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Practice Information


Medicare uses a variety of mechanisms to set policies for coverage of services. At the national level, the Centers for Medicare and Medicaid Services (CMS) may issue a National Coverage Determination (NCD). Medicare administrative contractors (MAC) may issue Local Coverage Determinations (LCDs) or may choose to cover services or therapies on a case-by-case basis. If an NCD or LCD does not exist, it does not simply mean that Medicare will not pay for the service.

When national coverage has not been specified in NCD, MACs may choose to provide coverage for a service through an LCD. An LCD may be written in a manner that provides broad coverage, coverage with certain restrictions, or non-coverage. MACs develop LCDs through a process that is less formal than that used to develop an NCD. That process includes expert feedback from designated physician representatives. In Florida these include our CAC Representatives listed about who attend three formal meetings per year and consult with our carrier, First Coast Service Options.

Additional Tools for Practices
This tool provides current and draft local coverage determinations (LCDs), when they exist, for Medicare-covered procedure codes. Not every procedure code is covered by an LCD. For previous versions of an LCD, refer to the CMS Medicare coverage database. Click here for the tool.

Heart House has developed a network of CAC representatives from across the nation that meet as a group to review trends and analyze issues. The chair of the Third Party Reimbursement Committee is active at the national level through meetings and constant communication with colleagues.

National ACC has a web portal dedicated to practice issues. See this link for in-depth issues."Do Your PART" to Improve the Prior Authorization Process 

Payer-directed prior authorization for diagnostic imaging and medications is a tremendous barrier to patient care in today's cardiovascular care landscape. Help the ACC improve the prior authorization process by expanding the current data collection of inappropriate denials and difficult cases. ACC members and their staff are encouraged to submit instances of incorrect prior authorization denials for cardiac procedures and PCSK9 prescription through ACC's Prior Authorization Tool (PARTool) suite. Robust data collection is the first step to identifying and correcting exhaustive administrative burdens. Do your PART to improve the prior authorization.
Submit your data at ACC.org/PARTool today!


Estimate RVUs With Physician Fee Schedule Calculator

Work, practice expense and liability relative value units (RVUs) are updated annually through Medicare physician fee schedule rulemaking. ACC's new Physician Fee Schedule Calculator allows clinicians and practice managers to estimate the practice impact of changes included in the proposed 2021 Medicare Physician Fee Schedule and related addenda. Over time, the goal of the tool is to facilitate a thorough understanding of impacts from one year to the next. Download the tool.

CMS Launches New “Care Compare” Tool

The Centers for Medicare and Medicaid Services (CMS) on Sept. 3 launched the Care Compare tool, a streamlined redesign of eight existing health care compare tools previously available from CMS. The new tool allows patients and caregivers to extract a wealth of information about doctors, hospitals, nursing homes and other health care services, including cost, quality of care and volume of services. CMS has also made improvements to other agency data tools, including a price transparency tool and online decision support. Access the Care Compare website here.

Health Care Delivery During the COVID-19 Pandemic and Beyond: CV Transforum Fall’20 Virtual

Join cardiovascular experts from around the country for MedAxiom’s CV Transforum Fall’20 Virtual, taking place Oct. 8 – 10! The conference will feature a mix of general sessions on today’s top-of-mind issues and intimate breakout sessions that take a deep dive into unique cardiovascular challenges. Hot agenda topics include: Strategic Planning in a Post-COVID World; Telehealth and Remote Patient Monitoring Programs For the Future; Contemporary CV Physician Compensation Models; and Pandemic Recovery Best Practices. View the agenda and register now.

Deep Dive Into Proposed Physician Fee Schedule QPP Policies

In response to the continued need for clinicians across the country to address COVID-19, CMS limited the number of significant changes to the Quality Payment Program (QPP) in the proposed 2021 Medicare Physician Fee Schedule. Among the highlights: CMS delayed the implementation timeline for the Merit-Based Incentive Payment System (MIPS) Value Pathways (MVPs) until the 2022 performance period. Additionally, the agency introduced an Alternative Payment Model (APM) Performance Pathway (APP) to align with the MVP framework. As part of APP implementation, the CMS web interface would be sunset as a collection type beginning in the 2021 performance period. Read more details

HHS Extends Provider Relief Funding Deadline For More Providers

The Department of Health and Human Services (HHS) announced an application deadline extension for the Phase 2 general distribution of CARES Act Provider Relief Fund to Medicaid, Medicaid managed care, Children's Health Insurance Program (CHIP) and dental providers. The agency plans to allow certain Medicare providers who experienced challenges in the Phase 1 Medicare General Distribution application period a second opportunity to receive funding. Both groups will have until Friday, Aug. 28 to apply. Get details relevant to your practice and apply here

Coming Soon: 2021 Self-Nomination Application Virtual Office Hours With CMS

The 2021 MIPS performance period self-nomination is quickly approaching! On Thursday, Aug. 13, from 1 – 2:30 p.m. ET., CMS will host 2021 self-nomination application virtual office hours to give attendees the opportunity to ask questions about the self-nomination forms for the 2021 MIPS performance period in the QPP website. Register here

CardioSmart Debuts New Website For Patients, Clinicians

Your ACC’s new CardioSmart website is designed to emphasize the value of the patient and clinician partnership to personalize care. With the goal of better connecting patients with their clinicians to prevent or treat heart disease, the new CardioSmart.org provides information on heart conditions and trusted resources and tools to support important health conversations and foster strong partnerships. “Our new website is user-friendly, for both health care professionals and patients. Clinicians can refer patients, and patients can effortlessly find the information they need to aid in making key health decisions,” said Martha Gulati, MD, FACC, editor-in-chief of CardioSmart. “We continue to evolve and develop the resources our members want for our patients, be an up-to-date reliable source for everyone and improve the ease with which everyone can access information, whether from a clinic setting or at home.” Learn more

JACC Study: Cardiology Practices Consolidate in Response to Market Changes

Cardiologists are joining larger practices over time as health care markets change and emphasis on alternative payment models (APMs) increases, according to a study published July 27 in the Journal of the American College of Cardiology. Jose F. Figueroa, MD, MPH, et al., looked at whether cardiologists joined larger practices between 2013 and 2017 and at physician-level, community-level and supply-side factors associated with practice consolidation. The researchers found an association between higher market concentration and greater growth in practice size, suggesting “cardiologists may be responding to market-level forces.” “The rise of APMs, such as bundled payments and accountable care organizations … may be contributing,” they concluded. Read more

Understanding COVID-19 Testing For CV Specialists: Small Words With Big Pictures

With countries and states slowly reopening, questions and controversies around antibody testing and its effectiveness persist. Watch a Summer COVID-19 Education Session, “Understanding COVID-19 Testing For Cardiovascular Specialists: Small Words With Big Pictures,” led by Edward T. A. Fry, MD, FACC, with an expert panel of scientists, on demand to get an overview on serologic antibody testing, antibody tests and research articles. Also, be sure to read the latest document in Quick Tips on your ACC’s COVID-19 Hub, explaining how CMS and private payers have changed billing for telehealth/telemedicine/digital/remote services. 

Thinking Differently: Care Delivery and the Business of Medicine During COVID-19

By late March, MedAxiom's Impact of COVID-19 on Cardiovascular Organizations Survey found that more than half of respondents were performing less than 25% of their patient visits face-to-face. The pandemic proved that cardiovascular programs and practices can make enormous shifts in their access protocols, at lightning speed, but challenges remain. Read a new article in Cardiology magazine to learn more about operational changes and thinking differently when quick pivots are needed for care delivery. 

CMS Announces Ability to Opt Out of 2020 MIPS Program Due to PHE

This week, the Centers for Medicare and Medicaid Services (CMS) announced that physicians will have the option to opt-out completely or partially from the 2020 Merit-Based Incentive Payment System (MIPS) program by completing a hardship exemption application and indicating it is due to the COVID-19 public health emergency. Individual clinicians and group practices have until Dec. 31, 2020 to complete the hardship application. Learn more

New Telehealth Research and Learning Opportunities!

HHS has formed a 10-week virtual learning community, “Telemedicine Hack,” to accelerate telemedicine implementation for ambulatory providers. The community will meet every Wednesday through Sept. 23, from noon – 1 p.m. ET. The program will include “teleECHO” sessions on key topics and case studies from the field, virtual office hour discussion panels, peer-to-peer learning through virtual discussion boards, and CME/CEU credit. Register and learn more here. Also, the American Medical Association is seeking clinician input as part of a Telehealth Impact Physician survey, an effort of the COVID-19 Healthcare Coalition. Survey responses will build on existing research to help provide insights to federal and state policymakers, and identify gaps in current research. Take the survey here

CMS Releases 2020 Measure Development Plan (MDP) Annual Report

CMS has released the Annual Report of the 2020 Quality Measure Development Plan (MDP), which describes progress in developing clinician quality measures to support the QPP. The report provides information and support to key stakeholders who develop clinician quality measures, many of which are implemented in the QPP. CMS continues to emphasize streamlining measures and reducing administrative burden. Of note, the agency is increasing reliance on digital quality measures and will continue the development of cost measures. ACC’s Partners in Quality (PIQ) Subcommittee is currently reviewing these and other quality- and measure-related issues. To learn more about the PIQ, please contact Fareen Pourhamidi at fpourham@acc.org. Read more about the MDP annual report here

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Florida Chapter, American College of Cardiology
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Orlando, FL 32803


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