CMS pilot to ease medical record reviews for certain advanced payment models

The Centers for Medicare & Medicaid Services today announced a pilot program to reduce medical record reviews for physicians and hospitals participating in certain advanced alternative payment models. The 18-month program will apply to payment models that CMS has identified as advanced APMs under the Medicare Access and CHIP Reauthorization Act of 2015: Next Generation Accountable Care Organizations, Medicare Shared Savings Program tracks 2 and 3, Pioneer ACOs, and the two-sided track of the Oncology Care Model. During the first phase of the program, from January 2017 to June 2018, CMS will direct Medicare Administrative Contractors, Recovery Audit Contractors and the Supplemental Medical Review Contractor to consider provider claims for beneficiaries aligned to the model a low priority for post-payment medical record review. In the second phase of the program, from April 2017 to June 2018, such claims also will be considered a low priority for prepayment medical record review by MACs. CMS said it will consider whether to expand the program based on the pilot results. For more information, see the CMS factsheet and FAQ. “We are pleased that CMS recognizes the significant burden that excessive audits can place on providers, inhibiting their ability to invest in implementation of payment and delivery reforms,” said Ashley Thompson, AHA senior vice president for public policy analysis and development. “We look forward to working with CMS to identify additional ways in which Medicare regulations and policies can be improved to help clinicians – and the hospitals in which they practice – reduce administrative tasks and focus on providing high-quality patient care.”