians who are Qualifying APM participants (QPs) and eligible to receive an Alternative Payment Model (APM) Incentive Payment that CMS does not have the current billing information needed to disburse the payment. This advisory provides information to these clinicians on how to update their billing information to receive this payment.
Full Text
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<title>Federal Register, Volume 88 Issue 145 (Monday, July 31, 2023)</title>
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[Federal Register Volume 88, Number 145 (Monday, July 31, 2023)]
[Rules and Regulations]
[Page 49309]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2023-16140]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Part 414
[CMS-5538-N]
Medicare Program; Alternative Payment Model (APM) Incentive
Payment Advisory for Clinicians--Request for Current Billing
Information for Qualifying APM Participants
AGENCY: Centers for Medicare & Medicaid Services (CMS), Health and
Human Services (HHS).
ACTION: Payment advisory.
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SUMMARY: This advisory is to alert certain clinicians who are
Qualifying APM participants (QPs) and eligible to receive an
Alternative Payment Model (APM) Incentive Payment that CMS does not
have the current billing information needed to disburse the payment.
This advisory provides information to these clinicians on how to update
their billing information to receive this payment.
DATES: Updated billing information must be received no later than
September 1, 2023 (see SUPPLEMENTARY INFORMATION for details).
FOR FURTHER INFORMATION CONTACT: Tanya Dorm, (410) 786-2216.
SUPPLEMENTARY INFORMATION:
I. Background
Under the Medicare Quality Payment Program, an eligible clinician
who participates in an Advanced Alternative Payment Model (APM) and
meets the applicable payment amount or patient count thresholds for a
performance year is a Qualifying APM Participant (QP) for that year.
For payment years 2019 through 2024, which corresponds to Performance
Periods for 2017 through 2022, an eligible clinician who is a QP for a
year based on their performance in a QP Performance Period earns a 5
percent lump sum APM Incentive Payment that is paid in a payment year
that occurs 2 years after the QP Performance Period. The amount of the
APM Incentive Payment is equal to 5 percent of the estimated aggregate
paid amounts for covered professional services furnished by the QP
during the calendar year immediately preceding the payment year.
II. Provisions of the Advisory
The Centers for Medicare & Medicaid Services (CMS) has identified
those eligible clinicians who earned an APM Incentive Payment for the
calendar year (CY) 2023 payment year based on their QP status for the
2021 QP performance period.
When CMS disbursed the CY 2023 APM Incentive Payments, CMS was
unable to verify current Medicare billing information for some QPs and
was therefore unable to issue payment. In order to successfully
disburse the APM Incentive Payment, CMS is requesting assistance in
identifying current Medicare billing information for these QPs in
accordance with 42 CFR 414.1450(c)(8).
CMS has compiled a list of QPs we have identified as having
unverified billing information. These QPs, and any others who
anticipated receiving an APM Incentive Payment but have not, should
follow the instructions to provide CMS with updated billing information
at the following web address: <a href="https://qpp.cms.gov/resources/resource-library">https://qpp.cms.gov/resources/resource-library</a>.
If you have any questions concerning submission of information
through the website, please contact the Quality Payment Program Help
Desk at 1-866-288-8292.
All submissions must be received no later than September 1, 2023.
After that time, any claims to an APM Incentive Payment for the CY 2023
payment period based on an eligible clinicians' QP status for the 2021
QP performance period will be forfeited.
All submissions received by September 1, 2023, will be processed
together on one date as soon as practicable after September 1, 2023.
CMS will not notify the submitter if we are unable to process the APM
Incentive Payment based on the billing information submitted for an
eligible clinician.
The Administrator of the Centers for Medicare & Medicaid Services
(CMS), Chiquita Brooks-LaSure, having reviewed and approved this
document, authorizes Evell J. Barco Holland, who is the Federal
Register Liaison, to electronically sign this document for purposes of
publication in the Federal Register.
Dated: July 25, 2023.
Evell J. Barco Holland,
Federal Register Liaison, Centers for Medicare & Medicaid Services.
[FR Doc. 2023-16140 Filed 7-28-23; 8:45 am]
BILLING CODE 4120-01-P
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</html>Indexed from Federal Register on July 31, 2023.
This is legal information, not legal advice. Laws vary by jurisdiction and change frequently. Always verify current law with official sources and consult a licensed attorney in your jurisdiction for advice on your specific situation.