April 22, 2016

CMS Seeks Input on Patient Relationship Categories for MACRA Programs

Last week, the Centers for Medicare and Medicaid Services (CMS) released a new Request for Information (RFI) seeking public comment on patient relationship categories and codes to be developed under the new Merit-based Incentive Payment System (MIPS).

The patient relationship codes are seen as a tool that could be used to more accurately attribute patients to the appropriate physicians for the purposes of identifying the physician who is responsible for particular services.

Medicare Access and CHIP Reauthorization Act (MACRA) requires the establishment and use of classification code sets to include care episode and patient condition groups and codes, and patient relationship categories and codes. These patient relationship categories and codes will be used in the Merit-based Incentive Program (MIPS) to measure resource use. They could potentially be used in alternative payment models (APMs) as well.

MACRA requires CMS to collaborate with the physician and stakeholder community to improve resource use measurement and the establishment of classification code sets. MACRA also requires a 120-day comment period. Comments will be due August 15, 2015. Physicians will have to include the newly developed codes on their claims as of January 1, 2018 if they choose to participate in MIPS.

The ACR is reviewing the categories and questions and will be developing comments.

The RFI is available here.