MIPS&MACRA, MIPS in healthcare, MIPS reporting, MIPS 2019, MIPS quality measures, MIPS qualified registry

MACRA MIPS – Get Ready For These Changes In 2019!

For those covered by Medicare, the paperwork requirements wait for your attention, as a physician, and you can’t take a step back from those duties.

Why has this become crucial for medical practices? Because the Medicare Access and CHIP Reauthorization Act of 2015 and MIPS incentives depend on fulfilling these requirements in the new value-based care system!

And, once you have followed these requirements in letter and spirit, 5% incentives add to your 2020 Medicare payments. Those of you, who don’t think much of this payment adjustment, think again! Because the adjustments increase your finances by huge numbers!

Not all of us are in it for monetary benefits. Nevertheless, the reputational advantage as a clinician will take your practice to the next level. People are going to recognize you as a clinician with superior healthcare knowledge and consider you as an authority in the industry.

To consider MACRA into your practice, upgrade your outdated EHR system to the 2015 certified EHR technology edition. And, consider doing so in case you are an old-fashioned paper-based practice. In addition to that, ensure the technology vendor is trustworthy and has a history of meeting government proposals. A tip to remember here is that proper training of the staff goes hand in hand with the newly installed EHR system.

Prepare yourself for the few changes regarding exemptions under extreme conditions, an increase in the cost category’s weight, an increase in low-volume thresholds, and a boost to the cost performance category in 2019.

Change 1 – Exemptions under Harsh and Uncontainable Situations

Get ready for changes in The MIPS

CMS owns the fact that extreme conditions can affect gathering, storing, and submitting patient information. Hence, in 2019, it gives more space to such clinicians under intense circumstances. According to Clinician Today, in the performance year 2017, the clinicians were not scrutinized for any lack of information if they had to face extreme conditions such as California wildfires.

The automatic exemptions expect to continue going forward in 2019. God forbid, if there are any acts of God or natural disasters, as a MIPS reporting physician, CMS will not put you on a penalty list. First, we pray that neither a flood nor a wildfire breaks around your practice. Second, choose P3 Healthcare Solutions MIPS consulting service for Quality measures and reporting other categories properly 1-844-557-3227.

info@p3care.com is the address you’ll be emailing your queries to.

Change 2 – Expect an Increase in the Weight of the Cost Category

As the Medicare reimbursement model transforms into the value-based care model, MIPS in healthcare will have the cost category hold more weight than in 2018. It was at 10% of the total weight in the previous year and it is going to stay that way or go higher in 2019.

Clinician Today mentions that the cost category is going to accommodate 30 percent of the total MIPS score (CPS) by the year 2022. By preparing early and maximizing on this category, your practice can achieve a decent MIPS final score. Consequently, everything falls in line with quality-based care.

To maintain the balance between categories, expect a formidable decrease in the weight of the Quality category at an equal level.

Change 3 – Expansion in Low-Volume Thresholds (LVT)

A Low-Volume Threshold (LVT) depends on the number of allowed Medicare Part B charges and the number of patients cared for by an eligible clinician. There is a consistent increase in the LVT in subsequent years until 2018. And, 2019 is not going to be any different.

Currently, the LVT has more than or equal to 200 Medicare patients or your practice/group has billed more than or equal to $90,000 in Medicare Part B allowed charges. It was an uptick to MIPS 2017 requirements of 100 Medicare Part B patients or $30,000 Medicare Part B allowed charges.

You may not be eligible in the past year, but there is a high probability of your eligibility for MIPS submissions in 2019. Therefore, be well aware, and as soon as you reach the Low-Volume Threshold, P3Care being a MIPS qualified registry, reports on your behalf so that you receive high incentives.

Change 4 – MIPS Cost Category to Experience a Boost

We can see the cost category weight rise to 15% in 2019. MIPS 2019 reporting is not going to be a child’s play because the focus on trimming healthcare expenses is now more than before. CMS suggests adjusting this raise by offsetting the Quality category from 50 to 45%.

Hence, be on the lookout for any changes in government regulations around Medicare reimbursements! Quality reporting aims to improve healthcare delivery and better compensation to physicians.

We try to give you insight into the world of medicine as it crosses paths with medical billing. P3 Healthcare Solutions deals with the revenue cycle management process efficiently when it comes to MIPS consulting and medical billing service in general. One remedy to stay updated with the latest Medicare MIPS reporting requirements and to provide quality billing services to clinicians.

MIPS healthcare, MIPS solutions, QPP MIPS program, MIPS quality measure, MIPS cost measure, MIPS Submission Methods

How to Avoid Penalties in MIPS 2018, 2019 and Beyond?

Back in 2018, the American Medical Association (AMA) stated that the only way to avoid penalties regarding MIPS 2018 was to report on a few of the MIPS quality measures.

Now, that we are about to conclude 2019, reporting PI and IA are deemed crucial aspects of MIPS 2019 reporting. Eligible Clinicians (ECs) have the right to bonuses from the $500 million pool set aside in 2019 if they score more than 75. In this way, ECs get to avoid negative payment adjustments waiting to happen in 2021 by a distance.

Until now, the four approved performance categories to attest to include:

  • Promoting interoperability
  • Quality
  • Improvement activities
  • Cost

How Reporting Criteria Changed Over Time?

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

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

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

The tips below can help you avoid a financial penalty in 2020 and 2021 and a chance at a high Composite Performance Score (CPS)

Report on Improvement Activities (IAs) to Score Higher

The best way to meet the required threshold is to report Improvement Activities (IAs) immediately.

The Centers for Medicare & Medicaid Services (CMS) defined 113 measures under this performance category in MIPS 2019. Each performance measure has further subcategories in the form of medium and high-weighted activities. The high-weighted activities carry more points and can get you closer to the maximum score.

Similarly, MIPS 2019 has 118 Improvement Activities from which clinicians have to select and submit. It is a constant process of reporting for 90 days. Let’s be compliant with P3Care because we can get you the right combination of medium and high weighted measures to score in the 80s or above.

How do You Calculate Performance Categories?

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

How to Submit MIPS to the CMS?

Healthcare providers can submit clinical data for MIPS 2018 via:

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

Improvement Activities – Small Practices Have an Edge

Reporting Improvement Activities (IAs) under MIPS 2019 can improve revenue cycles of small practices. The program rewards small healthcare practices with double the points as compared to well-established healthcare facilities.

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

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

MIPS Quality Measures Shield You from Negative Payment Adjustments

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

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

  • Efficiency
  • Outcome
  • Patient engagement

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

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

Report At Least Two Performance Categories in 2018

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

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

Report One of the Categories in 2019

Even though you have to report in one of the categories in 2019, but there are certain criteria set for each category. For instance, small practices with 15 or fewer clinicians, when they are reporting solo or as a group will have to attest to 1 high weighted and 2 medium-weighted improvement activities. That’s one example. And, the list goes on.

Call us to discuss more on our toll-free number: 1-844-557-3227.

Score Comparison

Ordinarily, we see small medical practitioners reporting one medium-weighted improvement activity and one quality measure. This reporting tactic earns you 10 points and with an extra 5 bonus points, you may achieve a total of 15 points. This was back in 2018.

Now, you need a score of 30 points to avoid penalties.

Promoting Interoperability (PI)

MIPS Quality Measure and Interoperability

 

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

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

In 2019, the score to achieve bonuses moves up to 75 and beyond.

EHR Technology – One Step Ahead

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

Tricks of the Trade

The data submitted on quality measures for at least 20 patients fulfill the data completeness requirement.

Two medium-weighted improvement activities and four quality measures can get you a score of 16 points in 2018.

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

Vote for Better Healthcare

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

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

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

4 Tips For Accounts Receivable Management In Medical Billing

According to a report, out-of-pocket expenses have increased by 230% from what they were in the previous years. As a patient, it means our health maintenance costs have gone up and it doesn’t look like coming down any time soon. MIPS 2018 is an important advancement in this context as clinicians continue with value-based services while the state incentivizes or disincentivizes them based on their performance.

Medical billing and coding teams create accurate claims in complete synchronicity with clinical functions to stay compliant with MACRA-MIPS. Hence, a billing company that is also a HIT consultancy is vital to the MIPS reporting process.

Coming back to our topic, Group One Healthsource reports that around 40% of the healthcare providers are unable to collect $31,713 from their patients every year. The reasons why they fail to collect such a huge amount are errors in documentation of medical procedures and misinformation (we can’t really misspell or mistype date of birth). Hence, accounts receivable (AR) needs special attention to close the gap between the claimed amount and the received amount.

Given below are a few tips to improve the billing process for physicians and boost AR management permanently.

1. Focus on Error-Free Medical Claim Submissions

Late payments and claim denials usually occur due to medical billing and coding errors. The insurance companies accept only those claims that are according to their claim filing standards. The strict policies don’t have room for even minor errors.

It is important to review each claim precisely before submitting it to the insurance companies. In the case of a claim denial, you must have a professional denial management system in place. Insurance payers’ representatives can help rectify each problem efficiently.

2. Make the Payment Procedure Transparent

Another approach to minimize accounts receivable is to make payment procedures transparent. When physicians notify patients of outstanding medical expenses prior to the treatment, it becomes easier to collect payments. Hence, more and more claims come out of the unreceived pile onto the received shelf.

Billing companies inform physicians about the payments approved by the insurance companies and payers like Medicare and Medicaid. To maintain transparency in the medical billing system, professional medical billers verify the eligibility of the patient before submitting the medical claim. It reduces the problems in later on.

When you collect copayments earlier into the revenue cycle management (RCM) process, stop worrying about the escalating number of AR days. It also saves you from unnecessary paperwork later.

Medical billing outsourcing companies perform at crunch times, as their performance is crucial to the cashflow of physicians on their subscription lists. Subscribe to P3Care on this number: 1-844-557-3227.

3. Make Use of the Latest Medical Billing Tactics

Medical billing standards have changed over the years. Hence, the billing staff requires constant training and knowledge to improve their skills. It results in improved medical billing tactics for better reimbursements and reporting MIPS 2018 Quality measures to score high in MIPS.

The latest trends demand investment, but they benefit in the end. By staying up-to-date with the latest tactics, we not only reduce errors in medical claims but improve accounts receivable management as well.

4. Audit Medical Billing Process

By auditing the medical billing and coding of a certain practice, we may identify the problem areas creating the mess we know as accounts receivable. For instance, when there are frequent changes to patient’s information, errors have a high probability to occur. Such mistakes lead to outright denials.

Correct and timely identification of where the claims are choking the system is what companies like ours are trained to do. Such audits catch errors and breathe life into a billing system by streamlining the process of revenue generation.

By training the staff and physician’s financial management team, areas with glitches are more frequently identified and fixed accordingly. Soon after a claim is fixed, it gets resubmitted to the insurance company starting the appeal process. The earlier the better because then reimbursement doesn’t have to face any further delay.

Conclusion

The above-mentioned tips reduce the number of resubmissions of claims to the insurance companies. The time duration for payment collection shortens. In addition, physicians get to receive revenue in a timely manner.

P3Care’s medical billing services provide professional medical billing solutions to healthcare professionals and increase their revenue considerably via the latest billing methods.

Follow P3Care on LinkedIn – https://www.linkedin.com/company/p3-healthcare-solutions/ to stay updated with the US healthcare industry.

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.