MIPS 2021 reporting, MIPS Qualified Registries, revenue cycle management, MIPS 2021 score, MIPS incentives

MIPS 2021 Reporting Period Opens Now!

The QPP MIPS 2021 reporting period has started, and the deadline extends to March 31, 2022. Although, CMS has offered flexibility in many aspects! However, without accurate and reliable reporting, eligible clinicians can lose many revenue-generating opportunities.

For instance:

  • Up to 5% of MIPS incentives
  • Qualification for $500 million bonus pool
  • Reputation in the Physicians’ Portal

Tough Time for Physicians Have Started

MIPS eligible clinicians have now two months to report their data. They or their MIPS Qualified Registries have the time to review data and make the necessary adjustments. There are four basic MIPS performance categories.

  1. Cost
  2. Quality
  3. Improvement Activities (IA)
  4. Promoting Interoperability (PI)

The interested participants only have to submit data for three categories. CMS (Centers for Medicare and Medicaid Services) automatically measures performance in the Cost category by looking into the claims.

How Does P3care Help Physicians?

MIPS consulting partner like us can make your reporting process easy and reliable. With dedicated resources in hand, each medical practice can report data that adds to its revenue cycle management.

Be Free from the Administrative Load

Of course, the administrative load has been one of the major issues in the healthcare industry. No one can deny the fact that if physicians stay caught up amidst the documentation, they cannot stay focused on their primary tasks.

So, if clinicians want to win the MIPS reporting 2021 game, they should take help from a professional. To aid the processor for a high MIPS 2021 score, clinicians also have to meet certain requirements.

Why Is Timely Data Submission Necessary?

To target MIPS incentives, CMS has a set deadline. And to observe the strict deadline is particularly important simply because the authority has to consider performance from hundreds and thousands of physicians across America. With an extension in the deadline, CMS would never really compare performances and grant points in MIPS 2021 reporting.

Thus, to ensure success, physicians must know that this is the time to get started! If you need help in this regard, team p3care is here

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Clutch Names P3 Healthcare Solutions As One Of The Top Medical Billing Services Providers For 2022

At P3 Healthcare Solutions, we ensure our clients stay on top of their health IT needs, whether they are a small practice or a large hospital. We update you on any changes in the healthcare industry to improve your bottom line, cash flow, and workflow. We signify peace where doctors, nurses, and administration can take a breather. We are the one-stop destination for physicians, patients, and payers to find relief in billing and compliance obligations.

P3Care Gets Recognition from Health IT Experts

With that said, we are deeply proud of the recent news that came to us. Clutch has recognized P3 Healthcare Solutions as one of the leading medical billing services providers for 2022. For context, Clutch is an established B2B reviews platform that helps firms across the globe connect with the solution providers to improve effectiveness and increase productivity. Clutch cuts through disorganized market research by collecting client feedback and analyzing industry data, arming businesses with the insights and analysis they need to connect and tackle challenges with confidence.

Clutch Leader Awards recognize the highest-performing B2B companies by industry, service focus, and location every month. These firms meet their methodology’s standards of excellence and can be trusted by potential B2B buyers to excel at new projects. We work hard to deliver the absolute best products and working experience to our clients, and we’re thrilled that this hard work has paid off.

We are truly thankful to all our clients and partners that supported us throughout the years. We are especially grateful to those who took the time to leave us a review on how we impacted their businesses on our profile on Clutch. Take a look at a recent review we received.

A Kind Response from One of Their Clients

“They’re incredibly responsive, answering my questions on the weekends and at night. We’re a few hours ahead of them, but they still answer our calls, even when it’s early in the morning for them.” – Lou Galterio, Founder, SunCoast RHIO

Are you looking for medical billing and coding, revenue cycle management, and other HIT services? Fill out the form or give us a call.

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Methodist Health System Remedied Revenue Cycle Management

Healthcare service providers and medical billing services in the USA have always rooted for automation. One thing is there is a lot of administrative loads that are attached to this industry.

Even when the clinicians have to send claims to payers, a third-party intermediary outsourcing medical billing company has to assist their needs. And how can we forget their QPP participation? MIPS reporting services are altogether another avenue.

How A Healthcare Facility Managed to Counter Revenue Cycle Problems?

Methodist Health System, a facility headquartered in Omaha also faced such issues that resulted in gaps in RCM. They, therefore, decided to automate their revenue cycle management implemented in2019.

How Did They Work?

They amalgamated with the AKASA to automate the revenue cycle as per the Cerner EHR.

Jeff Francis, vice president of Finance and CFO for Methodist Health System, states that they started with the considerable problematic areas that led down the revenue cycle. Their teams worked until the automation filled in manual errors in any capacity.

In retrospect, they say the automated revenue cycle was a systematic guide where all stakeholders learned about the pain points.

What Was the Outcome?

The outcome was quite fruitful that gelled well for medical billing services and the performance category of the MIPS program, Improvement Activities (IA).

They managed to:

  • Reduce healthcare cost delivery
  • Improve the patient financial experience
  • Empower patients likely in the billing

Ultimately, the team started educating the staff members about how automation can improve their roles in the capacity. Moreover, they started a debate on what jobs should be permanently eliminated to move forward with efficiency.

Having said that, it doesn’t mean that healthcare professionals lost their job! Revenue cycle management people now have more complicated jobs to handle.

How Automation Helps Expedite the Medical Billing Process?

The thing is automation has overtaken repetitive tasks. In all honesty, what is the need of a staff member to spend their time checking the status of each claim and ticking it in the practice management software?

With their Methodist’s automation method, their medical billing services now don’t have to send updated denied claims to payers.

With all the considerations, it was estimated that automation is simply required to add value to the staff’s time.

The Facility Wishes to Go with the Futuristic Approach

Now, the healthcare facility wants to broaden its perspective by adding machine learning and robotic process automation along the way.

Their team worked majorly on the new use cases in the front-end and mid-cycle. However, they are looking for new ways to automate the process.

Can We Completely Rely on Automation?

The truth is we are slowly reaching the pinnacle of automation of the industry where there are dead ends. For instance, some complex claim compilation cases could be handled only with manual knowledge. Automation or machine learning fails there.


Now not just this healthcare facility, but many others are also moving towards technology innovation. The idea is to reduce the manual overhead that takes away precious working hours. In the end, medical billing companies and the overall healthcare industry will be improved. We now have a case study in front of us. So, when in doubt, this study will help you stay on the right path.

alternative payment models, APM participation, APM reporting, Centers for Medicare and Medicaid Services, CMS Updated, MIPS 2021, MIPS 2021 Reporting, MIPS eligible clinicians, MIPS qualified registries, MIPS qualified registry, QPP Participation, quality payment program

CMS Updated the QPP MIPS APM Participation Status

CMS (Centers for Medicare and Medicaid Services) has recently updated the QP status. Alongside, they have also updated the MIPS APM participation status. They have also released the second snapshot of APM data.

Eligible clinicians can explore their information via QPP Participation Tool. However, it is to remember that the data is based on the second snapshot data. You can also take help from a MIPS Qualified Registry.

A Little History about the Participation Eligibility Status

CMS, under the QPP (Quality Payment Program), determines eligibility data over multiple occasions during the performance year. They take these steps to help MIPS eligible clinicians with their incentive payment program participation process.

The analysts analyze the past and current Medicare Part B Claims and PECOS data and form results based on that.

Review Periods about the 2021 Determination Period and Snapshots

  • The performance period begins from January 01, 2021
  • The first snapshot comes by July 2021
  • The second snapshot comes by October 2021
  • The third snapshot comes by December 2021
  • Here the performance period ends on December 31, 2021
  • The fourth snapshot (MIPS APMs) comes by March 2022

How CMS Reviews (Snapshots) Eligibility Status?

CMS reviews data four times for all MIPS 2021 eligible clinicians, and the eligibility is determined by the third snapshot.

MIPS APM LVT Determination

Some modifications have been observed through this period.

In 2021, there were no low-volume threshold determinations at the APM Entry Level. To be exact MIPS 2021 reporting eligibility is the same as for the APM reporting.

In simple terms:

  • Solo MIPS eligible clinicians who participate in MIPS APMs can take part as APP individually.
  • Groups and APM Entities can also participate as MIPS eligible clinicians through APP.

However, if a group earns a final score through the APP, it will apply only to those MIPS eligible clinicians who appear on a MIPS APM’s Participation List. These can also apply to the clinician of Affiliated Practitioner List.

The APM snapshot data was made available on October 20, 2021. Thus, interested entities or MIPS Qualified Registries can see data on their behalf.

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HHS Now Introduces New Surprise Bill Compliance Rules

The extension to the No Surprise Bill has released a month ago, which is supposed to prohibit the surprise bills for patients. A step in the direction of optimizing medical billing services!

HHS (United States Department of Health and Human Services) and other federal departments came up with a notice known as NPRM (Notice of proposed rulemaking). This regulation will allow authorities to penalize clinicians and billing service providers for up to $10,000.

NPRM Validates the Existing Penalties for Surprise Bill Violation

To be exact, the new regulation comes as the Reporting Requirements Regarding Air Ambulance Services, Agent and Broker Disclosures, and Provider Enforcement. And it codifies penalties for PHS (Public Health Service) Act for violations under Part E.

The new rule will allow putting sanctions and fines as civil monetary penalties. It will also empower health insurance payers to keep a check on surprise medical bills.

The Explanation of the NPRM Law

The new law also explains a framework to establish authority over healthcare service providers, hospitals, and providers of air ambulance services.

How will HHS Put the Penalty over a Surprise Bill?

HHS will also have the authority to ask for any documents in case of a complaint, and it can happen within six years of the claim processing, compilation, and submission. Thus, medical billing services would also be playing a very important part, and they must have all documentation to support their claim.

Moreover, it is also to keep in mind that the penalty and the complaint repercussions would be judged over the level of violation.

Action for Air Ambulance Service Provider

If air ambulance service providers fail to provide any document, they can receive a penalty of up to $10,000 under the Social Security Act.

The data includes:

  • Payer data
  • Claim denials
  • Air ambulance bases and aircraft
  • Transportation and medical costs
  • Number and nature of air ambulance transports

The rule is particularly for the air ambulance service providers as it is a consolidated market.

These rules established by the Biden-Harris administration would allow authorities to get any data and read the market trends. Moreover, they would be able to give their insights based on the available data.


It is indeed a great step in terms of preventing patients from the hideous surprise bills. Besides, it can make healthcare services affordable for everyone, be it providers, payers, or medical billing services. Ultimately, this law grants rights to CMS to take action against facilities that do not comply with the regulations.

We could expect some more laws to come as an extension to this. This Act will go into effect from January 1, 2022.

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The Deadline for MIPS 2020 Performance Year Targeted Review Extended

The impact of covid-19 is still not over. We are feeling its after-effects, to say the least. And MIPS reporting services are no exception in this regard.

Due to the lag in 2020, CMS (Centers for Medicare and Medicaid Services) extended the deadline for its targeted review.

The deadline extends to November 29, 2021, until 8 p.m. ET. Now, clinicians, groups, virtual groups, and Alternative Payment Model (APM) entities can request reweighting any category. However, it all happens under the Extreme and Uncontrollable Circumstances (EUC) policy.

Why Is EUC Deadline Extension for MIPS 2020 Reporting Serious?

Well! Now, all MIPS 2020 eligible clinicians have the authority to review their final MIPS score, individually or as a group. Moreover, they can also go through their MIPS payment adjustments

It is also important to review every single detail in order to avoid penalties of any sort. Because it is observed that some clinicians have also received a penalty for reporting Medicare Part B claims in 2020.

What This Program Is All About?

Under the EUC policy, CMS is also granted to reweight any category to 0% in case of the no MIPS 2020 data submission. However, this condition applies only to MIPS-eligible clinicians that qualify for group, virtual group, or APM entity participation.

Having said that, if any medical practice compiles Medicare Part B claims for 2020 as an individual and group! It could lead to negative payment adjustments for clinicians who were not eligible to report as individuals but the group.

So, Review Your MIPS 2020 Data Scrupulously!

MIPS 2020 eligible clinicians must take this opportunity to review all their data as an individual and group to keep a check on the impact on the non-eligible clinicians of their facility.

What you or your MIPS reporting services can do on your behalf is to see if your group data meets the performance threshold. If yes, it is fine. Otherwise, ask for a review for a score below then 45 MIPS points.

So, hurry up! Time is running out.

Medical billing services, AMA, COVID-19 Vaccine, medical billing codes, COVID-19 Vaccine Codes, medical billing company, Moderna, Pfizer

AMA Updates CPT Codes Regarding COVID-19 Vaccine

COVID-19 vaccine booster shots have been introduced. And AMA (American Medical Association) updated the CPT (Current Procedural Terminology) to accommodate these vaccine changes.

Credits here to the organization that has been working alongside medical billing services for their convenience! Briefly stated that the updates also include the billing and coding details for the newly formulated COVID-19 vaccine developed by Pfizer. AMA also shed light on the formulation of this vaccine, whose basic chemical formula is different from the new one.

Here is the list of updated AMA medical billing codes.

Updated List of COVID-19 Vaccine Codes

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How does Industry see the Changes?

We have full authority as a medical billing company from the FDA regarding Pfizer’s original formulation. Moreover, they have also authorized the emergency use of the vaccine as a third dose or booster shot.

Government sources also indicate that Moderna is soon to release its booster shot. However, they will be released after the third shot of Pfizer.

Update About the Moderna’s COVID-19 Vaccine 

The Moderna vaccine needed full FDA approval until September 2021. However, its emergency use has been modified to release its third dose. It has been said that the documentation of its efficiency has still not been updated by the authorities. On the contrary, Pfizer is long done with this task.

Another set of codes to be used by medical billing services to accommodate Moderna’s first dose are as follows.

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Medical billing services can consult the official website of AMA to stay updated with the relevant codes. It will surely help them make clean claims.

MIPS 2021 reporting, MIPS Qualified Registries, MIPS Reporting 2021, MIPS 2020 feedback, Medicare and Medicaid Services, MIPS payment adjustments, MIPS score, MIPS consultants

QPP MIPS 2020 Feedback Is Available for Review

You heard it right. The Centers for Medicare and Medicaid Services has officially released the feedback for the MIPS Reporting 2021 period. Now clinicians have the chance to review their final score and the MIPS payment adjustments, which they still receive in 2022.

Why This Review Matters?

This review is an opportunity where you are more than welcome to look into details and check if there is any issue or error in the processing of your submitted data.

MIPS data reflects your performance for the whole year, and clinicians pay attention to this process throughout. They spend time understanding the reporting requirements that MIPS CMS mentions. However, it is a hectic process and requires careful diligence. A MIPS Qualified Registry becomes important in this regard.

Why it’s High Time to Consult a Reporting Registry?

MIPS consultants will give you the ease to cater to the administrative load without any stress. CMS has tough requirements and tougher reporting details that cannot be missed. The resources seem to provide the professional documentation that ultimately adds up to your score.

Now, when there are a few months left for MIPS 2021 reporting, MIPS Qualified Registries are also gearing up to manage their clients. Physicians! They are the most suitable or convenient option among the data submission methods because they offer reliability and transparency in all matters.

Another plus point that such associations can offer is the accuracy of measure selection that safeguards the interests of clinicians.

So, it is better to review 2020 feedback and look for all the errors that somehow reflected on your score wrongfully.

You Can Call For a Review until October 01, 2021

Now, when you can go through the MIPS data and review your performance and payment adjustments, you can know about the payment adjustments that you will be receiving in 2022.

And, if there happen to be any errors, clinicians can apply for targeted review to CMS for reassessment and readjustment. However, you have a deadline until October 01, 2021, 8:00 PM (ET).

The good news is if you were already in touch with the MIPS consultants, you would have no problem in recognizing areas where CMS misinterpreted your data. You would already access how much MIPS score and what percentage of incentives you should get.

QPP MIPS 2021, MIPS Qualified Registry, MIPS Quality measures, MIPS incentives, MIPS consultants

Get up to 5% Incentives from CMS as Payment Adjustments in 2023

QPP MIPS 2021 is a chance to target up to 5% Medicare payment incentives. So, if you want your medical practices to be financially strong, here is an opportunity to leverage.

Do you know CMS (Centers for Medicare and Medicaid Services) updates performance categories every year? Starting from the Quality category that was 45% of the total MIPS score in the previous year is now set at 40%. The Promoting Interoperability (PI) category is set at 25%, Improvement Activities (IA) at 15%, and Cost category is set at 20%.

Avoid Up to 9% Penalty by Successfully Submitting MIPS 2021 Data

MIPS 2021 has brought many opportunities for financial gains, which is explained in the latter paragraphs. However, even you don’t want to earn incentives and think that your medical practice is doing great! Think again!

According to CMS, medical practices, which are failed to report MIPS data for 2021, will have to face serious repercussions. There is a set percentage of 9% penalty that MIPS eligible clinicians might bear for “not reporting data”.

Moreover, you could also lose the chance to get featured in the “Physicians Portal” through which you can cash on many growth prospects. Thus, ignoring MIPS 2021 is not an option.

It is a Chance to Improve RCM!

Especially amidst the peak pandemic hours, the healthcare industry has suffered significantly. There were lesser resources and more patients. All thanks to the healthcare workers, they have managed everything quite impressively.

Where we are commending the roles of healthcare workers, we should also realize that medical practices have suffered on the financial front. They delivered more than their capacity and actually incurred the loss.

So, when there is an opportunity to compensate for the losses, why not utilize it!

P3Care, being the MIPS Qualified Registry, for five years now, has been helping eligible clinicians to report specialty-specific MIPS Quality measures to CMS. The outcomes for our physicians have been quite fruitful.

Not only they managed to avoid a penalty but also targeted MIPS incentives respectively. You can also be a part of the list whose name comes in a good light in the Physicians Portal.

Stakes Are High with MIPS 2021

Yes! The stakes are quite high with QPP MIPS reporting 2021. The reporting requirements have changed. Some quality measures got topped out, while some are the new additions to the list. No doubt, there is a lot of administrative load on eligible clinicians that need laser-focused attention. Otherwise, there will be no point in catering to this incentive payment program with below-average performance.

MIPS consultants allow you to cater to all such worries with their experience and latest resources. So the final verdict is if you want to receive up to 5% incentives as payment adjustments in 2023, it is time to plan and implement successful strategies.

medical billing experts, medical billing services, Medical billing companies, medical billing

Payment Integrity Audits Proves to be a Burden for Clinicians

A study conducted by Change Healthcare highlighted a serious matter about the payment integrity audits. It stated that payment audits cost physicians up to $1 million for administrative expenses each year.

Clinicians who consult a third party for medical billing services have lesser data to handle in general. However, the effect remains the same. Not just clinicians have to compile claims and send them to the payers, but the additional auditing load adds to the pressure. Moreover, it also dents the relationship between both physicians and insurance companies, government or private.

So, What Is the Solution?

A pre-submission notification process for claims seems a suitable solution. Medical billing companies can be of great help in this regard. They can stay in touch with the payers to know the potential errors before the claim submission. It certainly improves the accuracy of claims and reduces potential errors.

Moreover, the risk of post-payment integrity audit is also reduced.

Technology Can Help Win This Game

Technology is a savior when it comes to assisting in operations. To reduce the burden of data administration, medical practices and medical billing experts can use technology. Moreover, a significant amount of time is also reduced.

Physicians say that it is a huge step in minimizing the risk of post-payment integrity audits. We can also see a reduction in associated costs.

Why Post Payment Audit Is An Issue?

Many payers fail to understand that why post-payment integrity audit is an issue with physicians when it helps with financial stability.

However, the truth is ensuring payment accuracy is costly. A regular audit by the payers or medical billing company applies to the utilization of codes, accuracy of bills, quality of healthcare, and the incurred costs and efforts.

What is concerning that up to four out of ten providers do not know that post-payment auditing is costing their medical practice.  Moreover, it is not just about the administrative load and cost, but many physicians have negative experiences with these programs.

Most requests for the audits concern the correct billing of clinical procedures. However, the majority of cases end up in dissatisfaction.


A better strategy for clinicians or their hired medical billing companies is to pay more attention to the pre-claim submission process. With lesser chances to mess up, the need for post-payment integrity audits will reduce.