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06/Aug/2018

Launched as a part of the Affordable Care Act (ACA) or the Obamacare Act of 2010, the physician compare initiative started out as a simple online searchable database of healthcare professionals eligible under Medicare. Since its launch in 2011, the Physician Compare website has been regularly updated by the CMS’ Medicare department to enhance the information that helps patients make informed healthcare decisions.

Changes to Physician Compare Website

Presently, Physician Compare website shows necessary physician and group association information like physician name, practice name, location, phone numbers, specialties, gender, medical certifications, affiliations, and languages spoken. However, so far the website is just that, it gives the necessary information. The website does say whether or not a physician participated in the outdated Physician Quality Reporting System (PQRS) program and the most recent information on the site is from 2016. Doctors supporting the Million Hearts initiative by the Department of Health and Human Services (HHS) are also identified.

However is this about to change?

CMS has declared that it will soon make available the MIPS score of all eligible providers on its website. Provider scores in each of the performance category, i.e., Quality, Cost, Promoting Interoperability, and Improvement Activities will be posted on the site based on 2017 performance scores. The data will be available in downloadable file format free for use by online directories and health information websites like Yelp, Zocdoc, Healthgrades, and Vitals, etc.

Reputation Impact of Physician Compare

What this means is that all those clinicians that have been reporting a minimal amount of data to avoid a MIPS penalty need to rethink their strategy. MIPS score is not only about receiving an incentive payment anymore. The doctor’s reputation is at stake here, not just dollars. Furthermore, the individual physician star ratings will follow them if they change their organization. The MIPS score may directly impact their future career opportunities, clinician recruitment, potential mergers or acquisitions, insurance contracts and more.

Eligibility Criteria for Appearance on the Website

A physician or a provider group needs to have ratified Medicare PECOS information available. Furthermore, the clinicians should have submitted at least one value-based claim within the last 12 months. Groups must have at least two clinicians reallocating their benefits to the group as a whole.

What Sources of Data Will CMS Use?

CMS has been using multiple sources to update its website; these sources will be expanded in the future. Information displayed on the site may be derived from self-submitted data via claims, qualified clinical data registry, qualified registries, consumer assessment of healthcare providers and systems (CAHPS) and the provider enrollment, chain, and ownership system (PECOS). CMS also coordinates with national certifying boards to confirm board certifications. CMS determines which quality measures are statistically reliable enough to be displayed on the website.

Star Ratings for Easy Comparison

Beginning this year, performance on quality measures will be depicted by a one-to-five star rating system. Each star represents a 20 percent performance score on MIPS (i.e. 1 Star = 20%, 2 Stars = 40%, 3 Stars = 60%, 4 Stars = 80%, 5 Stars = 100%). These ratings are relative, that is, they depend on the performance of other eligible practitioners and groups under the program.

30-Day Preview for Checking Information & Correction

CMS has announced that it will provide a 30-day preview to the clinicians for review and correction before the measures and ratings are finally made public on the Physician Compare website. The physicians will be made aware through the MLN Connects weekly newsletter and various other platforms. If you discover any errors or omissions in the information, you can contact CMS for correction. You may need to submit proofs supporting your claim for your correction. Also, there is no formal appeals process thus ensuring correction within the 30 days preview period is highly critical. If you discover any errors during the preview period, you can report it to CMS via the contact information provided on the website.

How Can P3 Healthcare Solutions help?

Be patient, for instance, if you have switched a group practice or a hospital, or you upgraded your certifications, you need to update the information through PECOS. Corrections made in PECOS could take up to 4 months to be reflected in the website. Furthermore, healthcare providers will only learn about their MIPS score for the performance year 2018 by late 2019. That means when they learn about a bad performance, the year after the bad performance will also almost be over. Thus they can start focusing on improvement only in the next year. It means that not only the incentive payments will continue to get hurt, the reputation impact will also continue until at least the end of 2020.

P3 Healthcare Solutions is a MIPS Registry for the second consecutive year in 2018. Our advanced analytical tools help you track your performance throughout the year and can give an estimated MIPS score to ensure that you are satisfied with your score before you submit your reports to CMS.

It is very vital to get an expert opinion about how to balance the costs associated with getting a high MIPS score and the potential negative impacts of a low MIPS score. For any more questions related to this, or for instructions on how to get started call one of our MIPS medical billing service expert today at 1-844-557-3227 (1-844-55-P3CARE) or email at info@www.p3care.com.

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01/Jun/2018

The news just came in last night via the official CMS blog, where Seema Verma, the Administrator of the Centers for Medicare and Medicaid Services (CMS), announced that the participation rate for the Merit-based Incentive Payment System (MIPS) exceeded its 1st-year goal by 1 percent. The early goal was set at 90 percent for MIPS – one of the two tracks under the CMS’s Quality Payment Program (QPP). Furthermore, the announcement stated that the submission rates for ACOs (Accountable Care Organizations) were recorded at a whopping 98%, while those of clinicians in rural practices were found to be 94%. These figures show the results are truly outstanding. Verma says,

“What makes these numbers most exciting is the concerted efforts by clinicians, professional associations, and many others to ensure high-quality care and improved outcomes for patients.”

Patients Over Paperwork Initiative

Furthermore, these high participation rates show significant progress in the organization’s prime objective “Patients over Paperwork.” Patient over paperwork is an initiative by CMS, launched in November last year. The main idea behind the initiative was to streamline regulations by increasing efficiency, thus improving patients’ care and experience.

Steps taken through this initiative, according to Verma, resulted in:

Continued free technical assistance to clinicians in the program.
The number of clinicians required to participate in the program reduced, thus making it possible for them to give more time to their patients, instead of worrying about lengthy filing requirements.
Addition of new bonus points for small practitioners, or practitioners who treat complex cases or are using 2015 edition of CEHRT exclusively thus promoting interoperability of health information.
A higher number of opportunities for the healthcare providers to earn positive payment adjustments.

All of these measures helped CMS in achieving the success in its QPP program.

A Look Forward

Finally, Verma expressed CMS’s continued focus on reducing burden in various areas of MIPS, as has been mandated by the Bipartisan Budget Act of 2018. She further articulated her organization’s eagerness to continue its work on improving clinician and patient experience through their “Meaningful Measure Initiative”, instead of focusing on processes.

For instructions on how to get started call a medical billing service expert today at 1-844-557-3227 (1-844-55-P3CARE) or email at info@www.p3care.com.

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03/May/2018

MIPS 2017 update is over. All the eligible participants who took part in MIPS 2017, whether individuals or groups now await results and the payment adjustments due in 2019. Whoever was unable to participate in 2017 can start attempting measures in MIPS 2018 while reporting data to CMS through a MIPS Registry.

Let us look at the most prominent changes made in MIPS 2018. The Quality Payment Program’s track of MIPS in 2018 adds new clauses to the value-based reimbursement system in the form of measures and weight classifications. It will help us in learning about the program’s salient features as well as becoming aware of the new additions.

MIPS 2018 performance benchmark is raised from 3 to 15

From a total score of 100, now the eligible clinicians must have a score above 15 to avoid negative payment adjustments in 2020. To achieve this target, the eligible professionals will be reporting at least 6 quality measures and a clinical cluster or fulfilling the requirements of improvement activity category.

The Quality category carries 50% weight

The Quality category’s value is down by 10% making it 50% for MIPS 2018.

To achieve a safe final score, the participants should attest to and report a total 6 quality measures to the CMS. In those 6 measures, one must be an Outcome Measure or a High-Priority Measure, in case you can’t find a suitable Outcome Measure. However, if you choose to submit data via CMS web interface (eligible for groups of 25 or more clinicians), you will have to report 14 measures.

Outcome Measures are those measures that relate to the health of the patients after a possible treatment or intervention. For example, the number of patients who passed away after the surgery.

The other types of measures include reporting against procedures, arrangements, effectiveness and patient involvement/experiences.

Be prepared to score in the Cost category

The big change in MIPS 2018 is the addition of a new category, cost! Now clinicians will be judged against the cost category as well. It holds 10% weight in the MIPS final score. Performing well in this category means a better composite performance score (CPS). It will impact the total score and may be the only measure standing between you and the bonus payments. The two most important measures evaluated under this category are –

Medicare Spending Per Beneficiary (MSPB)
Total Per Capita cost per recognized beneficiary

Cost category works through medical billing claims analysis as there are no data submissions required for it. To have a higher score in cost category, clinicians:

Must see the patients in the hospitals
Must have a background in at least 35 cases for MSPB
Must have at least 20 cases for Total Per Capita
Must provide a multiplicity of Medicare Part B services to a beneficiary

The idea behind this performance category is to see how much cost on an average incurs in the treatment of the patients.

The Rise of the Virtual Groups

In 2018, we see the inclusion of virtual groups as a new method of participation in MIPS. There are a total of four ways to take part in MIPS 2018. They can take part in as:

Individuals
Groups
APM entity in a MIPS APM
Virtual groups

A virtual group combines two or more TINs (Tax Identification Numbers) associated with one or more individual practitioners or one or more groups comprising of 10 or fewer eligible professionals.

Quality reporting period extends from 90 days to a whole year

Remember to complete and report those 6 measures including an outcome measure or a high-priority measure for the entire year. If you haven’t started reporting until now, there is no time left. You must start reporting MIPS data instantly. We invite you to choose P3Care for better reporting and adherence to the rules and regulations laid down by CMS. The quality category holds 50% weight in the total score, thus, a crucial factor in the achievement of bonus payments.

Data completeness

This element is emphasized in 2018. In the current performance year, all the quality methods should report 60% data completeness instead of 50%.

Using Certified EHR Technology of 2015

To make the data more authentic and up-to-date, CMS will prefer reports initiating from the 2015 Edition of the Certified EHR Technology (CEHRT). A 10% bonus for Advancing Care Information (ACI) category will be a reward for those eligible clinicians using the most recent EHR system.

You have to report for quality performance category for the entire year and the rest of the three performance categories; you only need to report for 90 days.

Conclusion

Be mindful of the deadlines in 2018. To conclude it, we have MIPS 2018 with quality category holding 50% importance, Advancing Care Information with its 25% invaluable share, Improvement Activities (IA) carrying 15% weight and finally the cost category holding 10% value in the final score.

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28/Mar/2018

P3Care medical billing services are precise both regarding serving physician-specialists and accurate management of accounts receivables. CMS recognizes P3 Healthcare Solutions as a MIPS Qualified Registry. You can view it here – https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/2017-Qualified-Registries.pdf.

Outsourcing the medical billing services is a tough decision to make. There are several factors which influence the indecisiveness. Putting your finances in the hands of a company which is physically unreachable is not an easy thing to do.

Filing a claim with the insurance company needs to be speedily expedited for timely reimbursement of the incentive payment. When you receive the amount in your bank, it completes the revenue cycle for that claim. P3Care assists with revenue cycle management in a highly professional way providing you with timely transactional insights. Moreover, the first-time claim acceptance rate matters a lot, and P3Care does perform reasonably well when it comes to first-time acceptance of claims.

What is an ASC? P3Care Stands by Your Side in Critical Times

ASC stands for Ambulatory Surgery Center. P3Care’s philosophy and the visionary statement speaks of the deep relationship it has with the healthcare professionals dealing with emergencies. Emergencies can be traumatic and stressful.

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19/Mar/2018

Welcome to P3 Healthcare Solutions. Medical billing services are getting sophisticated and tech-oriented with new rules and guidelines. The electronic health records are fast replacing the old way of manually maintaining medical records. It is becoming difficult for medical practitioners to be able to get a grip on procedural necessities leading to obstacles in the collection.

Previously, PHI documents were hand-written and exchanged through the traditional mail, but since the advent of the internet, things have become effective. However, complexities are a big part of the new age computerization with hard-to-understand software functionalities and apps. They are designed to make the medical billing process easier which often prove to be a roadblock for the providers.

Core Objective of P3Care Medical Billing Service Company

P3Care Healthcare Solutions offers many services, and medical billing is one of them. The goal, however, is to support the healthcare industry by leveraging advanced technical and computerized solutions for both the physicians and specialty-specific clinical experts all across the US.

P3Care always works hard on delivering for the providers to help add to their revenue. The high claims acceptance percentage in one go is relieving for both the providers and the payers which further endorses their confidence. Getting the job done before it gets complicated is accomplished through experience, dedication, skills and staying on our toes.

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06/Mar/2018

The MIPS 2018 will help the healthcare providers realign themselves to ensure compliance, enabling them to keep taking advantage of the incentive payments.

CMS gave an update on 2nd November 2017, sharing MIPS 2018 updates applicable to the QPP (Quality Payment Program).

A Background to the MIPS 2018 Updates

We all know that there is a shift in the US healthcare industry towards quality healthcare. These new updates reflect the refinement of the policies for QPP while taking into consideration the US healthcare industry’s transformation concerning infrastructure, technology, clinical practices, and physician support practices.

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30/Jan/2018

Medical billing denial is the rejection of a claim by an insurance company made by any individual or by their provider, to pay for the rendered health care services. If you are a financial administrator in a hospital or any other healthcare facility, you would have an idea about the complications involved in medical billing claims. The denial of such claims proves to be a continuous headache as they affect the credibility, cash flow, and overall efficiency of a healthcare provider.

Studies suggest that the annual medical billing claims denials for hospitals stand at 2 percent, whereas, for medical practices, the percentage increases up to 10 percent. This makes the medical practices less profitable by comparison.

Some of the healthcare organizations even undergo a denial rate of 15 to 20 percent, which is considered extremely high. This means that providers facing this kind of denial rate have one out of five medical billing claims denied.

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30/Jan/2018

Provider credentialing is critical for authenticating expertise, experience, willingness, and interest in providing medical care. If you are not able to follow the provider credentialing process, it can result in delay or worse, denial of the provider payment.

Provider Credentialing Process

It is not one of the formalities that you have to complete or a form that you need to fill. It is an ongoing process that involves a lot of complexities. Therefore, you need to closely follow all the requirements. There are many steps that you need to follow in order to qualify for credentialing. Also, it is essential for your business that you practice without any hindrances.

Besides the simplistic definition, it also involves submitting a lot of documents and forms to various third parties for verifying your practice. You do not need to follow the entire process each year. However, you must provide annual updates.

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07/Dec/2017

The following article looks at CMS MIPS quality measures for LPTAC medicine. However, before we go towards the MIPS quality details, we need to look at the underlying purpose and objectives.

Purpose

CMS (Centers for Medicare and Medicaid Services) is always working on improving the policy to provide better healthcare facilities. Therefore, the new measures are aimed to help improve the overall care delivery and also reward clinicians who are better engaging patients, families, and the caregivers.

Here is how CMS looks at MIPS.

“To these ends, and to ensure the Quality Payment Program works for all stakeholders, we further recognize that we must provide ongoing education, support, and technical assistance so that clinicians can understand requirements, use available tools to enhance their practices, and improve quality and progress toward participation in APMs, if that is the best choice for their practice.”

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07/Dec/2017

The sorry state of affairs in the American medicare industry reflects the inability of many Americans to afford quality healthcare. Many can’t afford medical billing despite having insurance. The Obamacare premiums are making it difficult for them to continue with the payments.

Can’t Afford To Go To the Doctor – HealthPocket

A recent survey by HealthPocket revealed the difficulties that many Americans face. The Affordable Care Act is reducing people’s ability to afford health insurance. They have so many other expenses that they can’t afford take out money for health insurance.

The survey results show that a lot of Americans can only afford $100.

Here are the results.

Around 52.5% say that they can only afford $100 or more.
Only 15.95% can afford $200 each month.
The number of Americans drops 11.6% who can pay $300 each month.
The percentage further reduces to 5.5% for $400 health insurance deductible assistance.
Only 4.8% say they can set aside $500 each month.
Only one out of ten Americans, or 9.8% say that they can give away $500 a month for health insurance.

Older Posts

Changes to Physician Compare Website

However is this about to change?

Reputation Impact of Physician Compare

Eligibility Criteria for Appearance on the Website

What Sources of Data Will CMS Use?

Star Ratings for Easy Comparison

30-Day Preview for Checking Information & Correction

How Can P3 Healthcare Solutions help?

Patients Over Paperwork Initiative

Steps taken through this initiative, according to Verma, resulted in:

A Look Forward

MIPS 2018 performance benchmark is raised from 3 to 15

The Quality category carries 50% weight

Be prepared to score in the Cost category

The Rise of the Virtual Groups

Quality reporting period extends from 90 days to a whole year

Data completeness

Using Certified EHR Technology of 2015

Conclusion

What is an ASC? P3Care Stands by Your Side in Critical Times

Core Objective of P3Care Medical Billing Service Company

A Background to the MIPS 2018 Updates

Provider Credentialing Process

Check Eligibility for MIPS!