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Why Your Medical Practice Needs a MIPS Qualified Registry?

The stressful time of the year for MIPS eligible clinicians has arrived.  We are going towards the end of the performance year MIPS 2020. It is the time when MIPS Qualified Registries help you check all boxes of reporting requirements.

They not only simplify the reporting process but also optimize your performance and help you stay ahead in the game with useful tools and strategies. Of course, the merits of submitting data via a MIPS Qualified Registry knows no bound.

Given below are some of the reasons why should your medical practice choose to consult a MIPS consulting service.

Merits of Consulting a Professional Qualified Registry

All-in-One MIPS Services

MIPS Qualified Registry submits data for all MIPS performance categories via an efficient and optimized system.

  • Quality
  • Promoting Interoperability (PI)
  • Improvement Activities (IA)

With a state-of-the-art infrastructure to manage data in one place, it is easier to estimate the final MIPS score. Moreover, the process goes smoothly, and reporting objectives are easily achieved. Moreover, professional companies also estimate the cost incurred in quality healthcare services. So, you can make better strategies to counter issues.

Specialty-Specific Quality Measures are Easy to Choose

Do you know that eligible clinicians were allowed to report only fifty measures via EHR (Electronic Healthcare records) in 2019? Whereas, with a MIPS Qualified Registry, there were 232 quality measures to choose from.

With professional help, clinicians can choose from a wide list of measures and report data for MIPS 2020 as per the specialty expertise. For Instance, at P3Care, we ensure each client reports data for higher points and not just for the sake of it.

  • The list of quality measures are fully researched and analyzed
  • The team segments measures that strictly relate to the practice
  • MIPS Consultants discuss the prospect of each measure and prepare data as per the CMS’s standards

Professional MIPS Reporting

MIPS Qualified Registries have the experience and clientele to report QPP MIPS appropriately. Their clientele ranges from clinics, hospitals, and medical billing companies, small and large groups. They know how to present data that translate efforts to CMS for maximum score and help stay away from penalty as per the requirement.

An Electronic Management System

Smart electronic management systems at MIPS Qualified Registries help eligible clinicians to plan, analyze, and discuss plans with the consultants. You can easily keep a check on the MIPS performance and suggest changes that you want.

Estimate Financial Estimations

If you are working on your own, you cannot estimate the financial implications of your MIPS data appropriately. However, with professional help, you can easily do the entire Math to avoid any surprise element in the end.

For penalty estimation, incentive calculation, and other estimations, P3Care is there for you.

MIPS Reporting Support 24/7

A professional MIPS Qualified Registry guides you at each start from the beginning to the end. Whether you have any questions or need assistance in solving any matter, the team is there at your service.

You can also seek our help for any MIPS related question, contact P3Care at https://www.p3care.com/ | 1-844-557-3227.

Timely MIPS Data Reporting

When MIPS Qualified Registries compile all data, they allow medical practices to review data to the fullest. Once you are satisfied, the process goes further. They ensure every performance data is in order and then submit data on time.

We know submitting data to CMS is complex. Therefore, a MIPS Qualified Registry is the perfect option to ease this process. If you have any concerns related to a smart reporting strategy, effective tools, and an efficient team, we are here to answer your queries.

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Surgeons: Tips for Successful MIPS 2020 Reporting

One thing that we learn from the year 2020 for sure is uncertainty. COVID-19 pandemic has left us in a state of doubt, where we can’t be too sure of our present, and, clearly, not the future.

QPP MIPS reporting program of 2019 also had to face delays due to this catastrophe with overburdened staff, doctors, and suppliers associated with them any capacity. The closing date for MIPS 2019 went one-month further to facilitate clinicians busy dealing with the surge in COVID-19 patients. It was indeed a rollercoaster ride for them from the very first day.

MIPS 2020 reporting, however, is still very much happening and clinicians are required to submit data as individuals, groups, and virtual groups to receive positive payment adjustments. One of the ways to receive incentives is to score above 45.

Contrary to the previous years, MIPS 2020 program requires clinicians to submit data for all the reportable categories and avoid negative payment adjustments. Regardless of the method you use, it is not possible to score above 45 by submitting only the Quality measures.

  1. Check Your Participation Status

The first thing to do while reporting MIPS 2020 is to check whether you are eligible for the program or not. Special statuses qualification also awaits certain surgeons. Once you are there, include your NPI to display the required participation status.

Surgeons with special statuses may get bonus points and also have their categories reweighted.

Physicians can outsource MIPS 2020 reporting to a MIPS Qualified Registry. They will ask you for the required information and check your eligibility status from the CMS portal.

  1. Select Quality Measures Carefully

Instead of being casual about the Quality measures, my next tip is to be careful about them. It is crucial to choose only those Quality measures with benchmarks that do not limit your points that you may score on that measure.

For example, many surgery-driven measures are topped-out, and you can score as much as 7 points through them, which may tempt you to look for other measures, outcome measures, or high-priority measures resulting in bonus points.

A MIPS Qualified Registry makes the quality measures selection easy for you. Physicians do not have to stress upon looking into the list of measures, but an experienced team conducts analysis on your expertise and picks out the most appropriate measures.

  1. Participate in COVID-19 Clinical Trials Improvement Activity

While the COVID-19 pandemic has left us with many questions, it poses a challenge to humanity as we speak. Thankfully, MIPS 2020 reporting, now, has a new high-weighted COVID-19 clinical trial activity. Accordingly, it adds to the total scores for MIPS eligible clinicians. While it is an opportunity to score high, it can help you receive recognition for the COVID-19 breakthroughs.

The two ways you can utilize this IA and receive credit for it:

  • Participate in a COVID clinical trial and have that data become part of a data portal for an ongoing study; or
  • Caring for COVID patients, you may submit clinical data to the clinical data registry for future references.

National Institutes of Health (NIH) hold Covid-19 clinical trials, and that is where participation starts. The goal of this Improvement Activity (IA) is to innovate and improve the collection of COVID-19 information that the clinicians have and develop best practices in patient care as COVID-19 drags on.

Let’s hope for the best outcomes shortly. MIPS Qualified Registries submit measures for all the reportable measures. Therefore, signing up with one of those registries is a good start.

Scoring Cases for Clinicians with Special Statuses

The cost category is excluded from the examples below because the category uses complex claims data to calculate scores.

  • Scoring example for clinicians who are eligible for PI exemptions

    • 25% of the weight of the PI category transfers into Quality, reweighting it to 70% of the total score.
    • (26 measure points in Quality are equal to 30 MIPS points approximately) + (IA’s complete submission is equal to 15 points) = 45 points
  • Scoring example for physician groups of 15 or fewer

    • If they report at least one Quality measure, they receive six bonus points for the Quality category.
    • (20 measure points + 6 bonus points in Quality = around 30 MIPS points) + (IA’s complete submission is equal to 15 points) = 45 MIPS points

Recommendation of the American College of Surgeons

45 is the safest score for MIPS 2020 submissions regardless of the method you use. Moreover, the American College of Surgeons recommends the above techniques to score higher. In addition to that, clinicians breeze through the compliance program.

There are no changes in eligibility status and opt-in determinations. The criteria are simple, and with the COVID situation going on, MIPS eligible clinicians can also report their preparation and planning in regards to receive reimbursements.

The threshold is certainly high this time, but clinicians who are prepared and have good specialty-specific measures to report can show outstanding performance.

So then, there’s nothing to fear. It’s just a program for clinicians to get incentives as a reward to improve their quality care delivery.

How CMS determines MIPS eligibility?

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How CMS Determines MIPS Eligibility?

The QPP MIPS participation starts from knowing the eligibility status. For MIPS 2020, clinicians can check eligibility via QPP Lookup Tool. Later on, CMS updates the eligibility status that if physicians can report data to them or not.

However, the reporting requirements change each year due to changed policies.

 MIPS 2020 Eligibility Check Requirements

According to the official website, interested clinicians must have:

  • National Provider Identifier (NPI)
  • Associated Taxpayer Identification Numbers (TINs)

A TIN is required when you own a practice; belong to a hospital as a medical facility or a medical practice.

In the case of physicians’ reassignment of Medicare Billing Rights to TIN, their NPI gets associated with that TIN, referred to as TIN/NPI combination. For Instance, if any physician has assigned billing rights to multiple TINs, he/she will have multiple TIN/NPI combinations.

CMS assesses TIN/NPI combination for MIPS eligibility and use TINs for practices’ eligibility.

Eligibility Determination Period of MIPS

CMS looks into past and current Medicare Part B Claims and Provider Enrollment, Chain, and Ownership System (PECOS) data for clinicians and practices, each year twice.

Data analysis from the first segment is referred to as preliminary eligibility. Data from the second review are then attached to the first segment of data and presented for final eligibility determination. The requirement is to pass the Low-Volume Threshold (LVT) during both reviews.

What is Low-Volume Threshold (LVT)?

LVT includes three aspects of professional healthcare services as follows.

  • Allowed charges
  • Number of services provided
  • Number of Medicare patients who receive services

Other than exempt cases, physicians are required to participate in QPP MIPS 2020, if they:

  • Bill above than $90,000 for Part B covered professional healthcare services
  • Check more than 200 Part B patients
  • Offer above than 200 covered professional healthcare services to Part B patients

It is to consider if physicians report Medicare Part B claims in the second review with a medical practice’s TIN, the eligibility status at that practice will only reflect data from 2nd review.

Who Can Participate in MIPS 2020?

CMS has an eligible clinician type. Clinicians falling into this list and satisfying all the requirements can participate in MIPS.

  • Physicians (including doctors of medicine, osteopathy, dental surgery, dental medicine, podiatric medicine, and optometry)
  • Chiropractors
  • Physical therapists
  • Occupational therapists
  • Clinical psychologists
  • Osteopathic practitioners
  • Physician assistants
  • Nurse practitioners
  • Clinical nurse specialists
  • Certified registered nurse anesthetists
  • Qualified speech-language pathologists
  • Qualified audiologists
  • Registered dietitians or nutrition professionals

MIPS Data Submission Methods

Eligible physicians can report data to CMS as individuals, a group, or a virtual group.

MIPS 2020 Participation as Individuals

For MIPS participation as individuals, physicians must:

  • Belong to eligible clinician type on Medicare Part B claims
  • Have enrollment in Medicare before the performance year 2020
  • Surpass the Low-Volume Threshold requirements
  • Not qualify for Alternative Payment Model Participant

MIPS 2020 Participation as Group

For MIPS participation as a group, physicians must:

  • Belong to eligible clinician type on Medicare Part B claims
  • Have enrollment in Medicare before the performance year 2020
  • Belong to a medical practice that surpasses the Low-Volume Threshold requirements
  • Not qualify for Alternative Payment Model Participant

The MIPS score and payment adjustment will be awarded as a group in this case.

MIPS 2020 Participation as Virtual Group

For MIPS participation as a virtual group, physicians must:

  • Belong to eligible clinician type on Medicare Part B claims
  • Have enrollment in Medicare before the performance year 2020
  • Not qualify for Alternative Payment Model Participant
  • Be associated with a medical practice that surpasses the Low-Volume Threshold requirements & is part of virtual practice

Physicians are required to report their data as a virtual group.

The above-mentioned are all the requirements that a MIPS participant should know. We are halfway in QPP MIPS 2020. Many professionals already had planned and implemented a strategy for optimized performance in the end.

If you’re an eligible MIPS clinician, the best advice to you is to concentrate on quality care outcomes. A professional MIPS Qualified Registry will take your efforts into account, and you can target more measures if you have a proper plan of action on board.

Best of luck.

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The 2020 CMS Quality Conference Speaks of Objectives & Accomplishments

CMS has come up with practical solutions for the healthcare industry; it has constantly fought against physician burnout by reducing reporting requirements. We, as a MIPS Qualified Registry, appreciate their efforts and of their administrator, Ms. Seema Verma.

In the recent CMS Quality Conference 2020, the captain spoke herself and mentioned the achievements of the agency and what lies ahead. Starting with the accountability of her team, she said she has identified the set of objectives moving forward. In fact, she stressed on quantifying and measuring progress as they go through the 16 strategic initiatives.

The Three Objectives

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CMS has a mission and a goal to achieve. According to administrator Verma, CMS is going to be relentless in their approach. In brief, they will accomplish the objectives below:

  1. Improve the quality and bringing healthcare within the means of all Americans;
  2. Drive healthcare towards a value-based system from a volume-based system;
  3. And, don’t let the bubble of American healthcare spending go bigger.

Quality is the top objective CMS is looking to nail. Without good quality, Ms. Verma indicated, efforts to lower cost and improve healthcare availability are fruitless. What good is a health plan when the care you get is below par?

The Unique Role of the Government

Similar to the rules for the airline industry or the food sector, the government must set for the healthcare industry as well. Not only do they ensure a high standard of care, but the guidelines will protect the patients’ rights from the very beginning.

The consumers have to know and have to be sure that the hospitals are safe for them, thus the government’s role is crucial now more than ever.

On the whole, a lot depends on nursing homes in the years to come. They are places where our seniors go on to live their lives. Their safety has to be A-grade. Similarly, when we talk about laboratory tests, a lot depends on their accuracy. It is all about dignity when it comes to hospice care.

CMS has an overall responsibility to oversee quality not because they are the nation’s largest insurer, but because people look up to them. Moreover, they are responsible for setting the safety and quality standards for every facility that receives Medicare reimbursement. They believe that the government has a unique role to play to create and preserve an unbiased rulebook for a healthy competition.

In that sort of environment, patients are protected and providers compete against each other to provide the highest quality of care. Soon after MIPS 2019 reporting, we have MIPS 2020 to look up to, so that high-quality care prevails across the country.

The physician compare or hospital care portals populate for the sake of patients to make informed decisions. Choose the right clinician with reviews and performances in the Quality Payment Program (QPP).

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Trump Administration’s Take on Quality

Trump administration has a keen interest in healthcare, and over the past three years, it has come up with several Presidential executive orders to ensure quality and price transparency, Advancing American Kidney Health, and redefining Medicare.

To realize Trump’s vision, CMS is the enforcing body to implement these orders for better quality outcomes. Since the elections are near, the Trump administration’s stance on the quality of care in hospitals, facilities, and practices is going to be key. As a matter of fact, healthcare is going to be the difference in his win. Whether Bernie Sanders or Joe Biden, in my opinion, whoever takes a bold initiative on healthcare will make the underlying difference.

 

CMS’ New Quality Strategy

In this recently held conference, Ms. Seema Verma unveiled the new quality strategy that will implement the Trump administration’s vision in letter and spirit. It was a proud moment for her and the agency that dedicates most of its time to healthcare management, improve patient experience, and focuses on patient engagement for distinct results.

Last year, the framework that was initiated for the safety and quality of nursing homes was incredibly successful. As a result, CMS has announced to apply the same framework in other areas with room for improvement. The MIPS in healthcare is a step in that direction in which we can have a close to a perfect system.

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The Four Pillars of the New Quality Strategy

  • CMS will establish government standards for quality care. They will set measures such as MIPS Quality measures.
  • Improve the knowhow of the system and enforce quality protocols for accountability.
  • Share quality information with the public to promote transparency and competition. In short, it promotes a grand patient experience.
  • Modernize quality activation efforts by the use of technology and data analytics.

MIPS Value Pathways in 2021 will Navigate the Quality Measures

One of the ways the new quality strategy will see the face of implementation is in the form of Merit-based Incentive Payment System Value Pathways in 2021, according to Medscape. Instead of using the six quality measures, MIPS Value Pathways will allow physicians to choose measure sets most relevant to their specialty or patient population.

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How Can Physicians Increase Patient Referrals?

Survival in the healthcare industry is getting tough day by day. The cost factor to provide value-based healthcare services is doing well in patients’ favor, but it’s also been a burden for physicians. While MIPS reporting services, MIPS Quality Measures are the parameters to show progress in terms of interoperability, cost, quality, and improvement activities.

Other than making efforts to earn incentives and bonuses and to remain protected from penalties, MIPS has been a great help. But, first physicians have to meet the criteria of checking 200 patients and bill more than $90,000 for Part B covered services.

Why Referrals are Important?

Referrals are an excellent way to keep up with the high number of patients. Word of mouth from fellow physicians and patients also helps to maintain goodwill in the industry.

It helps to grow the practice and improves the worth of your services rapidly.

How to Increase Referrals for your Practice?

Here are several suggestions upon which medical practitioners can thrive and get referrals without any problem.

  1. Connect with Fellow Physicians

Find those physicians in the industry with which you can build a give and take relationship.

For Instance, if you can refer a patient for any service to another physician, he should be able to do the same for you for your area of expertise.

  1. Increase Patient’s Engagement Level

Make processes easy and less hectic for patients. Such as a simple or automated way of patient scheduling system automatically improves patients’ engagement.

Another way is to send follow up messages to remind patients about their appointments.

These tactics can help to get referrals from patients.

  1. Have a Friendly Behavior at Work

When someone treats you with kindness, it leaves an impact on you. The same rule works for organic referrals. If a physician treats his patients with a smile, listens to them, and take time to make things easy for them, he is more likely to get referrals.

  1. Be Kind to the Staff Working for You

Nurses, physician assistants (PAs), and others spend a major deal of effort and time for the well-being of patients.

Spend time with them, and make small talk to release work stress. In this way, your behavior and kindness will reflect across the board. Not only it does improve your performance but also makes an ideal working environment.

Additionally, it helps to know your staff’s relationships with others in healthcare. Through them comes the goodness for a practice. In fact, physicians can definitely deduce better results from this strategy.

  1. Embrace Technological Innovations

Adopting technology gives points for Improvement Activities (IA) in QPP MIPS. This way you get the reputation of a progressive medical practice and achieve higher MIPS points for incentives.

Medical practitioners can use the following things:

  • Make their own app if possible
  • Create a user-friendly website for their services
  • Figure a way to make the appointment scheduling process easy and automated
  • Use technology to offer support to staff and patients alike
  1. Be Informative & Unique with your Website

The website is the first portal to reach patients. Patients search online about what services they want and what doctor they need.

If you have all the information on your website, it’s easy to get referrals from others against your user-friendliness.

Given above are just a few ideas to improve physicians’ worth in the industry and getting referrals. More referrals mean more patients and ultimately reimbursements and incentives to straighten up revenue cycle management.

So, get started now.

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Report & Edit MIPS 2019 Data before March 31, 2020

A MIPS Qualified Registry is one of the collection types to submit data on behalf of clinicians. In 2020, CMS recognizes P3Care as a MIPS registry for the fourth time in a row since 2017. In an effort to maximize incentives for physicians, we work to produce the best MIPS results for eligible clinicians to seal their authority as value-based clinicians.

From day one, it is our motto to encourage clinicians to do their MIPS data submissions as early as possible and not delaying them to the very end. Because at the very end, it becomes difficult to recognize and omit errors with less time on our hands.

In this article, some of the factors directly related to MIPS 2019 reporting are highlighted comprehensively. To have a go at it without any ambiguities, we have organized information to help you report the year 2019 in a winning way. You get to score high; incentives come with performance as if it were meant to be yours in the first place.

Submission Type & Collection Type

As students of the value-based care phenomenon, we have often noticed at times that we confuse a collection type with a submission type. So, in this section, we’d like to get some weight off our chest by discussing them.

A submission type is a doorway to report MIPS 2019 to CMS. Such methods include –

  • Medicare Part B Claims
  • Certified Electronic Health Record Technology (CEHRT)
  • Qualified Clinical Data Registries (QCDRs)
  • Qualified Registry (Like P3 Healthcare Solutions)
  • CMS Web Interface
  • CAHPS for MIPS Reporting Survey Vendor

While collection types are types of measures MIPS eligible clinicians can use to submit data. For instance, you can use the following types of measures to report MACRA MIPS.

  • Electronic Clinical Quality Measures (eCQMs)
  • MIPS CQMs or Registry Measures
  • QCDR measures
  • Claims measures
  • CAHPS for MIPS survey

Improve Your MIPS 2019 Measures Performance Reporting by P3 Healthcare Solutions

It seems odd but you still have time to edit, delete or replace it with more accurate data. As a third-party intermediary, we have our agents dedicated to these corrections on behalf of clinicians to make their lives easier if their previous submissions were inadequate.

At least six Quality performance measures have to be reported to fulfil MIPS 2019 Quality component requirement. If the same Quality measure is reported multiple times through the same collection type, then CMS will evaluate only the most recently submitted data for that measure.

Similarly, when a single measure is reported using multiple collection types, CMS uses the measure with the highest achievement points. Hence, the scoring system works in favor of the clinicians no matter what one thinks.

P3 Healthcare Solutions works to benefit clinicians, therefore, if you think your data can be more accurate, get in touch with us and we’ll help you optimize your MIPS final scores. Report MIPS 2019 for each category including Promoting Interoperability (PI) and Improvement Activities (IA) like a pro.

For Improvement Activities, the process of aggregation occurs for the activity submitted via attestation, file upload, and/or direct reporting.

For PI, we suggest using a single mode of submission. If CMS receives conflicting data from various submission methods, it will automatically result in a score of 0 for this performance category. We advise each of you, clinicians, to be careful while reporting PI in 2019.

Last Date of Submission is March 31, 2020

In order to report, edit or delete your previously submitted data, new data is acceptable until March 31, 2020, before 8 p.m. EDT. It feels great to be part of the MIPS 2019 reporting system because up to 5% of incentives and reputation on Physician Compare are waiting for you on the other side.

All we require is your NPI; phone number; practice’s name; and 5-10 minutes of your time to discuss and finalize measures. You can also choose from one of our affordable packages, to achieve a score you prefer the most. Packages include MIPS Essential, MIPS Budget Neutral, and Benchmark MIPS.

To talk to us, you can call us for a free consultation on this number: 1-844-557-3227. We wrote an article specifically on the Quality performance category a few months ago in which we discussed some quality measures in detail. You can take a look here: 7 most reported MIPS Quality measures – A technical guide.

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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 instructed by the American Medical Association (AMA) CPT Editorial Team. The four levels of E/M codes remain intact for new patients with five levels dedicated to 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.

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5 Front Desk Basics to Improve Your Medical Practice

Like in any business, front desk staff plays a vital role in healthcare affairs. The business of knowing the right person for the right job matters in healthcare more than it matters anywhere else. Because whether it is a hospital or a private practice, patients need all the attention they can get. Moreover, if it is missing out from a crucial place such as the front desk, they can expect the worst outcomes later on.

P3 Healthcare Solutions, Ontario, CA analyzes this aspect of healthcare while it deals with the IT side. Since first impressions are usually the last ones, we have to make the most of them. Otherwise, we can’t promise patients to become a long-term asset of the practice.

Greet Patients As You Mean It

Every human, related or unrelated, deserves care. When a patient decides to check-in, they deserve to be treated in the best manner by the front desk staff. Greet them with a smile because what happens at the front desk sets the tone for the rest of their visit. Making lasting first impressions and treating them like someone you care about is the key to running your medical practice. Believe me, it makes a huge difference. Higher patient satisfaction level depends on the positivity that starts right after a patient checks-in and registers their presence by the front desk.

Speak Politely on the Phone

To get by your day rather smoothly, treat everyone on the phone in a polite way. It is similar to having a patient in real in your office and talking to them. A friendly attitude, calmness in manner, and providing appropriate information are the three factors to an ideal patient-practice relationship. Because they are not well in the first place, and when someone is not well, emotions take over rather quickly. Anything that’s said and done in that situation lasts forever.

As a medical billing service, we start proceedings with clients both old and new with positivity, and replying carefully to their queries. There’s a QA team present behind the calls to check them for quality, and ensuring seamless delivery of service.

A Clean Environment Influences the Most

A clean and well-maintained waiting area has wider implications than one can imagine. A sick patient can get better just by spending some time in it. As a doctor, you speak of cleanliness now and then. How can you expect your patients to sit in a dirty room? It won’t do your practice any good.

Wipe chairs and tables with a disinfectant before they arrive and make sure the place smells good. Put the trash in the bin where it belongs. A seemingly neat and tidy place can look all messed up if the magazines are not returned to the shelves. What matters is that the visitors enjoy their stay while they wait for the physician.

Smooth Patient Workflow Needs to be In Place

From the time a patient checks-in to the time they go out of the doctor’s office, the workflow needs to be in place. I am talking about timely notifications of the arrival of the patient to the doctor. A seemingly simple visit to the doctor’s office can become a complex problem when the front desk staff fails to function.

Furthermore, the front desk has to notify patients of any delays in their check-ups. And if there are any system failures, before the IT staff can deal with it, it has to come to the notice of both the patients and their doctors. When the front desk delivers to the best of their abilities, a smooth patient flow happens as a result.

Full HIPAA Compliance for Patient Records

As a HIPAA medical billing company, P3 considers the safety of patient records as its number one priority. Because breaches of any sort can result in fines and even jail time in some cases. The same is the case with a doctor’s office.

Verification of patient information is the first thing that happens when a patient checks-in. The front desk has to stay updated on the demographic and other relevant data like the date of birth, address, and phone number.

MIPS in healthcare is an incentive program that rewards clinicians with incentives year after year with performance categories such as promoting interoperability in action. The category was previously meaningful use of EHRs ensuring quality use of Certified Electronic Health Record Technology (CEHRT). Hence, electronic health records are crucial as the US healthcare industry moves into the next phase of value-based care.

To read more about medical billing services, go here – 5 advantages of electronic medical billing services for providers

MIPS 2019, CMS, MIPS QPP, MIPS Quality measure, PI Exception

All about the MIPS 2019 Hardship Exception Rules

CMS expects eligible clinicians to perform well in MIPS QPP.  Sometimes despite the efforts, physicians are unable to meet even the minimum performance threshold.

We can’t blame them if they happen to suffer from unexpected hardships such as severe weather conditions or other unfavorable situations. CMS offers relaxation for such cases.

The time for sending applications for MIPS 2019 exceptions has been started. Eligible clinicians, groups, and virtual groups now can apply in the exception context in two categories.

  • Promoting Interoperability (PI) Hardship Exception
  • Extreme and Uncontrollable Circumstances Exception

Exceptions will be offered only to those, who fulfill the criteria as specified by the CMS. Also, clinicians or groups who fall in the category of automatic reweighting of PI reporting shouldn’t have to apply for an exception.

MIPS 2019 Promoting Interoperability (PI) Hardship Exception

To submit for MIPS 2019 Promoting Interoperability (PI) measure, physicians must have access to 2015 Certified Electronic Health Record Technology (CEHRT).

The net weight of the PI category is 25% of the total MIPS score. Clinicians unable to report in this measure will have their percentage shifted to the MIPS Quality measure category.

Who Can Apply for PI Exception?

The mere absence of 2015 CEHRT will not grant any relaxation for PI data submission.

However, if you suffer from any of the below-mentioned scenarios, you qualify the PI hardship exception criteria.

  • Inadequate/Unsatisfactory Internet connectivity
  • No Control over the access of CEHRT
  • Extreme and Controllable Circumstances
  • De-certified EHR technology
  • A small medical practice with fifteen or lesser clinicians with the same Tax identification number

There are special cases in which eligible physicians are already exempt from the PI category, and are not required to submit hardship exception application of any sort.

For MIPS 2019, Clinicians with special cases are:

  • Non-Patient Facing clinicians
  • Hospital-based MIPS eligible clinicians
  • MIPS eligible clinicians associated with Ambulatory Surgical Center (ASC)
  • Nurse practitioners, physician assistants, certified registered nurse anesthetists, clinical nurse specialists
  • Physical therapists, registered dietitians, occupational therapists, speech-language pathologists, clinical psychologists, audiologists, and nutrition professionals

Note: If you participate in MIPS 2019 as a group, all members should apply for a hardship exception to reweight the PI score for the group.

Extreme and Uncontrollable Circumstances Exception

CMS states that extreme and uncontrollable conditions refer to the cases in which you have no control over anything or the facility in which you work.

By coming across such situations,

  • Clinicians may be unable to collect data for PI category
  • Clinicians may be unable to submit data to CMS for a long time (For any performance category)

In case of such circumstances, eligible medical practitioners as either individuals or groups can apply for an exception in all of the four categories.

  • Quality
  • Cost
  • Improvement Activities (IA)
  • Promoting Interoperability (PI)

Upon requesting an exception, clinicians must report the category, which was affected by the extreme conditions along with the impact.

Required Information

Eligible clinicians and groups must have the following information:

  • For Virtual Group: VG ID
  • For Group: Group name & TIN (Tax Identification Number)
  • For Individual clinicians: Clinician’s NPI (National Provider Identifier), Group Name, Group TIN

How to Send Application?

Clinicians and groups can send their applications via the official QPP website. The applications must be sent out before December 31, 2019.

Either CMS approves or disapproves of your request for an exception; CMS will notify you. The approval status will also be updated on the physician’s profile (QPP Participation Status Tool).

There’s only a little time left to submit an application for MIPS 2019 hardship exception. Although, CMS doesn’t require supporting data for the application. But, it is advisable to retain any important information in case CMS asks for it (for validation or audit).

Learn about 3 Points to Consider Before MIPS 2019 Reporting!

MIPS 2019, MIPS 2019 reporting, MIPS & MACRA, MIPS in healthcare, Quality payment program 2019

5 Key Takeaways from the Quality Payment Program by Year’s End

The Merit-based Incentive Payment System (MIPS) comes under the direct obligation of the Medicare Access and CHIP Reauthorization Act (MACRA), the law that regulates the incentive program across the US. It is the practical start of the value-based care model.

Eligible clinicians (ECs) have a responsibility to report MIPS 2019; they include physicians, osteopathic practitioners, chiropractors, physician assistants, nurse practitioners, and registered dietitians or nutritionists among others. To summarize, providers are to fulfill the low-volume threshold to qualify for MIPS 2019 reporting. Moving on to MIPS 2020, your next goal has its own set of requirements.

MIPS in healthcare gauges a clinician’s performance in terms of care delivery and reduced expenses. In this article, we come to an understanding of five key elements in relation to this program. In fact, the following data correlates with the preliminary data findings released by CMS on July 11, 2019.

  1. Two Branches for Positive Payment Adjustments

The Quality Payment Program (QPP) 2019 branches out into MIPS and Advanced Alternative Payment Models (APMs). Whichever path you choose, it results in incentives for eligible clinicians, clinician groups, and virtual groups.

Furthermore, MIPS & MACRA go side by side; it is the popular track with stats and reports going in its favor. MIPS incentives for 2019 are less as compared to incentives in MIPS 2020. On the whole, the program is evolving, but once it does, it will be the birth of an improved healthcare system.

It divides into four performance categories such as Quality, Promoting Interoperability (PI), Improvement Activities (IA), and Cost. Each category has certain measures that have to be reported through a MIPS Qualified Registry, CMS Web Interface, EHR, or Qualified Clinical Data Registry (QCDR). Not to forget, there is another catch to it in the form of collection types, which are the actual measures according to their submission systems.

  1. Participation Level Increases Each Year

Since the start of the program in 2017, the participation level has gradually increased. It showed an increase from 95% in 2017 to 98% in 2018. Moreover, MIPS 2019 is only going to give us more eligible clinicians participating in it. The whole program suggests progression with higher participation levels across the country.

  1. Small Practices Clinician Participation Status

According to the Centers for Medicare & Medicaid Services (CMS), 90 percent of clinicians from small practices engaged in MIPS 2018 which was 81 percent in 2017. So, that’s a 9% increase.

The primary flexibilities introduced in the Physician Fee Schedule (PFS) rule for the 2018 performance year included an increase in Medicare patient count and Medicare Part B allowed charges.

What did it mean?

It meant fewer clinicians from small practices were eligible to report MIPS in 2018. On the contrary, they decided to report it anyway. It goes to show that the system adjusted itself with practitioners’ convenience.

It was mentioned in a blog post by Seema Verma, Administrator CMS on July 11, 2019.

  1. Advanced APMs Are Not Far Behind

Alternative Payment Model’s (APM) participation level isn’t far behind that of MIPS. CMS reports twice an increase of participants in 2018 as compared to 2017. There were 99,076 total participants in 2017, while the number doubled to 183,306 in 2018. We attribute this jump to new participation opportunities in 2018, especially through ACOs in the Medicare Shared Savings Program.

Even if we are to condemn MIPS in general, I can’t see any downside to opportunities and hope that clinicians continue to grab MIPS incentives year after year.

  1. Spectacular Results So Far

The program collects incentives for the participating clinicians year after year, but the payout occurs one year after the performance year. For example, the payout for MIPS 2017 happened in 2019 in which 93 percent of the participants received positive payment adjustments.

Similarly, MIPS 2018 participants will receive a payout in 2020 which is almost here. CMS reports that 97 percent of the clinicians will be the owner of positive payment adjustments in 2020 based on their performances in 2018.

P3 Healthcare Solutions, Ontario, CA keeps an eye on what goes around as the MIPS performance period 2019 enters the final stages.