What Is About MIPS That Is Making Physicians Unhappy?

This ongoing period is the MIPS 2018 reporting season! Physicians and MIPS consulting services have buckled up their shoes to assemble appropriate clinical data that best favors medical practice in terms of financial matters and physicians’ reputation.

MIPS QPP promises physicians to take their financial journey one-step more towards the progressive road leading to a better healthcare system. The eventual objective is to build a healthcare system that makes both patients and physicians happy; patients with value-based care service and physicians with accurate reimbursements, incentives, and bonuses.

From the past two years, physicians tend to have several reservations regarding MIPS. In their first year, they were not sure about reporting criteria and MIPS quality measures. However, for MIPS 2018 reporting period, physicians learned from their mistakes and performed to actually use this system in their benefit.

MIPS Quality Measures Are Huge Set Back for Physicians

Even though, CMS acted upon some reservations for 2018. Still, there are voices raised against MIPS 2018 to trap physicians within the penalty cycle that ultimately will lead to poor-quality services for patients.

  • According to the research of members of the American College of Physicians, around 37% of the 86 MIPS quality measures are not up-to-the-mark and can’t contribute to improved quality care standards.
  • Physicians also explained that the given measures are not meaningful. In addition, the investment made to improve the quality of these measures just increase the administrative cost.

Approximately, medical practices are spending $15.4 billion per year in the USA-healthcare industry that means about $40,000 per physician to report for MIPS.

There is a debate that whether MIPS quality measures for the industry’s improvement are worth investment or not. Because, if they are not good enough, they are just a waste of money on the patient’s behalf.

For Instance,

According to Dr. Catherine MacLean (lead author of the analysis and chief value medical officer at the Hospital for Special Surgery), there is a quality measure that ensures all patients to have a blood pressure of 140/90 or lower. However, this may be lower for some patients.

The Medicare Payment Advisory Commission has raised similar concerns. Therefore, Problematic areas of MIPS need to be overcome in order to improve healthcare quality standards and the payment model.

CMS Website Should be Updated on a Regular Basis

Moreover, physicians were facilitated with an online database to view their status. However, the CMS website doesn’t update on a regular basis. This may have led physicians to not meet reporting standards on time. All of the practices rely on the information provided by CMS. If data is not updated duly on the site, how will physicians ensure the accuracy of MIPS requirements? After all, the ultimate burden would have to be bear by physicians as a penalty or less MIPS score.

CMS is trying to Rectify Errors in MIPS!

According to the spokesperson of the CMS, they are very dedicated to looking into every issue that is a hurdle in raising the quality levels of the healthcare system.

MIPS Success Depends Upon How Much CMS Pays Attention Towards Reservations!

The MIPS 2018 performance period is over however, it is compulsory for CMS to render each problem that is making physicians unhappy, rather than, forcing them to report aimlessly without any attraction.

Another way to ensure success in MIPS reporting is via hiring a professional MIPS consulting service as P3 Healthcare Solutions that provide the best MIPS solutions.

Follow our LinkedIn page for more information: https://www.linkedin.com/company/p3-healthcare-solutions

The Popular FAQs About MIPS – Explained!

Providing value-based healthcare services to patients and having a penalty-less spot in MIPS 2018 requires great effort. However, if strategize properly, physicians can get incentives and bonuses from this program.

Knowing the MIPS program better and accordingly report MIPS quality measures to increase your chances of payment rate from CMS. Therefore, it is always the best to resolve any misconception that might disturb later.

Given below are some of the important FAQs about MIPS that might answer your MIPS queries.

Is saving from penalties in MIPS is not enough?

2018 was the second operational year of MIPS and the minimum threshold for penalties was 15%. This bar is expected to rise in the coming years with strict reporting criteria.

70 MIPS points are the threshold set to get incentives. However, when achieved score higher than that, physicians can qualify for the bonus pool of $500 million. Physicians’ score is displayed on website www.medicare.gov/physiciancompare. The high scorer physicians get an extreme reputation and well-renowned authorities like Medicare, AARP, and CMS endorse them as a brand in the healthcare industry.

Thus, targeting incentives rather than just aiming for a penalty-less spot can open success gateways.

If physicians are still eligible for MIPS, when not using EHR technology?

If you don’t use the 2014 version of EHR technology, physicians may not be able to earn points for Advancing Care Information (ACI), now known as Promoting Interoperability (PI). For maximizing your score, physicians can earn from MIPS quality measures of Quality and Improvement Activities (IA).

Does reporting data for more than 90 days increase the chances of getting a higher MIPS score?

Physicians can choose to report clinical data for 90 days or more for up to 12 months. However, your result is solely based on the performance you showed throughout the performance year.

Thus, choose a report for the period that best suits your requirements and helps to increase the score.

What is the best practice, reporting as a group or an individual clinician?

Both practices benefit clinicians in their own manner so before deciding the best approach, consider the following points.

  • While reporting data to CMS in a group, all physicians will have the same payment rate. However, as an individual clinician, you’ll get your own payment rate. You have to decide which practice will benefit from more revenue generation.
  • Moreover, if any physician has a low-volume threshold, he will not be considered as an individual but as a member of the group.
  • In a multi-specialty group, some providers may find measures that are suitable for their practice, and conversely, they may not be suitable for others’ practice. In such cases, you have to choose measures that suit the single specialty of medical practice.

Is there any exclusion for MIPS?

YES! Physicians are only excluded from the participation of MIPS when,

Medicare allowable is less than $30,000 or less than 100 Medicare patients in 12 months

The healthcare service provider is already a participant of Medicare Advanced APM

Hospital-based healthcare providers are exempted from ACI (MU) category. For them, 25% weight of this category is reassigned to Quality category making its worth to 85% in the final MIPS scorecard

What happens when a physician moves to another medical practice in the payment year?

MIPS score moves with the physician. Even, if you have moved to a new working place, your score will be based on the data reported in the last year, no matter what the medical practice is.

When you work in two different medical practices in the same year, your payment rate under the new TIN (Tax Identification Number) will base on the higher score among both.

What factors should be in mind while selecting MIPS Quality Measures?

MIPS Quality measure and MIPS registry

Choosing the right MIPS measures, according to your practice is a difficult task so research properly about the following points.

There are 250 quality measures and 5 MIPS submission methods and some quality measures are only available for specific reporting methods, so how will you collect data and report to CMS?

Never report for a measure that has less than 20 eligible cases or no benchmark will receive 3 points.

Each reporting method has its own benchmark; thus, determine score by using the correct benchmark. For Example,

The same measure may have less benchmark when reported via a qualified registry as compared to EHR technology.

The above-mentioned points are the most frequently asked questions (FAQs). This article is all about clarifying those misconceptions, which may confuse physicians and block their way of success.

For detailed information about MIPS and its reporting services, visit our LinkedIn page https://www.linkedin.com/company/p3-healthcare-solutions

P3CARE Offers What Physicians Exactly Want!

The Healthcare industry is evolving at a fast pace. This revolution has led all stakeholders to adapt to unconventional ways of attending patients. Moreover, the MIPS payment model has turned the quality of medical services upside down. It serves to comprehend the importance of valuable health services along with the financial needs of physicians.

P3Care isn’t a new name and been known as a legendary MIPS qualified registry in the competitive industry. Their focus is entirely on accurately reporting MIPS to support and uplift revenue cycle management (RCM) for medical practitioners. The reporting pattern is so precise that saves physicians from penalties and makes them eligible for incentives and bonuses.

Getting a star rating from a physician compare portal is not any problem for their professionals. The Centers for Medicare and Medicaid (CMS) and the National Committee for Quality Assurance (NCQA) monitor and ensure the quality of medical service and reward accordingly. P3Care is well aware of their standards and help physicians to get a prominent position in the healthcare industry.MIPS qualified registry

How P3Care’s MIPS Reporting Services Credit to a Physician’s Success?

The Efficient MIPS Consulting Service

MIPS has been operational for two years now. It has changed quite a lot in terms of higher standards and reporting requirements. The threshold for eligibility and penalty prevention is also increased as compared to last year.

The reporting experts at P3Care are experienced and trained enough to recognize the tricks and tactics that can benefit in higher MIPS score. Preventing physicians from penalties is not their goal. Rather, they aim for incentives to increase revenue and get appreciation in the respective industry.

What Makes P3Care Different from Others?

When you have the goal of helping physicians and hospital systems to accomplish their objectives in the first place, your efforts should match respectively. P3Care no doubt possesses this quality.

It doesn’t matter if your practice is a small-scale or a well-established one, maintaining the balance of eligibility for higher points without putting too much pressure on practice to spend more, is an art. And, P3Care is a pro in this field.

  • The credentialing specialists at P3care ensure your legitimacy and enable you to get the rightful fame in the healthcare industry.
  • They spend quality time understanding the services you offer to patients and suggest improvement methods in your system.
  • From a budget point of view, they are very flexible and report clinical data as per your expertise.
  • Moreover, only by understanding your medical expertise, they plan and select the right MIPS quality measures to confirm that you get more MIPS points.

HIPAA – Compliant Medical Billing Services

P3Care is a renowned qualified registry for the last two years. However, it is also known as a leading medical billing service in the USA. Gone are the times when creating medical bills was that simple. Ensuring the patient’s and physician’s privacy is equally important. Therefore, HIPAA – compliant medical billing services serve the purpose.
Using the latest technologies such as; EHR technology to target Medicaid Meaningful Use (MU) and protecting the private information is their expertise. Patients feel secure and trust healthcare providers for the confidentiality of their data.

They have separate dedicated teams for creating medical claims and submitting to payers and reporting clinical data to CMS, according to the requirements.

P3Care – Your One Stop Place for Reporting Services

Many happy and satisfied clients testify P3Care performance. According to the founder of SunCoast, RHIO, Lou Galterio stated in a telephonic interview for Clutch. Co that his experience with P3Care has been immensely amazing! Their team is dedicated and leaves less room for error.

If your practice is unable to improve revenue cycle management and can’t find break-through for a penalty-less spot, consult P3Care services and experience what it likes to be in a prominent position in the healthcare system.

To talk to their H I.T consultant, visit their website https://www.p3care.com or call right away 1-844-557-3227

Take Advantage Of MIPS 2018 Reporting Standards & Score High!

2018 has been a revolutionary year for MIPS in healthcare. MIPS has faced much criticism as physicians were not comfortable with its payment model. The minimum threshold for a penalty-less spot was unacceptable for many clinicians, as it didn’t seem to bring any improvement in the healthcare industry in any manner. Physicians only worried about saving themselves from negative adjustments and that’s just it.

CMS replaced prior MIPS reporting rules with the new ones to address such reservations and to benefit physicians and the healthcare industry’s growth.

Apart from the changes in the percentages of the performance categories, the changes that CMS proposed for MIPS quality measure reporting; let’s look at them and analyze how we can target incentives and bonuses instead of just worrying about penalties.

Virtual Group Participation is now LEGAL

  • This year, a terrific advancement is seen in MIPS reporting guidelines as CMS is offering virtual group participation.
  • Virtual groups should consist of solo practitioners and an eligible group of 10 or fewer clinicians. They should work together VIRTUALLY for the MIPS performance year.
  • Generally, the participants in a virtual group report against all four performance quality measures and meet all reporting standards the same as any non-virtual MIPS group would.

The requirement for a Virtual Participating Group

  • Groups and solo medical practitioners who want to participate, as a virtual group needs to go through an election process.
  • The election process must end before the performance year and can’t change in-between. For Example, the election date for MIPS 2018 was from October 11- December 31st, 2017.

Low-Patient Threshold Update

Low-Patient threshold has been increased to exclude individual clinicians or groups with less than or equal to $90,000 in Part B allowed charges or less than or equal to 200 Part B beneficiaries. It is done in the determination period or during or prior to the performance year.

Bonuses for Care Services of Complex Patients

CMS grants 5 points as a bonus to the final MIPS scorecard by adding average Hierarchical Conditions Category (HCC) risk factor. The information is based on the complexity of the medical condition of the patient.

MIPS Favors Small Healthcare Practices

When small medical practices either individually or as a group submits data on at least one performance category, they get an additional 5 points in their final MIPS score. Thus, MIPS 2018 understands struggles that small medical practices go through and is trying to uplift such practices by favoring them.

Submit Hardship Exception Application for Extreme Cases & Save Yourself from Penalty

If the eligible clinician doesn’t use CEHRT- Certified EHR Technology, due to uncontrollable circumstances, for instance; natural disaster, he can submit Hardship Exception Application for reweighting Advancing Care Information (ACA) performance category. It increases the percentage of other remaining categories in the final MIPS score.

An update in this regard is that 31st December 2018 is the last date for hardship application submission.

According to CMS estimation, around 572,000 clinicians will participate in MIPS 2018 reporting. They also propose that clinicians will receive approximately $173million as positive payment adjustments via MIPS consulting services. So, why not report clinical data to CMS, the way it wants and get more payment incentives than expected.

The threshold for Penalty-Less Spot has increased

In its first year, keeping yourself safe was just a matter of three points. Now, the bar has been raised to at least 15 points. This way, clinicians have improved their care standards drastically and the overall pace of the healthcare industry improved.

Keeping track of all the changes is surely hectic for the clinicians; therefore, consulting a MIPS qualified registry becomes a necessity. P3Care has a distinguished name as a professional MIPS consulting service.

Follow us for inquiries: https://www.linkedin.com/company/p3-healthcare-solutions

How P3care Handles Medicare MIPS Reporting For Cardiologists

P3Care.com sort things out with the payers and at the same time keep the communication lines open on behalf of the providers. This way the patients receive the best care and the insurance reimbursement workflow keeps on moving.

Everyone is happy.

In addition, P3Care has a strong grip over the Quality Payment Program under MACRA. The Merit-Based Incentive Payment System (MIPS) track reporting mechanism for both the specialty-specific clinicians and the primary-care physicians brings in both incentives and reputational benefits.

What is P3?

The three “Ps” stands for –

  • Providers
  • Patients
  • Payers

P3Care Simplifies MIPS Reporting for Specialists

Merit-Based Incentive Payment System (MIPS) is an integral part of the value-based system. In addition, CMS recognizes P3Care as a MIPS Qualified Registry vendor in back to back years of 2017 and 2018. That makes it a favorable enterprise for physicians who want to choose a registry as their MIPS submission method.

The recognition puts a bigger responsibility on our shoulders in terms of performance and meeting your expectations.

The US healthcare system revolves around a working relationship between providers, patients, payers, and medical billing services. If there are disparities at any level, at any step, there is a high probability of bottlenecks.

The government has set the course for MIPS in healthcare to go the distance and want all the clinicians to accept it. If they fail to comply with MIPS, they must be ready to face financial penalties along with putting their integrity on the line.

Heart specialists or cardiologists choose quality measures, outcome measures (or high-priority measures) from specialty-specific sets and start their journey for incentives through MIPS reporting. We take a few minutes of your time and finalize measures before submitting it to CMS.

Peace of Mind for Cardiologists

What do the cardiologists say?

First, they are ready to participate in the Merit-Based Incentive Payment System (MIPS). They are actually more excited about it than the general physicians. However, more than half of the cardiologists working in the healthcare industry have reported fatigue and higher stress levels due to excessive documentation.

If IT regulations ease up, it may give them ample time to treat patients and rest as well. P3 Healthcare Solutions is here to help you report MIPS in a timely manner. Connect with us 909-245-8350 to discuss.

CMS Incentivizes Practitioners

The doctors’ job is to treat the patients, but instead, they work 10 to 20 hours a week on paperwork. That is the fact, unfortunately.

The ground reality is that CMS has allocated $20 million on the smooth transition to the Merit-Based Incentive Payment System. All these initiatives are going to improve healthcare down to the grassroots level. It must do so and silence those voices screaming the phrase, ‘Americans not getting the treatments they deserve’.

To make it more difficult for cardiologists, the data coming out of the EHR system is vague and doesn’t help with the diagnosis. Often it is descriptive rather than suggesting crucial care points. P3Care brings a solution to this problem by synchronizing the medical billing service with the practice management system.

Specialty-Specific Demotivating Factor

There are no standards set for specialty-specific clinicians when it comes to MIPS quality measures. Hence, there is no way to compare the scores of specialists. The result is a low MIPS Final Score, and there may be no bonus payments at all. It is derogatory and depressing.

Quality measures outlined by the Qualified Clinical Data Registry (QCDR) reporting mechanism also have a similar story. Generally, many specialists vote in favor of QCDR.

Data Submission for Physicians and Specialists

After the month of March, CMS takes around 6 months to generate detailed results on MIPS reports.

Medicare MIPS reporting on Quality measures through a registry is highly suitable because it helps to identify and list down probable errors in the report. There is no other way to identify any ambiguities because CMS directly publishes the results. We can’t afford to make mistakes. However, at the end of those evaluations, CMS gives time to practitioners to ask for a review if they are not satisfied with the MIPS final score.

MIPS Cost Measures

Cost is an additional category in MIPS 2018. It accounts for 10% of the composite performance score (CPS). As a cardiologist, you don’t need to worry about it, though. CMS directly manage this category according to your billing to Medicare.

P3Care has a plan in place for the cost category so that CMS gives you the highest ratings on it. If you’re a specialist, please follow us on LinkedIn https://www.linkedin.com/company/p3-healthcare-solutions/.  We are technologically tenable and keep a close eye on news, views, happenings, and information regarding the US healthcare industry.

When you add the inpatient and outpatient costs, the average of which is compared to the national standard set in the specialist category.  That is an overview of how the cost category is calculated. The lower the cost, the better the ratings!

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.

MIPS 2019 – A Brief Overview

We have gone one step ahead. Now in the 3rd performance year of MIPS, the percentage of all performance measures has changed as follows.

MIPS penalty level has gone to -7% and the minimum score to avoid a penalty is 30 points.

The scores for each performance category are:

  • Quality 45%
  • Promoting Interoperability 25%
  • Improvement Activities 15%
  • Cost 15%

Every eligible clinician who reports for Medicare Part 2 or Critical Access Hospital (CAH) Method II payments can participate in MIPS 2019.  Moreover, every clinician can report as a group or as an individual but it applies across all categories.

It means, if a clinician chooses to report individually, he can report solely with this submission method for all categories.

Eligible clinicians have lots of chances to earn incentives and bonuses in this year by performing well for interoperability and maintaining quality.

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.

4 Statistical Reports To Access Revenue Cycle Management

Medical billing services in the US play a major role in the revenue cycle management process. They use the latest health IT tools and techniques to counter day-to-day challenges. According to the Kaufman Hall study of CFOs from more than 350 hospitals in 2018, the priority of the physicians was to reduce the cost of care delivery. Because the healthcare system is becoming more and more price-competitive.

MIPS being part of value-based healthcare has everything in favor of the physicians monetarily and patients in terms of their health. Quality is the number one requirement of this program, and it is judged by weighing doctors in four performance categories. Optimizing the RCM is one way to control the prices of care delivery, and that’s where P3 focuses the most.

Today, physicians or others related to them don’t have to manage patient records on paper, but there is dedicated software for them. As a billing company, we operate on Certified Electronic Health Records Technology (CEHRT) to maintain a steady cash flow for clinicians. In an EHR, data is automated, and we don’t have to worry about digging up a file from underneath a pile of papers.

Given below are some types of reports that will inform you about the progress of the revenue cycle management method.

1. High-Level KPI Report

This report helps in learning about the Current Procedural Terminology (CPT) in medical coding. It confirms that medical coders use the most common and profitable codes in a medical claim.

This report estimates the following parameters:
• Total encounters
• Total collected payments
• Accounts receivables
• Number of procedures

The difficulties in these KPIs help in knowing the areas that need improvement. For example;

If in a month, cost consumption increases, profit for that month should also increase in the same ratio. You experience a reduction in the accounts receivables (ARs).

Generally, medical billing software conducts everyday tasks of medical billing and coding in an efficient manner. The software has an inbuilt template for CPT, and if there isn’t, you must create one to promote future accurate claim creation.

2. Per-Encounter Reimbursement Report

Another KPI is to compare the reimbursement rates with that of your competitors. The formula to calculate the rate is simple – It is per-encounter reimbursement which is the total payment divided by the total number of encounters in a specific time.
When we know the average reimbursement rate per patient, it improves the consistency of the revenue cycle management process.

3. Report To Keep a Track of Accounts Receivables (ARs)

Revenue cycle management becomes more efficient when we keep a track of accounts receivables for the physicians. Ordinarily, medical billing and coding agencies neglect accounts receivables which exceed 120 days.

However, professional medical billers know the periods for particular claims – 30 days, 60 days and so on to keep an eye on the amount due by the insurance companies. If payments cross the 120-days mark, medical billers find out the exact reason for the delay and join heads to figure out a solution.

When the AR is less than 10%, it represents an ideal situation. If it is more than 25%, drastic changes in the revenue cycle management or a medical billing audit may be the ultimate remedy.

4. Report for Checking the Ratio of Net Collection

By the net collection rate, we know the exact performance of the revenue cycle management system. It highlights whether we are collect payments as per the number of resources we utilize or otherwise. Medical billing practices aim for 95% of revenue collection to progress in the healthcare industry. If the ratio is lesser, there is room for improvement in the RCM.

Charge value is an important parameter and it is the contractual adjustment of the total billed amount. By knowing this value, billers can calculate the total collected amount and give an estimate of the profit.

Conclusion

We can’t measure the performance of a physician’s practice unless the billing system works on specific lines of improvement. Ineffective billing directly affects revenue at the end of the day. Therefore, it is crucial to have your best personnel on revenue cycle management to keep it in a profitable mode.

P3 works to increase the revenue of physicians in an organized yet efficient way. Because they know the vitality of such an effort. It gives them a chance at increased revenue along with satisfied patients. The statistical reports mentioned in this article breathe life into the process of revenue generation from start to finish.

For a free RCM consultation, call 1-844-557-3227 without hesitation.

As a clinician, why do you think it is important to have an effective RCM process in place?

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.

MIPS Track Participation Exceeded 1st Year Growth – CMS

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.” A 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 are 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 the 2015 edition of CEHRT exclusively thus promoting interoperability of health information.
  • A higher number of opportunities for 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.

Now that the 3rd performance year MIPS 2019 has started, CMS expects even more participation than the previous years. Their efforts to minimize administrative burden and address concerns that clinicians highlighted are appreciated throughout.

An Overview of MIPS 2019

MIPS 2019 and Quality measures

For 2019, positive or negative payment adjustment is raised to 7%. Talking in numbers, if medical practice scores well and bills approximately $1,500,000 in Medicare, it can earn up to $1,605,000. The huge money is surely an attraction.

Moreover, this year, the performance threshold is 30 points instead of 15 points. Achieving double the points than last year is quite easy if you use appropriate resources and the latest tools.

CMS is stepping up each year for incentive payment program MIPS to make things work out for healthcare organizations. The competition is surely getting tougher, but the expected outcomes/incentives are worth putting efforts into the progressive healthcare industry.

While there is still time for MIPS 2019 data submission period, ensure an impactful performance for MIPS performance categories and report data via an MIPS qualified registry as P3 Healthcare Solutions.

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.

MIPS 2018 Updates For Clinicians And Healthcare Providers

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.

MIPS 2018 Updates & QPP Strategic Payment Program Objectives

CMS aims to accomplish 7 strategic QPP objectives with the introduction of MIPS 2018 Updates.

  1. To assist in the overall improvement of beneficiary outcomes. It also means engaging patients by deploying relevant MIPS and Advanced APM policies.
  2. The improvement in the clinician experience through the introduction of a transparent and flexible program. This approach will help provide clinicians with easy to use program tools.
  3. Increase adoption and availability of the robust Advanced APMs.
  4. Maximize participation and understanding of the program by deploying customized communication that focuses on support, education, and outreach. The underlying theme is to ensure the program fulfills the needs of diverse types of practices, patients, physicians, and small healthcare providers.
  5. To promote the increased sharing of data and information relating to the program’s performance. Thus, the underlying concept is ensuring timely yet accurate availability of actionable feedback to clinicians and other relevant stakeholders.
  6. Help deliver IT systems with improved capabilities relating to reporting, data submission, and an overall improvement in its front and backend, delivering greater efficiency and value.
  7. Lastly, one of the core strategic QQP objectives is to improve program implementation and foster ongoing development that keeps the requirements of the US healthcare industry into context. Furthermore, it also helps small and rural healthcare providers successfully take part in the program.

What are the MIPS 2018 Updates?

MIPS 2018 Updates and quality measures

Let’s look at the highlights of MIPS 2018 updates.

  • Performance Period
  • The performance period is changed from 90 days to the 12-month calendar year.
  • The cost will be applicable based on the 12-month calendar year.
  • A minimum of 90 days period will be under review for Advancing Care Information.
  • A minimum of 90 days period will be under consideration for evaluating Improvement Activities.

Performance Threshold or Payment Adjustment

  • Minimum Performance Threshold will consider 15 instead of 3 points.

Road to accomplishing 15 points for performance threshold

Here is how you can attempt to accomplish the 15 points. You can fulfill any one of these criteria to reach the goal of 15 points.

  • To submit 6 Quality Measures that meet data completeness criteria.
  • To meet the base score for Advancing Care Information. To accomplish it, you will have to submit 5 base measures and also submit a medium-weighted Improvement Activity.
  • To meet the base score for Advancing Care Information. Also, submit 1 Quality Measure which meets data completeness requirements.
  • Lastly, you can also reach the 15-points performance threshold goal by reporting all Improvement Activities.
  • For achieving exceptional performance, the providers must reach the threshold of 70 points.
  • The law requires the payment adjustment for the 2020 payment year to range between -5% to +5X% (where +5% means = 5% X scaling factor). The scaling factor is achieved to ensure the accomplishment of budget neutrality.
  • Under the revised MIPS 2018 updates, the adjustment factor applies to items and services under Medicare Part B (It includes Part B drugs too).

Quality

  • The 2018 Quality Measures Specifications will become applicable.
  • Weight to the final score is 50% instead of 60%.
  • For Data Completeness, CMS wants providers and clinicians to meet a minimum threshold of 60% instead of 50%. Therefore, measures not meeting this data completeness criterion will only get 1 instead of 3 points. However, small healthcare practices will still get 3 points.
  • The scoring has a 3-point floor for measures against the benchmark. There are 3 points for measures that either do not have a benchmark or they do not meet the case minimum requirement. Measures which fail to meet data completeness requirements will only get 1 point and not 3 points, except small practices getting 3 points. There is no change introduced for the bonuses. One of the MIPS 2018 updates is that CMS proposes the introduction of a cap of 6 points for a particular set of 6 topped out measures.
  • The improvement scoring will be given by measuring the rate of improvement. The increase in improvement will mean more points, particularly for the providers that have a lower performance during the transition year. The improvement will be measured in the Quality Performance Category Level, with ten percentage points available for Quality Performance Category.
  • One of the MIPS 2018 updates is about the topped out measures scored with a maximum of 7-points and not the standard 10-points.

6 topped out measures for 2018

  • #21. To either select the Prophylactic Antibiotic-First or Second Generation Cephalosporin.
  • #23. Venous Thromboembolism Prophylaxis, when they are indicated in all the patients.
  • #52. COPD (Chronic Obstructive Pulmonary Disease), Inhaled Bronchodilator Therapy.
  • #224. The overutilization of the Imaging Studies in Melanoma.
  • #262. Confirmation via image, of successful excision of Image Localized Breast Lesion.
  • #359. To optimize patient exposure by utilizing Standardized Nomenclature for CT (Computerized Tomography), imaging description.

Improvement Activities

  • The providers must be aware of the specifications of the 2018 Improvement Activities.
  • The weight to the final score will be 15%.
  • There isn’t any change in the number of activities that MIPS eligible clinicians need to report for reaching 40 points. CMS wants to propose more activities to select from and also wants changes to existing activities for Inventory. The clinicians practicing in rural areas and small practices would only be needed to report no more than 1 high-weighted or 2 medium-weighted activities for reaching the highest score.
  • For the TIN to get credit for group participation, only one MIPS eligible clinician would have to perform the Improvement Activity.

Advancing Care Information

  • The providers and clinicians must be aware of the specifications for the 2018 Advancing Care Information Measures.
  • The weight to the final score is 25%.
  • To allow the MIPS eligible clinicians to use either the 2014 or 2015 Edition of CEHRT in 2018. And also to grant them a bonus if they only use the 2015 Edition of CEHRT.
  • To add exclusions for the Health Exchange Measures and E-Prescribing.
  • To add more Improvement Activities which would show the use of CEHRT to the list eligible for a bonus of Advancing Scare Information.
  • One can earn 10% in performance scores if they report about any of the criteria to clinical data registry or single public health agency.
  • An additional 5% is allocated for submitting to one additional clinical data registry or public health agency (not reported underperformance score).
  • To add decertification exception for those eligible clinicians who’s EHR has been decertified, retro effectively for 2017 performance periods.
  • The deadline for exception application submission for the year 2017 and for future years, is set on December 31st for measuring the whole year’s performance.
  • Small practices which have 15 or fewer clinicians, the addition of a new category for hardship exceptions to re-weight the category of Advancing Care Information to 0. To reallocate the 25% of the category weight of Advancing Care Information to the category of Quality Performance.
  • CMS will reweight the category of Advancing Care Information to 0 and reallocate its 25% performance category weight to the category of Quality Performance for these reasons.
  • Automatic Re-weighting
  • Certified registered nurse anesthetists, clinical nurse specialists, physician assistants, and nurse practitioners.
  • The non-patient facing clinicians including pathologists and radiologists.
  • The hospital-based MIPS eligible clinicians.
  • The ASC (Ambulatory Surgical Center) – based MIPS eligible clinicians and the certified registered nurse anesthetists.
  • To reweight through an approved application.
  • There are significant hardship exceptions, and CMS will not be applying a five years limit for these exceptions.
  • A new hardship exception to the clinicians practicing in small practices has 15 or fewer clinicians.
  • There is a new decertification exception added for the eligible clinicians whose EHR has been decertified and becomes effective retroactively for the performance period of 2017.

Cost

  • There will be a weight of 10% added to the final score.
  • CMS will include the total per capita cost measures and MSPB (Medicare Spending per Beneficiary) for calculating the Cost performance category score for the MIPS performance period of 2018. These two measures will be carried over from the Value Modifier Program. These two programs are also currently used for providing feedback for the MIPS transition year.
  • CMS will be calculating the cost measure performance. The clinicians do not need to take any action.
  • The new changes offer Virtual Groups with participation options for Year 2, providing clinicians with another way to participate in MIPS. The Virtual Groups can contain Solo Practitioners and Groups containing 10 or fewer eligible clinicians. They are eligible to participate in MIPS, coming together virtually with at least one such other Solo Practitioner or Group for participating in MIPS. In general, clinicians’ being part of a Virtual Group would have to report as a Virtual Group for four different performance categories. They will also need to meet the same performance category requirements and measures as that of the non-virtual MIPS groups.
  • Virtual Groups need to conduct their elections at the beginning of the performance period. It cannot be changed once the performance period starts.
  • Groups and Solo Practitioners wanting to participate in a Virtual Group have to go through the election process.
  • The period given for election is from October 11thto December 31st, 2017, for them to be considered for the 2018 MIPS performance period.
  • To increase the low volume threshold by excluding individual clinicians or groups eligible for MIPS having < $90,000 in Part B allowed charges. It is also applicable to those individual clinicians or groups with < 200 Part B beneficiaries falling within the low volume threshold determination period occurring during a performance period or a prior period.
  • CMS is not changing the way it defines non-patient facing clinicians. Individuals <100 patient-facing encounters, and for groups, it stands at > 75% NPI’s billing under the group’s TIN falling within a performance period and labeled as non-patient facing.
  • Under the Complex Patients Bonus, there is an adjustment applied to up to 5 bonus points by adding average HCC (Hierarchical Conditions Category) risk score to the final score. The score addition would be anywhere from 1 to 5 points given to the clinicians depending on the patient’s medical complexities.
  • The Small Practice Bonus will adjust the final score of an eligible clinician or group working in a small practice as defined in the regulation, applicable to 15 or fewer clinicians. It would add 5 points to the final score provided eligible clinician or group submits the data for at least one performance category within the applicable performance period.
  • There are payment adjustments by CMS for Extreme and Uncontrollable Circumstances, approximately given to 572,000 eligible clinicians. They would have to participate in MIPS for the 2018 MIPS performance period. Under the newly proposed rule, the payment adjustment for the 2020 payment year may range from =5% to +5X%. (X is the adjustment factor that allows MIPS program for staying budget neutral.)
  • If the CEHRT for an MIPS clinician is unavailable due to uncontrollable circumstances like a natural disaster, public health emergency, or hurricane, etc. the clinician can submit a hardship exception application for getting reconsidered for reweighing of Advancing Care Information performance category. The application is due with a cut-off date of December 31st, 2017.
  • There is a final rule with comment period extending this reweighting policy for the performance categories of Improvement Activities, Cost, and Quality which starts with the 2018 MIPS performance period. The deadline for this hardship exception application is December 31st, 2018.

As far as 2018’s submissions are concerned, the deadline was April 2, 2019. Moving on, if you were eligible back then, you are eligible in 2019 as well.

MIPS consulting services job is to satisfy your end of the deal with the authorities for compliance and data completeness. That is what we do for our clients!

Moreover, those of you who weren’t eligible then may be eligible now. Give us a call or simply fill-up the form on the homepage to notify us. P3 Healthcare Solutions connects clinicians to high scores which means rewards and a better reputation.

QPP 2019 is prevailing and it is important to submit measures against Quality, Meaningful Use (MU) or Promoting Interoperability (PI), Improvement Activities, and Cost performance categories. With the promise of less reporting burden by CMS, we can expect the program to become clinician-friendly as time goes by. Please follow us on LinkedIn here – https://www.linkedin.com/company/p3-healthcare-solutions

What is next?

What changes to expect in MACRA-MIPS 2019?

For questions out of this knowledge base, or on instructions on how to get started call a MIPS specialist today at 1-844-557-3227 (1-844-55-P3CARE) or email at info@www.p3care.com.