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CMS updates, QPP MIPS, MIPS Data Submission, MIPS 2020, Eligible physicians, professional healthcare services, QPP MIPS 2020, medical practice

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 the eligibility status that if physicians can report data to them or not.

However, the reporting requirements change each year due to changed policies.

 MIPS 2020 Eligibility Check Requirements

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 use 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 this 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.

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

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.

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

Physicians are required to report their data as a virtual group.

CM

P3Care and Trump Administration Encourage Practices to Reopen

America should adopt smarter ways to counter COVID-19 as it reopens for patients and clinicians. In the meanwhile, CMS has come up with a guide for patients and beneficiaries as they decide to visit providers for in-person care.

As a result of the surge in COVID-19 patients, many providers were left with no option except to restrict care at their facility. They had to do that for the essential treatment of COVID-19 patients.

However, with a much-improved situation now, the government encourages private practices and clinics to resume their normal operations. They are to continue with their postponed non-emergency treatments and carry out in-person patient visits as we speak.

The patient guide ensures the safe reopening of healthcare facilities with patients receiving the much needed in-person care. National public health emergency took over, causing this delay in normal appointments, procedures, and treatments.

We can’t thank President Trump enough for his vision, the expansion of telehealth, to be specific, in a very short time. In this way, all this time when America was closed, patients were able to talk to their clinicians from the safety of their homes.

Ms. Seema Verma, Administrator of CMS, reinforces the vitality of in-person care and refers to it as a gold level of care. Such steps by the government are in favor of patients who have long been waiting at homes for procedures, vaccinations, operations, and evaluation of chronic conditions.

She further explained healthcare is the right of every American and our healthcare heroes are working day in and day out to deliver it safely. We should all feel confident when going for in-person care recommended by our providers.

On April 19, CMS issued the first part of recommendations to safely start in-person care activity in areas with a low occurrence or relatively low and constant number of COVID-19 cases. Hence, we move ahead with another set of recommendations.

CMS leaves no stone unturned when it comes to patient and clinician safety as healthcare systems, practices and clinics further enhance in-person care standards. Recommendations include a list of topics to ensure safety regulations are in place for patients and providers including facility measures; testing and sanitation levels; personal protective equipment and stock of supplies; and workforce presence.

The easy access to healthcare for everyone can be restricted to some extent. However, this decision can’t be prolonged due to financial discrepancies.

During the COVID-19 epidemic, healthcare professionals have lost a major amount of revenue as the resources were redirected towards the pandemic response. Now as the Trump administration is asking to bring normalcy in the economy under strict SOPs, we can expect a gradual balance between expenses and revenue.

As it was with part 1 of recommendations, decisions to reopen should be in line with federal, state, and local rules, CDC’s guidance, and association with the state and local public health authorities.

As the country continues to move on the path of reopening, patients have concerns about when to check-in with their providers for in-person visits.

CMS also acts as a guide with empathy for patients to make the right decisions as they prepare to meet their providers in person. Ultimately, it is in their best interest to follow the new rules.

Find guidelines for patients for in-person visits in English here: https://cms.gov/files/document/covid-what-patients-should-know-about-seeking-health-care.pdf and in Spanish here: https://www.cms.gov/files/document/covid-what-patients-should-know-about-seeking-health-care-spanish.pdf

To read one of the previous updates, go here – P3 investigates: Trump Administration plans to reopen nursing homes

To read about the work of the White House Coronavirus Task Force reaction to COVID-19, go to www.coronavirus.gov. For specific information about CMS, keep reading our blog updates.

Medical billing services, Medical billing service companies, Medical billing services near me, Revenue cycle management

P3 Defines the Role of Medical Billers and Coders

Any person who thinks there is a difference between medical billers and medical coders is right.

Because there is a difference. With defined roles, they bring the right charisma to a physician’s revenue cycle. Nevertheless, one depends on the other for the completion of the billing process.

Medical billing services hire both professionals to carry out an effective revenue cycle management process on behalf of healthcare providers. Theoretically speaking, both professions require the professionals to read, interpret, and comprehend Electronic Health Records (EHRs) and doctors’ notes. Hence, their education in science is a must.

We all know that medical billing is a complex process. But with medical coders and billers assigned to claims, medical billing becomes all the more manageable. Their capabilities provide all the help a healthcare provider needs to process medical billing claims.

For you, as a primary care physician or a specialty-specific clinician, an authentic team of health IT experts may, rightfully, carve the way to a successful practice.

Medical Billing Services Include Coding as the Living Proof of Care

Medical coding is a definitive structure of the medical bill. It becomes an integral part of medical billing service which reflects each and everything in a proper, organized, and coded form. At times such as this pandemic, the healthcare sky is lit with updates; new codes for COVID-19 have surfaced, so coders have a responsibility to keep in touch with CMS updates.

Moreover, they must remain proficient and knowledgeable in the ICD-10 coding system – the coding system that classifies diseases. The other one being the CPT set of codes to identify the treatment aspect of received cure.

The above systems help convert medical jargon into easier alphanumeric codes. For people inside and outside the medical industry, it may be hard to understand the names of diseases or certain procedures. Thus, such codes provide a comprehensive path to learn about diseases and medical solutions.

Since there are thousands of diseases, symptoms, and cures, it is not possible to write their complete names. The only way possible is to design a coding system and share it with stakeholders for convenience.

Hence, medical coders are required to manifest knowledge of thousands of CPT and ICD-10 codes accordingly. Moreover, coders translate medical records for reimbursements to happen later.

This gives us an overview of what coders are responsible for.

Medical Billing is the Social Part of Coding

After proofreading the claims, next comes the job of billing professionals to forward them to insurance companies. However, one must not forget the social side of billing.

A claim that is prepared by the coder has to go through a process; the person who carries it out through to the end is a medical biller.

Without experienced billing personnel on your side, a health care facility, or a primary care physician’s revenue cycle would fail to function. Here, at P3, we have a whole team dedicated to medical billing outsourcing, so feel free to reach out at this number: 1-844-557-3227.

Purpose

Billers to devise the billing claim use information emanating in the form of codes by medical coders. That claim becomes the first-hand information for insurance companies to release payments. A well-written billing claim without errors has a higher first-time acceptance rate. Furthermore, collections occur fast, almost within 2 weeks.

If some patients have outstanding bills, the medical billing experts are required to contact them as part of the following-up process. They will walk them through the process and inform them about any deductibles, copayments, or other insurance liabilities.

Besides, medical billing and coding teams coordinate with insurance companies to get providers on board if they are not enlisted on their panel. Sometimes the patients visit providers who don’t corroborate with the list of providers on their health plan. Thus, the outsourced medical billing services have an additional responsibility to enlist those providers with insurance companies. However, for it to happen fast, doctors must provide any documentation that is urgently required to complete the registration process.

Filing appeals and conversing with patients who do not pay up is part of their job. There is little time between denial and resubmission; therefore, we must act fast, recompile, proofread, and resubmit.

Where Do They Work?

‘Medical billing services near me’ is one of the search terms often search on Google. Why?

Because, one, physicians want to find someone near to where they practice; second, the job is flexible and people outside their immediate acquaintance circle can execute it from a distance. Hence, the popularity of the term: medical billing outsourcing.

Prerequisites

The prerequisites for this job are at least a high school diploma with a science background. However, an associate degree in medical billing helps convincingly in the long run.

You have four studying options:

  1. Bachelor’s degree in a health-related subject (4 years)
  2. Associate degree in medical billing & coding (2 years)
  3. Diploma (1 year)
  4. Certification (a couple of months)

All of these studying programs lead towards a bright future which is well-respected and well-paid.

Pro Tip – Choose schools that are recognized by AHIMA or AAPC.

For readers who like this article, please do comment. We love to read your feedback, and, also don’t forget to follow us on Instagram @p3healthcaresolutions.

News

Provider medical billing service, medical billing, Telehealth Services, CMS updates, Public Health Emergency

COVID-19: Public Health Emergency Telehealth Services to SNF Residents

CMS keeps on providing useful information as the COVID-19 pandemic drags on. In fact, the rebuilding efforts shall continue until a significant vaccine emerges to the scene and puts an end to this virus. When America, on one side, faces the challenge of COVID-19 testing kits shortages, on the other, it is the people who must work on their emotional resilience to continue to survive the 2020 pandemic.

Emotional resilience, the art of managing one’s emotions through the crisis has become even more crucial.

Coming back to today’s topic, the COVID-19 Public Health Emergency (PHE) does not relax the overall requirements for Skilled Nursing Facility (SNF) Consolidated Billing (CB); however, CMS releases a set of CPT telehealth codes for coverable time segments as long as the crisis lasts.

New Telehealth Reimbursement-ready Codes

Telemedicine codes like:

  • 99441,
  • 99442, and
  • 99443

assign three different time evaluations of telephonic Evaluation and Management (E&M) services by the provider. Physicians must bill for these services under Part B when providing care to an SNF’s Part A resident.

After such an announcement by CMS, Medicare Administrative Contractors (MACs) will reevaluate claims – for codes 9941, 99442 and 99443 – with service dates on or after March 1, 2020, that were denied because of SNF CB changes. You just have to sit tight and wait for the collections column to fill up. In case there is a provider medical billing service working on your behalf, they will update you once payments come through.

For those of you who have received payments from an SNF for telehealth services, it is obligatory to return them to the facility once the MAC repurposes your claim.

With COVID-19 still around, these changes had to be released eventually. On the whole, CMS finalized three payment rules for Medicare on July 31, 2020; they concur with payments for Inpatient Psychiatric Facilities (IPF), Skilled Nursing Facilities, and hospices.

We only wrote details for one of them – for SNFs.

CMS depicts an increase in total payments to SNFs by $750 million for FY 2021 or a 2.2 percent increase compared to FY 2020.

To know more about telemedicine’s remedial effects during the pandemic, we crafted a piece on our blog section: Telemedicine Emerges as Cure Outlet Amid the COVID-19 Outbreak. It gives you an outline of where we are headed to with remote visits.