4 QUALITIES OF MEDICAL BILLING SERVICES BENEFITING HEALTHCARE

What do you think is the main reason behind hiring or outsourcing a medical billing service? Follow https://www.linkedin.com/company/p3-healthcare-solutions/ to stay ahead in this field.

In the end, payments that you derive as a healthcare professional are the reason behind your survival, both socially and morally. If you are famous among your patients, it gives you satisfaction, but not for long if the revenue stream is unstable. The reimbursements are the lifeline of any practice, and hence, the role of a billing company becomes vital at this point.

Outsourcing medical billing improves the net collection rate as it gives a push to the reimbursements. It also speeds up the RCM process by not delaying the billing and coding of claims.

However, you should choose medical billing solutions cautiously, when you are in the right frame of mind. It means when you have nothing against them in any sense.  Read reviews, carry discussions, talk to co-workers, and the best way is to use Google for the best services nearby. Qualities below will keep you on the right track.

1. Top Medical Billing Services are Specialty-ready

Any company you’re looking to hire for your finances needs to be aware of your specialty. For instance, if you are a heart specialist, the HIPAA medical billing service company has to be familiar with the right billing codes and other standardized information.  Since there are constant changes in the system, it is not easy to keep up with it.

If they are a bunch of trained individuals who have experience with specialized healthcare practitioners in the past, it can be your best bet.

Some billing companies manage finances only for general practitioners such as physicians and physician assistants. Sometimes, it also goes to show their inexperience in medical billing.

Specialty medical billing services in the US are elaborate in their skills and work areas. They manage insurance companies by understanding the work process that goes in the acceptance or rejection of claims. The billers know their way around payers; understand them in a way better than the inexperienced billers.

It brings both the payer and the billing company closer to a point where they can produce better results. In addition, they also know how to avoid denials by creating insurance-friendly claims.

2. What Is Your Take On The Experience?

The answer to this question clears up any doubts about the ultimate selection. It is inadvisable to ask a newbie to handle your finances.

Your revenue cycle management is best suited in the hands of a veteran company with a multitude of satisfied clients. You need someone dependable who knows their way around the constantly changing healthcare system. It can only be someone with experience, the right attitude, and downright skills.

Given the current frequency of complex updates in the healthcare industry or Meaningful Use (MU) Stage 3 payment risks, it is sensible to find experienced medical billing services. In addition, they must provide 24/7 support and be at an arm’s length in case of developing situations.

Furthermore, if you need to talk to a person about a specific issue, the right technical person should always be reachable.

Ordinarily, with experienced companies, most bills see the light of approval rather than an outright denial.

3. Bear Advanced Software and Hardware Systems

Since an electronic health record (EHR) system has become a mandatory part of practices since 2017, you must be sound in practice management systems (PMS) and the use of EHR technology. It is clear that once both the systems corroborate with each other, the expenses drop and your practice prospers. It shows in the form of charged up reimbursements.

When three systems come together (PMS, EHRs and Patient billing systems) and form a solid alliance, there are fewer errors and the visit-to-billing cycle starts to roll.

Some medical billing services in the US have the latest machinery to keep an eye on the future and flexible enough to adapt to situations. Become one of those enterprises which use advanced computers and communication tools to meet the dynamic and ever-changing medical billing field.

4. Ready to Share Knowledge with Staff

The medical billing service companies not following the rules or adhering to the contractual agreements are not a good option. Despite the fact they are a professional team of billers, they must be ready and willing to bend a few rules just for your sake to make you feel well supported.

They should train the staff on the premises working for you. Moreover, the company has to be more than willing to educate someone in your staff that may help relieve the billing stress. Resultantly, when a situation builds up in real time, there will be someone to offer a potential solution.

AVOIDANCE OF PENALTIES IN MIPS 2018! GET READY TO REPORT SMARTLY!

The American Medical Association (AMA) has clearly stated that the only way to avoid penalties regarding MIPS 2018 is to report on one of the three significant MIPS quality measures. In this way, physicians can prevent those negative payment adjustments waiting to happen in 2020. Connect with P3Care instantly on LinkedIn – https://www.linkedin.com/company/p3-healthcare-solutions/

The three quality measures are

  • Promoting interoperability
  • Quality
  • Improvement activities

How Reporting Criteria Changed Over Time?

Eligible clinicians can avoid the penalty by following a reporting strategy as per AMA’s advice. In 2017, it was compulsory for physicians to score at least three MIPS points to avoid a financial penalty at the start of 2019. It means that they only needed to report one quality measure to overcome the penalty risk.

Nevertheless, now the rules are stricter and the focus on value-based services is now more than ever. With this advancement and the modified requirement criteria in the healthcare industry, the new threshold for MIPS 2018 reporting is fifteen points. The clinicians having a score of 15 are able to avoid penalties in 2020. As an EP, if you fail to report the minimum amount of quality measures governed under the Quality Payment Program’s specifications, it results in a definite 5% decrease in reimbursements.

Therefore, scoring equal to 15 is essential for those eligible in this program.

Follow the tips below to avoid a financial penalty in 2020, improve your MIPS performance, and increase your Composite Performance Score (CPS).

Report on Improvement Activities (IAs) to Score Higher

The BEST WAY to meet the required threshold is to report Improvement Activities (IAs) immediately.

The Centers for Medicare & Medicaid Services (CMS) defined 113 measures under this performance category in MIPS 2018. Each performance measure has further subcategories in the form of medium and high-weighted activities. Obviously, the high-weighted activities carry more points and can get you closer to the maximum score.

How Do You Calculate Performance Categories?

The activities for the performance categories function around care coordination, population healthcare, beneficiary engagement, and health equity factors. To score in any category, eligible clinicians are required to collect and submit data for 90 consecutive days in 2018.

How to Submit MIPS to the CMS?

Healthcare providers can submit clinical data for MIPS 2018 via:

  • Quality payment program 2018 (QPP) data submission system
  • Electronic health record (EHR) system
  • MIPS qualified registry
  • The qualified clinical data registry (QCDR)

Improvement Activities – A Lucrative Offer for Small Practices

Reporting Improvement Activities (IAs) under MIPS 2018 can elevate the revenue cycle for small medical practices. MIPS reward small healthcare practices with double points as compared to well- established healthcare facilities.

Another advantage to smaller practices is a bonus of five extra points when they score a total of 15 points. It ranks them above the others on the MIPS scorecard with 20 points. Therefore, if you report for one high-weighted improvement activity, you are bound to earn more points.

For the same MIPS score, ECs working for large medical practices must submit data for two or more improvement activities to get up to the threshold limit of 15 points.

MIPS Quality Measures Shield You from Negative Payment Adjustments

Negative payment adjustments can be a big setback for your profit journey. Therefore, use quality measures wisely and in a timely manner.  To stay on top of your game, you must fully understand the performance measures to make to turn it into a lucrative opportunity.

There are 275 quality measures and clinicians can select from among them the most suitable measures to meet the MIPS 2018 threshold score.  Each Quality measure has further sub-categories as per the following factors:

  • Efficiency
  • Outcome
  • Patient engagement

Moreover, CMS has developed a specialized set of quality measures to help physicians identify appropriate quality measures. Clinicians can report data for 12 months on six quality measures. However, it is necessary that one of the quality measures should be an outcome measure or a high priority performance measure.

Clinicians participating in the form of virtual groups can use CMS Web interface or Consumer Assessment for Healthcare Providers and Systems (CAHPS) for MIPS survey.

Report for At Least Two Performance Categories

To stay away from negative payment adjustments, report for at least two performance categories. For instance –

  • Improvement Activities and Quality
  • Or, Promoting Interoperability and Quality

How to Score High and Handsome?

Ordinarily, we see small medical practitioners reporting one medium-weighted improvement activity and one quality measure. This reporting tactic earns you 10 points and with an extra 5 bonus points, you may achieve a total of 15 points.

The Territory of “Promoting Interoperability (PI)”

Another way to earn 50 out of 100 points is by reporting on the Promoting Interoperability performance category. It investigates the patient and physician engagement level and makes the patient information available to other clinicians via EHR technology. EPs are required to submit data for 90 days or more on the base score of four or five measures in this category. The base score measures take their value from the certified EHR edition.

Large medical facilities can achieve high scores by reporting on PI and quality categories. However, they must report on PI performance category to score 50 and two quality measures to get to 70 points and target the bonuses out of a $500 million pool.

EHR Technology – One Step Ahead

Each EHR edition has a different set of performance measures. For instance, the 2014 EHR edition allows reporting on the Promoting Interoperability Transition Objectives and measure set.

Important Tips to Score Higher

  • The data submitted on quality measures for at least 20 patients fulfill the data completeness requirement.
  • Two medium-weighted improvement activities and four quality measures can get you a score of 16 points in 2018.

It is only possible when the physicians earn 12 out of 70 points in the “Quality” performance category and score 20 out of 40 points in the Improvement Activities.

Vote for Better Healthcare

As 2018 is about to end, the evergreen slogan for the welfare of Americans is to vote for a better healthcare system. That truly goes in favor of the Americans.

If you still haven’t done anything to avoid the penalty in 2020, it is time to connect with a reliable MIPS registry for submissions. America needs you to come out as a winner and reputable practitioner.

Most of the performance categories require data for 90 days. Therefore, reach out to P3Care and report QPP measures efficiently and be free from the worries of non-reporting.

LAYING DOWN THE NUMERAL FACTS OF MACRA-MIPS

MIPS a value-based reimbursement model activates under MACRA by the Centers for Medicare & Medicaid Services (CMS) to promote quality and cut-down the cost of healthcare. It is an opportunity for medical professionals to choose quality over quantity, effectively deliver, and in return, earn some incentives. The positive payment adjustments await only those with scores higher than 15 out of a total of 100 points.

To stay updated on the QPP, follow us on our LinkedIn page – https://www.linkedin.com/company/p3-healthcare-solutions/

For scores above 70, bonuses are likely to happen from the $500 million pool of money reserved only for the top performers. If you look closely, the program benefits all, the doctors, the insurance companies and most of all, the patients who are at the receiving end.

The Composite Performance Score (CPS) determines the overall performance of each practitioner when they report measures for four performance categories under the Quality Payment Program 2018.

Minimum Requirements of MIPS 2017

We saw the practical implementation of MIPS in 2017! The year 2017 was also the transition period to settle things down slowly and gradually. In 2018, the eligible practitioners are quite aware and implement the procedures to qualify for incentives, bonuses or simply to avoid penalties at the start of 2020.

There is a change in the set of rules for 2018. Each of the categories influencing the MIPS final score undergoes an increase in the number of measures. QPP 2018 is a chance for you to show brilliance in terms of quality of care and earn incentives along with a solid reputation in the healthcare industry.

Quality covers 60%, Improvement Activities (IAs) 25%, and ACI or meaningful use carries 15% of the total score. A MIPS Final Score of 3 or above would save them from negative adjustments in 2019.  It included reporting on 1 Quality measure, 1 Improvement Activity or all the Advancing Care Information (ACI) measures.

It was only recently that CMS published the scores of 2017 on their QPP portal.

Basic Requirements in 2018

In MIPS 2018, the Quality covers 50%, Improvement Activities (IAs) 15%, Promoting Interoperability (ACI or meaningful use) 25%, and Cost, the new category, makes up to 10% of the final score.

In 2018, the rules are changed and the stakes are higher now. The EPs need 15 points to make it to the safe zone and avoid a higher penalty (up to 5% of the Medicare Part B payments) in 2020. To achieve this score, you must successfully attempt 2-3 Quality measures, 4 Improved Activities or perform all the ACI base measures.

MIPS Qualified Registry like P3Care only takes a few of your minutes to shortlist those measures.

Mathematical Side of MIPS

Quality holds significance as a performance parameter for MIPS 2018. It adds to the total score by assessing how well the practitioners perform measures in terms of their practice or their field of expertise. The practitioners review the list of measures and select only those best suited to their practice.

For specialists, there are specialty-specific measure sets. In 2017, there were 30 specialty measure sets. Some sets have fewer measures and some have more, but you have to complete only those related to your specialty. For sets containing more than 6 measures, you must cater to those 6 and complete an outcome measure or a high-priority measure, additionally.

Topped Out Objectives

There are 6 topped out Quality measures identified by CMS in 2018. The measures identified as ‘topped out’ means that the eligible physicians are no longer able to score more than 7 in them. Performance for these measures is usually high and completing them does not mean improvement in the quality of service.

Multiple Measure Options for Eligible Clinicians in 2018

Quality – CMS website displays 271 measures from which you can select six of your choice with one outcome measure or a high-priority measure.

Improvement Activities (IA) – Report up to 4 measures to achieve a score of 40 points in this category.

Promoting Interoperability (PI) – The category was Advancing Care Information (ACI) or meaningful use the year before. ECs must report all 4 base measures to achieve a maximum score. Select from among the seven measures.

Cost – Medicare Spending per Beneficiary (MSPB) is at stake here and it has zero measures for you to report. CMS will deduce the score itself by analyzing the claims data of the practitioner.

Hard Work Pays Off

Successful execution of all these performance categories can earn you 15 points and save you from the penalty in 2020. However, when you complete more than 6 or 7 measures along with a few outcome measures or high-priority measures, you make yourself eligible to bonuses from the $500 million pool. The bonus payments keep on increasing with each passing MIPS evaluation period.

The 70 points will earn you a place in the elite class of doctors and practitioners who give maximum attention to their patients. They care for them to the best of their ability, and in return reap the profits. In doing so, they take the US healthcare system one-step closer to glory.

Everybody is a Winner                      

QPP 2018 has something for everyone. The clinicians reap the rewards in terms of positive payment adjustments, the patients go home feeling well, and the government feels the pride in its policy structure.

The resulting situation brings down healthcare expenses and improves efficiency. Everybody gets to be a winner.

We are an approved MIPS registry to report data on your behalf. Dial 1-844-557-3227 (1-844-55-P3CARE) or email at info@p3care.com to talk to a trained HIT consultant.