Frequently Asked Questions

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FAQ

Top Questions


What is an IRS Form CP 575?
The IRS Form CP 575 is an Internal Revenue Service generated letter you receive from the IRS granting your Employer Iden... (more)

What is the definition of "new patient" for billing evaluation and management (E/M) services?
Interpret the phrase "new patient" to mean a patient who has not received any professional services, i.e., evaluation an... (more)

[EHR Incentive Programs]  How can a provider meet the “Protect Electronic Health Information” core obj...
To meet the “Protect Electronic Health Information” core objective for Stage 1, eligible professionals (EP), eligible... (more)

How should eligible professionals select menu objectives for the Medicare Electronic Health Record (EHR) In...
Medicare eligible professionals participating in Stage 1 of the EHR Incentive Programs are required to report on a to... (more)

[EHR Incentive Programs]  For meaningful use Stage 2's transitions of care and referrals objective, in...
An EP, eligible hospital, or CAH could use 3 distinct approaches (which could also be used in combination) to meet th... (more)

How do I report for the 2014 Physician Quality Reporting System (PQRS) if there are fewer than 9 applicable...
For 2014 PQRS eCQMs, the expectation is that eligible professionals (EPs) or group practices reporting via the Group ... (more)

[EHR Incentive Programs] Who can enter medication orders in order to meet the measure for the computerized ...
Any licensed healthcare professional can enter orders into the medical record for purposes of including the order in the... (more)

What can I do to avoid the Physician Quality Reporting System payment adjustment?
Beginning in 2015, CMS will subject eligible professionals who are not successful reporters under Physician Quality R... (more)

Are self-insured health plans required to get a Health Plan Identifier (HPID)?
A self-insured health plan must answer two questions to determine whether it must obtain an HPID.• Does it meet... (more)

What physician referral data sets are publicly available?
... (more)

[EHR Incentive Programs] In order to receive payments under the Medicare and Medicaid Electronic Health Rec...
In order to receive Medicare EHR incentive payments, EPs, eligible hospitals, and critical access hospitals must have... (more)

[EHR Incentive Programs] A number of measures for Meaningful Use objectives for eligible hospitals and crit...
There are two methods for calculating ED admissions for the denominators for measures associated with Meaningful Use ... (more)

[EHR Incentive Programs]  When reporting on the Summary of Care objective in the Medicare and Medicaid...
CMS is aware of difficulties eligible professionals, eligible hospitals, and critical access hospitals (CAHs) are hav... (more)

[EHR Incentive Program]  Will the Centers for Medicare & Medicaid Services (CMS) conduct audits as...
Any provider attesting to receive an EHR incentive payment for either the Medicare or Medicaid EHR Incentive Program ... (more)

What simple steps can I take to submit Physician Quality Reporting System (PQRI) quality measures data on c...
Take the following steps to begin claims-based reporting for Physician Quality Reporting: 1). Use the measure specificat... (more)

[EHR Incentive Programs]  For Measure 2 of the Stage 2 Summary of Care objective for the Electronic He...
Yes.  An EP, eligible hospital or CAH may count transmissions in this measure’s numerator when a third party org... (more)

[EHR Incentive Programs]  When meeting the meaningful use measure for computerized provider order entr...
If a staff member of the eligible provider is appropriately credentialed and performs similar assistive services as a... (more)

How do I report medically reasonable and necessary units of service in excess of a Medically Unlikely Edit ...
For MUEs that are adjudicated as claim line edits, each line of a claim is adjudicated separately against the MUE value ... (more)

[EHR Incentive Programs] What do the numerators and denominators mean in measures that are required to demo...
There are 15 measures for EPs and 14 measures for eligible hospitals that require the collection of data to calculate a ... (more)

[EHR Incentive Programs]  When reporting on the Summary of Care objective in the Electronic Health Rec...
A transition of care is defined as the movement of a patient from one setting of care (hospital, ambulatory, primary ... (more)

Are Flexible Spending Accounts (FSAs), Health Reimbursement Arrangements (HRAs), Health Savings Account (HS...
FSAs and HSAs are individual accounts directed by the consumer to pay health care costs.  As such, they do not r... (more)

How do I obtain the National Correct Coding Initiative (NCCI) Policy Manual?
The National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services may be obtained through the CMS websit... (more)

What is a Medically Unlikely Edit?
An MUE (Medically Unlikely Edit) is a unit of service (UOS) edit for a Healthcare Common Procedure Coding System (HCPCS)... (more)

What is Measure-Applicability Validation (MAV)?
MAV is a validation process that will determine whether individual eligible professionals (EPs) or group practices sh... (more)

[EHR Incentive Programs]  Does the inclusion of certified Medical Assistant in the list of professiona...
We have revised the description of who can enter orders into the EHR and have it count as CPOE and have it count for pur... (more)

What procedures and services are payable when performed in the Ambulatory Surgical Center (ASC) setting und...
Under the ASC payment system, Medicare will make facility payments to ASCs only for the specific ASC covered surgical pr... (more)

[EHR Incentive Programs]   If my practice does not typically collect information on any of the co...
This FAQ applies to providers who are reporting 2013 CQMs.   Eligible professionals (EP) are not... (more)

How do I know if I have a PECOS Record?
There are three (3) ways to verify that you have an enrollment record in PECOS:  Check the Ordering and Referrin... (more)

How do I obtain a Health Plan Identifier (HPID)?
In order to enumerate (obtain an HPID), a health plan should:1. Create an account in the ... (more)

[EHR Incentive Programs]  If an eligible provider fails to meet meaningful use (MU) during a participa...
An Eligible Professional (EP), Eligible Hospital or Critical Access Hospital (CAH) that participates in the Medicare ... (more)

If an applicable manufacturer gave a contribution to support a medical conference, but did not have any say...
Unrestricted donations to a medical conference as described in this FAQ would not be subject to reporting under Open ... (more)

Does an eligible professional’s (EP’s) electronic health record (EHR) system have to be 2014 certified elec...
EPs and group practices are not required to have 2014 CEHRT for the full year of PQRS or have 2014 CEHRT implemented ... (more)

For 2014, how will my Physician Quality Reporting System (PQRS) incentive payment and/or payment adjustment...
Please note that EPs cannot combine reporting options to reach the nine (9) measures across three (3) National Qualit... (more)

How are the measure numerator and denominator determined for the Physician Quality Reporting System (Physic...
Physician Quality Reporting measures consist of two major components. Each component is defined by specific codes descri... (more)

[EHR Incentive Programs] Is the physician the only person who can enter information in the electronic healt...
No. The Final Rule for the Medicare and Medicaid EHR incentive programs, specifies that in order to meet the meaningful ... (more)

Which group health plans must obtain HPIDs?
A health plan (as defined in 45 CFR 160.103) includes a group health plan that provides, or pays the cost of, medical... (more)

[EHR Incentive Programs]  While the denominator for measures used to calculate meaningful use in the M...
The criteria for a numerator is not constrained to the EHR reporting period unless expressly stated in the numerator ... (more)

How and when will incentive payments for the Medicare Electronic Health Record (EHR) Incentive Programs be ...
For eligible professionals (EPs), incentive payments for the Medicare EHR Incentive Program will be made approximatel... (more)

Starting with 2016 Open Payments data collection and reporting to CMS in 2017, are payments provided by an ...
Yes, the payment is reportable if the applicable manufacturer determines that the payment meets the definition of an ... (more)