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

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

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

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

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

  1. Two Branches for Positive Payment Adjustments

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

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

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

  1. Participation Level Increases Each Year

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

  1. Small Practices Clinician Participation Status

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

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

What did it mean?

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

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

  1. Advanced APMs Are Not Far Behind

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

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

  1. Spectacular Results So Far

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

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

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

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MIPS Quality Measure Specifications 2019 in a Nutshell

By the term ‘Measure Specification’, it means the detailed description of a measure. Therefore, 2019 MIPS Quality measure specifications are the detailed guidelines of quality measures intended to be used by individuals MIPS eligible clinicians reporting CQMs via Qualified Clinical Data Registry (QCDR) or Qualified Registry and by groups reporting via Qualified Registry for the QPP 2019.

To make things simpler, each measure specification has a measured flow and related algorithm as additional help for data completeness and performance. However, a measure specification should be considered final descriptive information on measures because measure flows may or may not be attested by the Measure Steward.

A Brief Recap

MIPS by CMS is an evaluation system by which eligible clinicians can submit their performance with the government to stay compliant and eventually become well-established healthcare professionals. It is a metric to judge the quality of care and their performance via the submission of certain measures or measure sets.

MIPS 2018 was the successful application of performance analysis for many clinicians which brings us to MIPS 2019 and what it has in the box for them. Measures are not difficult to finalize, but an understanding of measure’s specifications helps each participant what exactly they are about to submit. Measure specifications also highlight their key aspects, the number of times they are to be reported, respective codes, and more.

ECs must report at least 6 MIPS quality measures in 2019 including at least 1 outcome measure or a high priority measure, or to report on a complete measure specialty or sub-specialty set.

What is New in 2019?

The government has come up with an improved criterion for 2019 to measure the performance of clinicians giving them freedom in the following ways:

  • CMS adds opioid-related quality measures to the set of high priority measures.
  • In 2019, you get more options in terms of submitting the same measure through different collection types (that include QCDR, MIPS CQMs, CMS Web Interface, and Medicare Part B Claims Measures) to optimize your score for that measure.
  • You can choose measures from different collection types available to you to find the most meaningful measures for your practice.

Understanding 2019 MIPS Quality Measure Specifications

Clinical Quality measures specifications encompass the guidelines to follow during the submission of CMS MIPS quality measures. Each measure is distinguished by a unique identifier. These are the numbers that represent continuity from measures in the 2018 QPP.

Furthermore, Measure Stewards have decided on these measures by applying some changes to the list of MIPS quality measures in the previous performance year.

  1. Frequency of a Measure

Frequency labels are part of each measure’s execution plan as well as part of the measured flow. The analytical submitting frequency suggests the time frame for which a measure needs to be submitted. Each eligible clinician participating in MIPS 2019 has to submit measures according to their given frequency. The definitions adhered to under the frequency label concerning 2019 MIPS Quality measure specifications are mentioned below:

  • Patient-Intermediate measures follow submissions minimum once per patient during the performance year. The most current quality codes should be utilized in case the measure needs submission more than once.
  • Patient-Process measures submissions happen once per patient at the minimum during the performance year. The most rewarding quality-data code is used if the measure undergoes submissions more than once.
  • Patient-Periodic measures undergo submissions once per patient at the minimum during the performance year. If it is submitted more than once, use the most rewarding quality-data code. If two or more quality codes are submitted, performance shall be evaluated through the most rewarding quality-data code.
  • Episode-based measures are submitted once per occurrence of an illness or condition during the performance year.
  • Procedure-based measures undergo submissions each time a procedure occurs during the performance year.
  • Visit-based measures go through submissions every time a patient visits the MIPS eligible clinician in their clinic or hospital during the performance period.
  1. Performance Period

The performance period for a measure may refer to the time duration from January 1 to December 31. There are many sections to a measure specification like Instruction, Description or Numerator Statement that may hold the details on the performance period.

  1. Denominator and Numerator

Quality measures consist of a numerator and denominator that are used to evaluate data completeness which forms the final score of the MIPS eligible clinician.

As a Qualified Registry for MIPS, P3 Healthcare Solutions, Ontario, CA works on behalf of clinicians to help them achieve scores above 75. Such high scores in 2019 can pave the way towards a future in which there is fame, respect, and ultimately high income. For the latest on Merit-based Incentive Payment System visit our company page on LinkedIn – https://www.linkedin.com/company/p3-healthcare-solutions/

Do you think the QPP program correlates with the demands of the healthcare sector?

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 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 an 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 is to follow the company page on LinkedIn – https://www.linkedin.com/company/p3-healthcare-solutions

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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.