MIPS 2020, MIPS 2020 reporting, MIPS solutions, MIPS Qualified Registry

4 Things to Consider before Adopting Health IT Innovation

With MIPS 2020 just around the corner, eligible clinicians are ready to submit quality data to CMS in order to improve their financial situation.

We all are rooting for quality healthcare services, and technology incorporation is an efficient way to achieve this goal. For the same reason, MIPS eligible clinicians from all specialties are adopting health IT.

Benefits of Health IT

Technology is in the best interests of the healthcare industry. Undeniably, the digital transformation where improves the care delivery system, it also helps in MIPS 2020 reporting.

Time efficiency of providing healthcare has improved.

The administrative load has been reduced.

The communication gap has gotten better between stakeholders.

The numerous benefits do not end here. The list goes on and on, varying in advantages to different specialties. The trend of technology in healthcare has just started, and with years to come, we can expect more advancement in this sector benefiting MIPS solutions.

How to Make Most of Health IT?

The incorporation of health IT is only going to increase in the future even in small medical practices. A month ago, the Harvard Business Review mentioned some interesting tips before embracing health IT innovation.

If you’ll be able to adopt these methods, you can optimize operations in the best way possible and empower every stakeholder from patient to healthcare service provider.

Let’s get through.

Build Healthcare System around Patient Satisfaction

Every medical practice should have a system that adds value to the patient satisfaction level. Moreover, the MIPS performance category, Improvement Activities (IA) also rewards points for quality patient experience.

For Instance,

Giving easy access to patients allows them to participate in improving quality, which ultimately maximizes the QPP MIPS score.

Therefore, adopt any technology that is efficient and safe to use by patients.

Hire Specialty-Specific Resources

The success of any medical practice lies in a diverse expert team dedicated to each task.  For Instance, if you need to submit MIPS 2020 data to CMS, the best option is to consult a MIPS Qualified Registry that is dedicated to this task.

They know how to handle the administrative load, and they process information quite well. Thus, there is a lesser chance to mess up when you go for MIPS data submission via professionals.

The same goes for other tasks. If you have different experts for all operations, their outcome will be optimized.

Incorporate Technology that Benefits Your Practice

Just because many adopt a technology, it does not guarantee that it will bear the same results for you as well. While moving towards health IT, we should be clear about how it will work for us.

For Instance, you adopt EHR (Electronic Healthcare Records) but do not have the resources to use it efficiently, it will only add to your expense.

The idea behind promoting interoperability as specified in QPP MIPS 2020 is to use technology to simplify the operations and to reduce burnout.  If you still cannot achieve results as desired, there is no point in investing in certain technology just for the sake of it.

Intend for User-Friendly Systems

Another factor to promote technology at every level is to adopt user-friendly systems. The more user-friendly interaction is between the machine and the user, the more beneficial it is for the medical practice.

Conclusion

These are just a few tips that can help you adopt technology in the most useful way. By keeping these factors in mind, healthcare service providers can establish health IT infrastructure across their organization and promote efficiency and productivity as per their requirements.

The ultimate benefit will be in terms of financial stability via MIPS 2020 data submission, improved healthcare quality, and the overall progressive healthcare system.

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How CMS Assists Physicians with MIPS 2020 Reporting Amidst Corona?

As QPP MIPS 2020 is approaching the end of the performance year, P3Care has decided to revisit the changes and flexibilities in response to COVID-19. It has been a tough year, especially for our heroes – the healthcare providers. In fact, the pandemic made the healthcare industry work more than its capacity.

Besides relaxation in compliance obligations, the purpose of these flexibilities is to assist physicians in a state of emergency.

COVID, even after the vaccine is out and about, is still pretty much there. The federal agencies alongside CMS work to immunize people in the fifty states. That’s more than enough a country could do but there is still work to be done.

On the whole, the Joe Biden administration seems to care for the environment a lot. We will continue to see improvements in the natural order of things from here on.

Let’s dive into the final rule 2020 and the changes across the MIPS 2020 performance categories.

Reporting Flexibilities in QPP MIPS 2020

COVID-19 pandemic has affected every sector of the healthcare industry. There is no surprise there. However, the effects are not similar in every medical practice. Some practices suffered financially, while some came under pressure due to a high surge of patients.

Meanwhile, CMS realized that physicians and MIPS Qualified Registries might not report QPP MIPS 2020 data effortlessly. Therefore, the authority allowed clinicians, groups, and virtual groups to request to reweight one or more performance categories under the Extreme and Uncontrollable Circumstances policy.

CMS MIPS 2020 Special Circumstances Deadline Extends

As you know, our healthcare facilities are still struggling with the extreme pandemic situation. Therefore, CMS also extended the deadline to apply for Extreme and Uncontrollable Circumstances until February 01, 2021, Monday.

Moreover, CMS introduced a new MIPS Quality measure under Improvement Activities (IA) for the QPP MIPS 2020 reporting. Under this measure, eligible clinicians can receive credit for their quality healthcare services (related to COVID-19) that improve the overall patients’ outcomes.

Overall Performance Flexibilities under QPP

For the 2021 performance year, QPP (Quality Payment Program) has released the Final Rule:

APM Entities can request for extreme and uncontrollable circumstances exception to reweight QPP MIPS 2020 performance categories

The current Complex Patient Bonus is revised to account for the complex patients’ treatments during the pandemic. Moreover, Clinicians, groups, virtual groups, and APM entities can earn up to 10 bonus points in their QPP MIPS 2020 score.

We think that these steps from the CMS encourage clinicians to participate in the QPP MIPS 2020 despite the corona. It is an effort to facilitate PHE (Patient Health Examination) while considering the difficulties of affected physicians.

Technology Saves the Day

If one good thing happened during the pandemic, it is the use of technology at every forum. Obviously, the Healthcare industry is no exception.

Technology has been a savior throughout the pandemic in the form of telehealth. When there was risk catering to elective face-to-face visits, physicians kept in touch with their patients via technology. It helped them to keep the revenue cycle running while restricting the virus exposure.

Not just doctors but MIPS Qualified Registries are also using the latest ways to compile reporting data efficiently to avoid health security threats.

COVID-19 Response Overview

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Updates for ACO Reporting

Another update is for ACOs (Accountable Care Organizations) that CMS considers them affected by the extreme condition. Thus, the Shared Savings Program extreme and uncontrollable circumstances policy applies to them. Besides, they do not have to file for Consumer Assessment of Healthcare Providers and Systems (CAHPS). In return, ACOS can receive full credit for the high patient experience.

Conclusion

All in all, CMS also supported the expanded use of PHI (Protected Health Information). Thus, we would see more technology-based services such as telephone-based evaluation and management services for CMS Web Interface and the CAHPS. Such services will assist in managing the QPP MIPS survey.

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MACRA MIPS – What it Means for Physicians?

MACRA MIPS (The Medicare Access and CHIP Reauthorization Act of 2015 – Merit-based Incentive Payment System) is a program that caters to physician finances under Medicare. Not only that, but it determines the quality of care within hospitals, practices, and clinics should meet certain standards.

The program is now in its fifth year (started back in 2017) and it would be right to say that it facilitates the whole physician reimbursement process. MIPS 2020 submission is not rocket science; however, it requires a certain skill set to achieve good scores.

Key Elements of QPP MIPS

MIPS program has four categories that cater to meaningful quality healthcare services.

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

The quality category replaced the PQRS (Physician Quality Reporting System) and reflects the efforts to improve the quality of care.

Improvement activities translate patient convenience and satisfaction in quality healthcare delivery.

Promoting Interoperability replaced Advancing Care Information (previously known as the meaningful use program) to integrate technology in healthcare.

The cost category replaced the value-based modifier program and translates the efficiency of the cost factor.

Each category has different weights. The respective percentages change each year under MACRA MIPS. Eligible clinicians, who exceed the minimum performance threshold get positive payment adjustments and avoid a penalty of a certain percentage.

MIPS Full Form in Healthcare

Large medical practices already know the implications of MIPS data reporting. However, it is small healthcare organizations or non-eligible clinicians that need to understand MACRA MIPS to the core.

Now, the performance bar has gotten high. Although CMS (The Center for Medicare & Medicaid Services) facilitates small/rural/underprivileged medical practices to much extent, the appropriate approach is to consult a MIPS Qualified Registry for MIPS solutions.

What Physicians Can Get from MIPS Reporting?

There are many advantages that eligible physicians can get by submitting data to CMS under MACRA MIPS.

  1. Physicians get to improve care quality.
  2. They can improve ranking among fellow physicians via the Physician Compare portal, thus, improves patient rate.
  3. Against the exceptional performance, physicians can receive incentives.
  4. High achievers can even receive a share from the $500 million bonus pool.

However, MACRA MIPS requires consistent efforts, but practices could get help from MIPS consultants to guide them through the process. In case you are one of the practices with pending MIPS 2020 reporting, there is still time for you to submit until March 31, 2021.

Should Physicians Report Data Despite Corona Pandemic?

There are lots of benefits if MIPS-eligible clinicians choose to report data despite hardships.

For instance, MIPS incentives and bonus pool worth $500 million are worth a try, and reputation on Physician’s Portal can help to improve patients’ volume. However, it all depends on how individual clinicians, groups, and virtual groups, report data to CMS.

The first rule is to deeply analyze your strengths and select MIPS Quality Measures that are most suitable for the medical practice. The more specialty-specific measures you report, the more chances you have for maximum points. Consequently, a smooth revenue cycle management is what you all get at the end of the reporting period.

How to Report MIPS Data?

Eligible clinicians can choose different ways to report MACRA MIPS. However, the easiest and comprehensive way is to report data via the MIPS Qualified Registry as P3Care.

We choose specialty-specific measures to submit data from the list as per the final rule proposed by CMS.

We Are in the Middle of MIPS 2021 Performance Year!

Now, it’s almost halfway down to the QPP MIPS 2021 performance year, which means we should be getting ready to strategize our reporting process.

Like every year, we know reporting requirements change, and only with the help of MIPS consultants, we can efficiently target incentives and bonuses. You do not have to report the Cost category, which CMS measures based on the claim submissions. However, to maximize points in the other categories, Quality, Promoting Interoperability, and Improvement Activities, eligible clinicians must be ready to implement the profitable strategies.

It is an opportunity to improve revenue cycle management, so further delays can dent the financial matters in 2023.

Conclusion

MIPS data submission under MACRA is a lot to take in, but as the years went by, it is in the best interests of physicians to attest to the quality payment program.

Especially with COVID, clinicians have lost millions of bucks to cater to the surge of patients. In such times, incentive payment programs are a ray of hope as they facilitate in many ways. Moreover, CMS also offered flexibility in the administrative load. So, there is no point in avoiding participation in such programs, right?

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MIPS Quality Measures 2020 and Specifications for MDs and DOs

Am I eligible for MIPS incentives in 2022?

The question that we hear a lot. And, I have to say it is your right to know.

Whether you are a general physician or a surgeon, submission of MIPS Quality measures leads the way to incentives.

Why?

The government started MIPS back in 2017 to incentivize eligible clinicians, and in return, improve the quality of healthcare. In short, it ensures ECs submit measures for the good of their patients – they will have permanent access to quality care.

The purpose here is to write down a MIPS Quality measures list that includes at least some measures and leave the rest to update in the future. Therefore, you’ll see some of them if not all; we’ll keep updating it, hopefully.

I also hope to provide info not only for family and general physicians but for specialists too. In an ideal system, the MDs, and DOs work in rhythmic harmony for better care coordination and patient experience.

Difference between an MD and a DO

For those of us who don’t know what an MD is, it is short for Medical Doctor, while DO stands for Doctor of Osteopathic Medicine.

Although they may use all the available methods to treat their patients, including drugs and surgery, DOs believe in a more holistic approach. By definition, DOs emphasize preventive medicine, musculoskeletal health, and holistic care. It doesn’t mean MDs are any less skilled or vice versa. Both are equally capable.

The Expertise of Both Specialists

Both specialists, MDs and DOs, can choose to practice in any specialty. Both lend their expertise to promote the quality of healthcare to patients translating CMS MIPS quality measures.

AMA (American Medical Association) studied that in 2018, up to 57% of more DOs preferred to practice in primary care compared to 32% of the MDs.

The total statistics for DOs participation in primary care were:

  • 9% went for family physicians
  • 8% went for internists
  • 8% went for pediatricians

However, both programs offer a license, thus, it does not matter what program a student pursues.

Define the Quality Performance Category

One of the categories of the Merit-based Incentive Payment System (MIPS) is the Quality performance category! It holds a 45% weight in the total score.

What does it account for?

It measures your performance in clinical activities and patient outcomes. MIPS data submission through Quality measures helps assess health care processes, manage results, and patient experiences. As a result, we can expect the highest quality of care while keeping expenses to a minimum. Hence, the achievement of the value-based care purpose.

Understanding CMS MIPS Quality Measures

  1. Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%) 

Diabetes, a menace, to say the least, shadows quite a part of the US population. How can we put a lid on it? Well, the answer lies in value-based care. More importantly, it is MIPS quality reporting that will eventually decrease the number of diabetics across the country.

This particular measure says to submit data on your patients from the age of 18-75 with diabetes who had hemoglobin A1c > 9.0% during the measurement period.

A CMS eCQM is available for this outcome measure. The collection types for this measure include:

  • Medicare Part B Claims
  • eCQM (electronic-clinical quality measure)
  • CMS Web Interface
  • MIPS CQM (clinical quality measure)

Since one of the collection types of this measure is MIPS CQM, you can submit it through a registry. It is one of the most effective of all the MIPS data submission methods thus far.

You can submit it if you are part of the following areas, provided you fulfill the low-volume threshold for MIPS:

    • Family medicine
    • Internal medicine
    • Preventive medicine
    • Nephrology
    • Endocrinology
    • Nutrition/dietician
  1. Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)

Measure number 2 is related to the heart. American Academy of Cardiologists

It includes people aged 18 and above who were diagnosed with heart failure (HF) with a present or past left ventricular ejection fraction (LVEF) < 40% and were prescribed beta-blocker therapy either within a year of procedure in an outpatient setting or at each hospital discharge.

Reporting MIPS through this measure sets the tone for the management of chronic conditions. Gladly, it is available in both eCQM and CQM type, thus acceptable through various sources.

Specialties for which this measure is suitable to include:

  • Cardiology
  • Family medicine
  • Internal medicine
  • Hospitalists
  • Skilled nursing facility
  1. Anti-Depressant Medication Management

Psychiatrists act as pillars of healthcare when it comes to mental health treatment. Especially, their role is critical through the COVID-19 pandemic. Could there be a worse time for mental health issues to rise? Well, it could be worse!

Being grateful and using empathy as a tool to interact with people around us is needed for sure. The description of this measure that we have with us is mostly for eligible psychiatrists. MIPS 2020 presents numerous measures to report with accuracy and data integrity as the two requirements.

It is quality measure #9, according to the official fact sheet released by CMS.

How do we describe it?

It aims to find a percentage of people aged 18 years and above who were treated for mental illness and prescribed antidepressants. As per their depression symptoms, they have prescribed medication for months. You should report the following two types:

  1. First, the percentage of patients who were on antidepressants for at least 84 days (12 weeks)
  2. Second, the percentage of patients who were on antidepressants for at least 180 days (6 months)

Why is this measure meaningful?

It is in line with the prevention and treatment of opioid and substance use disorders. A MIPS consulting firm helps you select the right measures to report. More importantly, it is the accuracy and data completeness that matters to maximize MIPS incentives.

The collection type available for this measure is eCQM. Moreover, the specialties that this measure services include:

  • Family medicine
  • Internal medicine
  • Mental/behavioral health
  1. Age-Related Macular Degeneration (AMD): Dilated Macular Examination

Eyes let us see the beauty around us, thankfully. They show us the world as it is. In this quality measure, people aged 50 years and above are to participate. As an EC, you are to report it once they are diagnosed with age-related macular degeneration (AMD), followed by a dilated macular examination.

Further, it led to the recording of the presence or absence of macular thickening or geographic atrophy or hemorrhage and the intensity of the damage caused during one or more office visits within the 12-month assessment period.

Henceforth, this measure assesses the chronic conditions management area. Ophthalmologists are to report it through their MIPS consultant. MIPS solutions and to send MIPS data via clinical quality measures type is doable with plenty of support from qualified registries.

The collection type for this measure includes:

  • Medicare Part B Claims
  • MIPS CQM

In fact, it is only available for the ophthalmology specialty.

  1. Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care

As the title clearly says, the measure goes against the menace of diabetes and its effect on the eyes. Value-based care becomes viable to bring back quality into healthcare, and at the same time dial-down, healthcare costs.

The measure specifications for clinicians help in its understanding. Our research concluded this measure to be part of the MIPS Quality measures list released officially by CMS.

Essentially, MIPS 2020 covers the continuing process of our healthcare, moving in the right direction. Let us see what the measure means:

“Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once within 12 months.”

Willing to go after MIPS data submission for this measure? It is most likely to score high if reported accurately. That is where P3 comes in to report to CMS on your behalf. The basics of this measure put it amongst the CQMs and eCQMs. Moreover, it is a high priority measure applicable to the ophthalmology specialty.

  1. Communication with the Physician or Other Clinician Managing On-Going Care Post-Fracture for Men and Women Aged 50 Years and Older

It is a measure that directly informs of the health of our seniors as far as their fractures and overall health is concerned. The meaningful area under discussion here is the Health Information Exchange (HIE) and Promoting Interoperability.

What does the measure exactly mean?

According to CMS, it derives the following explanation:

“Percentage of patients aged 50 years and older treated for a fracture with documentation of communication, between the physician treating the fracture and the physician or other clinician managing the patient’s on-going care, that a fracture occurred and that the patient was or should be considered for osteoporosis treatment or testing.”

It is submitted by the physician who treats the fracture and who therefore is held accountable for the communication. A high priority measure, to begin with, you can use Medicare Part B Claims and MIPS CQMs as its collection types.

As an EC, if you are part of the following specialties, you can choose to report this measure.
• Family medicine
• Internal medicine
• Orthopedic surgery
• Preventive medicine
• Rheumatology

  1.   Advance Care Plan

The Advance Care Plan deals with many branches of healthcare, including Cardiology, Family Medicine, Gastroenterology, General Surgery, Neurology, Obstetrics/Gynecology, and more.

How Do We Describe this MIPS Quality Measure?

MIPS in healthcare defines this measure by the percentage of the patients aged 65 years or older with an Advance Care Plan. This measure is also valid for those patients who document another decision-maker on their behalf as a surrogate on authentic medical records.

Another situation is when the medical records show that the Advance Care Plan was discussed with the patient, but they could not provide a surrogate neither they wished to.

MIPS 2020 Reporting Instruction for Advance Care Plan

MIPS eligible clinicians can submit this quality measure for just one patient seen throughout the performance period. There is no specific diagnosis attached to this MIPS Quality Measure. However, the MIPS Qualified Registry on behalf of physicians can submit data for the quality services provided to the patient based on the measure-specific denominator coding.

It is to note that that this measure applies to all healthcare settings, be it nursing home, etc., except for emergencies.

Measure Submission Type

Individual clinicians, groups, and third-party intermediaries such as a MIPS Qualified Registry submit the related data to CMS. However, only those third-party intermediaries can submit data, which used Medicare Part B claims.

Conclusion

Thus, paying special attention to the MIPS quality measures can maximize the chance to earn positive adjustments and even incentives.

It all depends on the CMS MIPS quality measures that you submit to CMS. Therefore, MDs and DOs, take time to strategize MIPS solutions properly and improve your financial situation.

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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 MIPS 2020 data submission 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 MIPS Consulting Firm

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)
  • Cost

For the Cost category, physicians do not have to submit data but CMS estimates its score based on the submitted claims.

With a state-of-the-art infrastructure to manage data in one place, it is easier to estimate the final MIPS score. 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 2020 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 step 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 that data for every MIPS performance category is in order and then submit it 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 in 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. Physicians, generally, submit MIPS data via a MIPS Qualified Registry.

However, whatever 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 before 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 also 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. Moreover, you will not have to worry about MIPS data submission by yourself.

  1. Select MIPS 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 and maximize your 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 for MIPS data submission success.

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 to avoid a penalty in the payment year 2022 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.

Conclusion

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. If you need help, you can contact MIPS consultants to enhance your performance.

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 if physicians are eligible for MIPS data submission or not.

However, the reporting requirements change each year due to changed policies. So, if we want to succeed in this program, we have to comply with the changes.

MIPS 2020 Reporting Deadline is Due March 31, 2021

We have almost 2 months to submit data to CMS. Most of you must have checked their MIPS eligibility status up until now. However, to ensure quality, go through this article to review the complete process.

Also, remember that MIPS participation is not easy, and the eligibility check is just the start. A MIPS Qualified Registry can take care of the administrative load without you being bothered. So, consult them for a seamless process.

 MIPS 2020 Eligibility Check

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 uses 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 the 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.

Eligibility Check for 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

Eligibility Check for 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.

Eligibility Check for 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

The above-mentioned are all the requirements that a MIPS participant should know beforehand of the MIPS data submission. We are halfway through QPP MIPS 2020, and many professionals already had planned and implemented a strategy for optimized performance in the end.

How to Report MIPS Data?

Physicians have a lot on their plate already, and the pandemic has increased their burden. In such a situation, MIPS quality reporting seems like a challenging task.

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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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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MIPS Quality Measures 2019 Vs. 2020 – Registry Investigates

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

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

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

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

 MIPS Quality Measures 2019 and 2020 – The Types

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

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

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

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

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

General Reporting Requirements Vary

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

Ordinarily, Quality measures refer to the improved care delivery standards and patient satisfaction, and data completeness constraint means providing care to more patients. The increase in performance thresholds reflects CMS’s vision of encouraging clinicians to be competitive in their data submissions. Eventually, it leads to the evolution of a quality healthcare system.

MIPS Submission Types

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

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

Six Measures

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

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

The Curious Case of Bonus Points

Although CMS requires improved quality, it doesn’t mean that they don’t want clinicians to target incentives and bonuses. You can qualify for MIPS incentives with the help of a Qualified Registry like ours.

Bonus points sound charming enough to know more about them. Therefore, we will try to find out more on how to get to them. Bonus points are in addition to positive payment incentives and maximize your Medicare reimbursements accordingly.

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

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

Conclusion

We write for you to stay illuminated by the present and the future requirements of MIPS reporting. As long as you have us on your side, you can only succeed in your compliance duties. We pride ourselves in MIPS data submissions, especially MIPS 2020 data submissions that are currently underway. The deadline for it is March 31, 2021, so hurry and send your info to us via the pop-up form that appears once the site loads. To directly get in touch, please call 1-844-557-3227 or shoot us an email at info@p3care.com.

To read more about MIPS 2020 measures, please give it a read: MIPS Quality Measures 2020 and Specifications for MDs and DOs. Have you planned your MIPS 2021 reporting yet?

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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 effect 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.