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Author: Lauren Brown

New CMS Updates: Check Your 2025 APM Participation and QP Status Now

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CMS has released the first snapshot of 2025 APM (Alternative Payment Model) data through the Quality Payment Program (QPP) Participation Status Tool. This update includes Qualifying APM Participant (QP) status and MIPS APM participation status based on Medicare Part B claims from January 1 to March 31, 2025. If you’re participating in an APM, now’s the time to log into the QPP portal and check your status using your 10-digit NPI number. It’s essential to…
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MDPP CY 2026 PFS Proposed Rule Summary Released

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The Medicare Diabetes Prevention Program (MDPP) CY 2026 PFS Proposed Rule Summary for MDPP is now available for your review. This summary provides important information regarding proposed policies for the Calendar Year (CY) 2026 PFS Proposed Rule related to MDPP. Access the Fact Sheet: MDPP CY 2026 PFS Proposed Rule Summary for MDPP

Prepare Now: Windows 10 Support Ends October 14, 2025

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After October 14, 2025, computers running Windows 10 will still function, but Microsoft will no longer provide the following:   While you could continue to use a PC running Windows 10, without continued software and security updates, your PC will be at a greater risk for viruses and malware. After this date, we recommend upgrading to a version of Windows that is still supported. A new device that can run Windows 11 makes for an easy…
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DAC Preview Period is reopening

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The Centers for Medicare & Medicaid Services (CMS) will reopen the calendar year (CY) 2023 Doctors and Clinicians Preview Period on Wednesday, July 23, 2025. The Preview Period will remain open for 30 days, closing Thursday, August 21, 2025, at 8 p.m. ET, 7 pm CT. CMS is reopening the Preview Period because 17 additional Quality Payment Program (QPP) performance measures were recently identified to be included in the CY 2023 QPP public reporting information. CMS also…
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CHAMPVA Providers: EFT Enrollment Required to Receive Payment

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Important information from the CMS Weekly Update issued on July 10th, 2025, If you see patients covered under CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs), enrolling in Electronic Funds Transfer (EFT) is mandatory to receive reimbursement. The VA has paused payments for providers not currently enrolled in EFT and will resume payment processing once enrollment is complete — this is a federal requirement. Why EFT Enrollment Matters: What is CHAMPVA?…
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2023 Doctors and Clinicians Preview Period Is Coming

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The Doctors and Clinicians Preview Period will open officially on Tuesday, May 27, 2025. You can preview your 2023 Quality Payment Program (QPP) performance information before it appears on the profile pages of clinicians and groups on the Medicare.gov compare tool and in the Provider Data Catalog (PDC). You’ll be able to access the secure preview on the QPP website. For help accessing the QPP website or getting your Health Care Quality Improvement Systems (HCQIS) Access Roles and Profile (HARP) user…
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CMS: New Wait Time Requirements Beginning January 1, 2025

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A new ruling by CMS regarding the Qualified Health Plan (QHP) requires issuers to ensure that patients can schedule appointments within the time frames listed below at least 90% of the time: Behavioral Health: 10 business daysPrimary Care: 15 business daysSpecialty Care (Non-Urgent): 30 business days “Secret shopper” calls will be made by third party entities to conduct assessments in order evaluate compliance with these wait time standards in the areas of primary care and…
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Blue Cross Transition to Labcorp Delayed Until March 1, 2025

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Blue Cross has delayed its transition to LabCorp as the exclusive national laboratory and only Preferred Medical Laboratory Plus (PLMP) provider in the Preferred Medical Laboratory (PML) network until March 1, 2025. By delaying this transition, providers will have more time to transition their electronic interface to a participating laboratory. These transitions can take up to 60 days, so it is imperative that providers begin to transition now. Blue Cross has stated that the new…
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QPP Exception Applications NOW AVAILABLE for 2024

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CMS has announced that the 2024 Quality Payment Program (QPP) Exception Applications are available now through December 31, 2024 at 8pm ET. There are 2 types of exception applications for users who are unable to report data for one or more Merit-Based Incentive Payment Systems (MIPS) performance categories. MIPS Promoting Interoperability Performance Hardship Exception Application which can be filed for the following reasons: MIPS Extreme and Uncontrollable Circumstances Exception Application – these circumstances are defined as…
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Medication Reconciliation Post-Discharge

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As a reminder, the Medication Reconciliation Post-Discharge measure is displayed for Primary Care Select providers. This measure looks at the percent of members 18 and older with an inpatient admission during the measurement year for whom medications were reconciled from the date of discharge through 30 days after discharge (31 total days) from the first qualified admission during the measurement year by a prescribing practitioner, clinical pharmacist or registered nurse. Patients who used hospice services…
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Patient Billing Best Practices

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Collecting patient balances in a medical billing environment requires a systematic approach to ensure timely and efficient payment. Not only is it necessary to be persistent, but also to remain committed to the best patient communication techniques. Patient engagement when it comes to payments should rank at the top of the list in importance for a financially healthy practice. Listed below is a helpful,  step-by-step guide on how to best manage and collect patient balances:…
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Industry Updates – in case you missed them!

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Blue Cross: Star Score Preview Coming Soon to Provider InsightsDuring the fourth quarter of 2024, Provider Insights will begin displaying a prospective star score for Quality. There will be a preview period through 2025 and become effective for scoring in the first quarter of 2026. This prospective star score will be used to determine the value-based payment for meeting Quality thresholds. This impacts primary care providers, including pediatricians as the shift to star score methodology…
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