CMS redefines relationship category codes, part of QPP, in updated RFI

by Richard Scott on Dec 15, 2016
Expect to see a new batch of HCPCS codes in the near future that you'll have to use to define the type of relationship between your providers and their patients.
 
An unfolding part of the Quality Payment Program (QPP), the "patient relatoinship categories and codes" provision requires that practices officially describe the nature of their patient relationships -- for example, you're likely to find codes that depict a "continuous," "episodic" or other type of treatment.
 
This week CMS released a four-page update to the patient relationship categories and codes initiative, which will go into effect in 2018. For now, CMS is seeking comment on a range of updated categories it plans to use to describe patient-provider relationships.
 
CMS plans to use Level II HCPCS modifiers to define such relationships.The modifiers, should they remain the method of choice, would be required on all claims starting Jan. 1, 2018. In the meantime, practices can submit comments on the overall scope of the program and on categories and codes specifically.
 
For example, CMS wants to know: "Are the draft categories clear enough to enable clinicians to consistently and reliably self-identify an appropriate patient relationship category for a given clinical situation?"
 
Also, "Are HCPCS modifiers a viable mechanism for CMS to use to operationalize this work to include the patient relationship category on the Medicare claim? If not, what other options should CMS consider and why?"
 
CMS will accept comments through Jan. 6. Comments should be addressed to patientrelationshipcodes@cms.hhs.gov.
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