MIPS 2020, MIPS 2019, MIPS Medicare, Mips submission methods, MIPS submission types, Mips qualified registry, Qualified registry for mips, Cms mips quality measures, MIPS consultants, Mips consulting service, medical billing services, health IT

MIPS Quality Measures 2019 Vs. 2020 – Registry Investigates

Merit-based Incentive Payment System (MIPS) has entered 2020, and, so have the Quality, Promoting Interoperability (PI), Improvement Activities (IAs), and Cost categories. It is a no-brainer to write a thoughtful comparison between the two years regarding MIPS quality measures.

Hence, we are here to discuss the Quality category in detail; the six measures adding up to the final score; any new requirements; and why P3 Healthcare Solutions is a smart choice to report registry-specific measures.

It’s not about the passing years that we have managed to make it to the next year of value-based care, but the essence of MIPS in Medicare lies in its delivery. Each year calls upon MIPS eligible clinicians to adopt a certain set of measures and activities and report them to the Centers for Medicare & Medicaid Services (CMS). 2020 is no different as long as you are on the right track of submission.

The reporting occurs through legitimate submission methods only, the result of which conforms to performance evaluation and incentive payments.

 MIPS Quality Measures 2019 and 2020 – The Types

I have to admit there are more similarities than differences between the two, because, for starters, they have the same collection (measure) types.

In MIPS 2019 and MIPS 2020, participants get to submit 6 quality measures data for 12 months (from January 1 to December 31, 2019, and January 1 to December 31, 2020, respectively). The amount of data to undergo submission depends on the collection (measure) type.

CMS finalized 6 collection types for both 2019 and 2020 CMS MIPS Quality measures. These measure types include:

  • Electronic Clinical Quality Measures (eCQMs)
  • MIPS Clinical Quality Measures (CQMs)
  • Qualified Clinical Data Registry (QCDR) measures
  • CMS web interface
  • Medicare Part B claims measures, and
  • The CAHPS for MIPS survey

As a rule, participants must submit a total of six quality measures from the above types.

General Reporting Requirements Vary

If you talk about 2019, the data completeness factor was 60%, i.e. clinicians were to report performance data for 60% of their patients eligible for a chosen measure. For MIPS 2020, clinicians are required to report data for 70% of their patients eligible for a certain measure. It is 10% more than the last year which means CMS plans to cover a wider population of patients and bring them into the fold of value-based care.

 MIPS Submission Types

In the case of MIPS submission types, there are 4 ways to submit quality measures. These include:

  • Medicare Part B claims
  • Sign in and upload (a MIPS consulting service can report on your behalf)
  • CMS web interface
  • API submission which is the direct method of submission

Six Measures

A total of six quality measures was the requirement back in 2019, and in 2020, it hasn’t changed much. We have a total of six MIPS quality measures in 2020 as well. It includes one outcome measure, but in case, the outcome measure is absent, go for a high-priority measure instead.

Practices, groups, and virtual groups with 16 or more clinicians will be automatically calculated on a 7th measure, the All-Cause Hospital Readmission Measure.

The Curious Case of Bonus Points

Bonus points sound charming enough to know more about their details. Therefore, we will try to find out how to make those bonus points ours and maximize our rewards in 2021 and 2022.

For MIPS Quality measures 2019 and 2020, you can earn bonus points on the following terms.

  • Submit 2 or more outcomes or high-priority measures. It doesn’t apply to the outcome measure or high-priority measure that is already there, but two separate measures are required to get your hands on bonuses. P3, as a MIPS consulting service, reports Quality measures for its clients across the US. Opioid-related measures are part of the high-priority measures list.
  • In MIPS 2020, measures that are part of the CMS web interface don’t qualify for bonuses, but if you report the CAHPS for MIPS along with the CMS web interface, you have a chance to win bonuses.
  • Submission using Certified Electronic Health Record Technology (CEHRT)
  • Besides, six additional points are there for small practices that submit at least one quality measure. Practices include individuals, groups, and virtual groups.
  • 10 additional points for practices that exhibit improvement in their Quality reporting from the previous year.

Conclusion

Before I end this article, I want you to stay illuminated by the present and the future requirements of reporting as long as you have us on your side. P3 Healthcare Solutions prides itself on reporting MIPS for clinicians across the United States. To get in touch, please call 1-844-557-3227.

We have a comprehensive piece written on MIPS 2020 on our LinkedIn page. If you have some questions related to it, you may go through it when you have some time. Here’s the link to it: Getting to know the changes in MIPS 2020 ahead of time.

MIPS 2019, MIPS 2020, MIPS Qualified Registry, MIPS Quality measures, MIPS consulting firms, Medical billing

Reimbursement Trends of 2020: MIPS Vs. Fee for Service

As we enter the year 2020, reimbursement challenges also enter another phase. They are getting more and more complex for independent physicians with each passing year. The reasons for this complexity are the ever-changing reporting requirements from regulatory authorities like the CMS, and the differences in contracts among commercial insurance companies.

First, the Merit-based Incentive Payment System (MIPS) in 2020 poses a new set of requirements for clinicians. Second, Insurance companies, in general, require more and more data to draft patient outcomes.

So, there is not one, but two pressures inherited by clinicians as they step into the New Year.

When we talk about the Quality Payment Program (QPP), some new Advanced Payment Models (APMs) are in the development phase regarding Primary Care. Based on them, the decisions that doctors make today can directly reflect on their future revenue.

Let’s see some of those reimbursement trends now.

CMS Focuses on Primary Care

In 2020, CMS sets the same E/M coding requirements for office and outpatient E/M activity as the American Medical Association (AMA) CPT Editorial Team. The four levels of E/M codes remain intact for new patients, and 5 levels for regular patients.

Another slight change occurs in the conversion factor for Medicare Physician Fee Schedule (PFS) which increases from $36.04 to $36.09. This factor isn’t expected to grow to a greater extent in the next six years.

According to Andres Gilberg, Senior Vice President Government Affairs, Medical Group Management Association (MGMA), the reason for this slight increase is due to the lack of adoption of MIPS and APM by clinicians at the pace Congress wanted when it sanctioned MACRA.

Clinicians concerning MIPS in 2020 face serious penalty consequences for not reporting MIPS 2020. They won’t be able to get away with it if they don’t participate resulting in a 9% deduction from their yearly Medicare payments.

MIPS 2019 reporting determines the potential bonus percentage to be 1.65.

To state a strategy that will work, I’d advise clinicians to report MIPS Quality measures in 2020 to come out as a winner in 2022.

APMs Expected to Increase in Number

CMS intended MIPS to lead into APMs eventually, resulting in less reporting burden and a seamless system of financial incentives. However, the number of APMs needs to increase. There was a notion that CMS would revert to fee-for-service and reset the payment model. But that didn’t happen, and we are stuck with MIPS.

Conclusively, we need to have more APMs to accommodate the growing number of clinicians. As a MIPS Qualified Registry, P3Care speaks for and on behalf of clinicians to value their unconditional and invaluable service to the people of the United States.

Private Insurance Companies Push for Quality

To show compliance and participate in value-based care systems, private payers continue to pay more attention to outcomes. It is not expected to change in 2020. What the Quality Payment Program has done is that it has increased the risk-sharing capability of the healthcare industry. Consequently, there is never a dull moment with value-based care.

Additionally, provider networks will expand to bring in-home care, pharmacy, and other fields categorically. Thus, changing the whole outlook in a meaningful way. In the past, it used to include inpatient, outpatient, and primary care areas only.

Private payers looking up to Medicare reimbursement models, as a result, pay attention to patient access, engagement, cost, and quality measures. If doctors are doing all of that they would be on the A-list of providers.

By examining closely what the doctors are doing to their patients, private payers will decide to keep the provider or cancel their contract altogether. For instance, if they are sending their patients to a far-away imaging center only because it is in their health plan, they won’t go unnoticed by payers for long. Insurance companies are allowed to terminate their contracts in such instances without prior notice, as United Health has done in the past.

Those who do exceptionally well and create a better patient experience are bound to get special invites from provider organizations tagged with bonuses as a reward.

Smaller Practices to Face Payment Difficulties

Mergers are likely to continue in healthcare as payers find cost-effective ways to navigate value-based care. You see, larger organizations have the power to provide better infrastructure to follow MIPS 2020 requirements. In comparison, smaller practices have a lesser chance to comply with what the program requires.

Nevertheless, bigger systems have other issues to deal with. As more and more physicians join mega hospitals and provider networks, getting them to follow QPP guidelines and execute coordinated care are two of the challenges they face.

Therefore, you focus on either fee-for-service model or value-based care because if you do both incentives won’t match with one another.

The next threat to small practices is the rise of retail clinics. A retail clinic is a doctor’s office at the shopping mall where you can get primary care services instantly. You are looking at revolution so to speak. For now, experts are unsure of the affect retail clinics will have on reimbursement rates, so it’s a waiting game from here on. Comment below and share your thoughts if you’d like to.

To show you a list of top MIPS consulting firms, we wrote an article titled – Top 3 MIPS Consulting Services in the U.S.

Evaluating Virtual Reality (VR) In Healthcare

Virtual reality (VR) has taken over the digital world. It was supposed to revolutionize gaming, but it has also entered into a sensitive field like healthcare. Physicians are using various technologies to provide high-quality medical facilities to patients. From assisting remote patients to medical billing to MIPS submission methods, technology is giving a new dimension to this field.

VR has opened new opportunities for clinicians to analyze diseases and severity of illnesses via 3D modeling. Moreover, it is a source to lessen pain caused by chronic diseases or severe burn injuries.

VR is Reliable

With successful research and trials, VR has proved itself a reliable Technology in Healthcare. This trend is not in its testing phase but is operational in some areas. Thus, it hasn’t remained a research-based project but is facilitating in a number of ways, changing human perception for improving the quality of care services.

For Example,

Cedars Sinai is a non-profitable healthcare organization in Los Angeles that is successfully running a clinical VR program for more than 3,000 patients.

Despite the numerous benefits that virtual reality offers to healthcare, some challenges also exist while implementing this technology to the full potential.

How the healthcare system uses this technology?

Healthcare Technology and Healthcare Services

According to physicians, virtual reality can provide a different environment for the patient’s healing process. It has the ability to take patients away from the clinical setting through an interactive experience. Via VR, patients are able to reduce their stress and pain and learn new techniques that may help them afterward for a better lifestyle.

The purpose of VR is not to create a fantasy world for patients but to make them able to learn new skills to cope with real-world problems. Hence, it serves as therapy.

In what capacity virtual reality works in healthcare!

Currently, VR is working in three different sectors as follows:

  1. Stimulates Relaxation and Calmness

Virtual reality helps in achieving the same goals, which are derived from cognitive behavior therapies. Depressed, traumatized patients with intense situations, mentally ill, or people with phobias can seek solace and get back to their regular lives.

  • Relieves Pain

Doctors have tested several virtual reality techniques against abdomen pain, back pain, and more. The results were astonishing. A pain-specific application, Pain RelieVR has shown great effects in this context. The result showed around 24% of the reduction of pain after 10 minutes.

Moreover, patients can be taught to cope with pain via special techniques and generate positive change in their habits.

  • Sharpens Memory

VR is a survival tool for patients with dementia or memory loss. It enables connecting patients with reality and sharpens their memory via therapeutic exercises.

In addition, it also helps in differentiating between reality and hallucinations.

The struggle for controlling a craving is real. VR can also support the process of damping signals that might be harmful to you as in weight management.

Impact of VR on Medical Practices

Healthcare services and virtual reality

To utilize this technology, physicians and hospitals require special training to streamline this technology in the real world. VR not only helps in the above-mentioned healthcare sectors but can support other healthcare applications as well.

VR is an amazing technology that benefits patients but also physicians. With the implementation of VR in the medical practice, quality of healthcare is improved which consequently fills up physicians’ pockets. Moreover, physicians can also earn incentives and rewards for utilizing new technology via MIPS.

It’s set up and the equipment placement remains the issue. However, with efficient planning and investment, it can be solved. Moreover, patients complained about the headsets being uncomfortable, but who knows with the passing time, VR gadgets become smart, and the healthcare system becomes more advanced.

Visit https://www.linkedin.com/company/p3-healthcare-solutions for all the latest updates on healthcare.

Introduction To The Physician Compare Initiative

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.

The second purpose of the Physician Compare Initiative is to incentivize clinicians and clinician groups to improve their performance. MIPS 2017 performance information on the portal is in line with both the purposes. Patients can select Medicare physicians with higher ratings while clinicians receive payment adjustments based on their performances.

MIPS quality measures, Consumer Assessment for Healthcare Provider and Systems (CAHPS), Qualified Clinical Data Registry (QCDR) measures convert into scores and ratings for individuals and clinician groups. MIPS thrives in the present and before it enters into the year 2020, CMS has a proposal ready for the MIPS 2020 program.

Changes to Physician Compare Website

Presently, the 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 related to MIPS 2017. Doctors supporting the Million Hearts initiative by the Department of Health and Human Services (HHS) are also identified.

Portal for Patients and Clinicians

The physician compare initiative stands firm on grounds to improve the quality of care and reduce healthcare expenses. CMS has made it clear on numerous occasions that the Quality Payment Program is here to stay and works for the betterment of US healthcare. After 2017, we are going to have a MIPS 2018 showdown of scores and star ratings, and it is going to add a rich flavor to this program.

The portal displays provider scores in performance categories, i.e., Quality, Cost, Promoting Interoperability, and Improvement Activities. 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 an 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, 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?

Healthcare Technology and  CMS

CMS has been using multiple sources to update its website; these sources will be expanded in the future. The 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 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 experts today at 1-844-557-3227 (1-844-55-P3CARE) or email at info@www.p3care.com.