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2024 MIPS Scores, Cost Measure Exclusion, and 2025 APM Incentive Updates: Key Deadlines and Actions

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2024 MIPS Final Scores and Targeted Review Available Mid-September As previously announced (QPP listserv sent 7/25/2025), there was a delay with receiving some of the final Medicare claims data needed to calculate cost measures, which is delaying the release of MIPS final scores for the 2024 performance year and the Targeted Review period. MIPS payment adjustments for the 2026 MIPS payment year will be released approximately one month after the release of final scores. The…
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PPL Status Applies to Practices With CLIA Certification Higher Than CLIA Waived

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All Preferred Medical Doctors (PMD) and participating advanced practice providers are eligible for reimbursement of laboratory services identified in Exhibit I of the PMD Agreement. Providers who perform more advanced laboratory tests not listed in Exhibit I must be credentialed as a PPL to receive reimbursement. A new report is available that provides the status of the PPL designation for your providers. Access the “Preferred Physician Laboratory” report from Profiles & Reports by logging in to ProviderAccess. This report…
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Reminder: Preview Your CY 2023 QPP Data for Public Reporting + New Measure Release Notes Available

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The Centers for Medicare & Medicaid Services (CMS) has reopened the calendar year (CY) 2023 Doctors and Clinicians (DAC) Preview Period, which will remain open until Thursday, August 21, 2025, at 8 p.m. ET (5 p.m. PT). CMS reopened the Preview Period because adjustments were made resulting in the addition of 2 clinician quality measures and 17 group quality measures available for public reporting. CMS also made updates and display corrections to the CY 2023…
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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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