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QPP MIPS, MIPS 2020 performance, MIPS Qualified Registry, healthcare services, submit MIPS data, healthcare system, MIPS reporting

Flexible Medicare MIPS Reporting Options Available Amidst Corona

CMS (Center for Medicare & Medicaid Services) recently announced the performance score for eligible clinicians of QPP MIPS 2019 on its official website.

Eligible physicians can review their MIPS 2019 score via a secure portal allotted to them.

This performance score depicts the percentage by which clinicians will be receiving positive, negative, or neutral payment adjustments. However, payment adjustments will be furnished in the year 2021.

Review Window for MIPS 2019 Is Closed Now

October 5, 2020, was the last date to check and challenge the MIPS 2019 performance score. During this period, individuals, groups, virtual groups, and even APM (Alternative Payment Model) participants can apply to review their score, if they disagree with it.

There was no special requirement to review data. With the same credentials, you submitted data, you could check the performance score.

It is to be noted that it is the best approach to check feedback as due to the pandemic situation going on, CMS enforced a policy to not penalized any physician, who could not submit data in the previous year.

(If you submitted data through MIPS Qualified Registry, they can review feedback on your behalf.)

Check Points for Performance Review

QPP MIPS is one of the most important incentive payment models. It accounts for quality healthcare services, which CMS recognizes and rewards for.

The performance review period allows seeing if your data is being reviewed properly or not.

Most of the time, physicians, who submit MIPS data through MIPS Qualified Registry have an idea of their final score. Because their expert resources already have a roadmap to report quality measures to get a certain percentage of the score.

Hence, QPP MIPS data submission through a qualified registry takes your stress away. You already become aware of your final score and even strategize to maximize performance.

You can see for the following situations while reviewing the MIPS performance score.

  • Errors or quality data loss in the MIPS submitted performance quality measures
  • Eligibility and special status issues (Example: low-volume threshold performance)
  • Being not listed in the APM participation, thus, not being reviewed
  • No performance categories reweighted although you qualify for automatic reweighting under the CMS extreme and uncontrollable circumstances clause

Relaxations for QPP MIPS 2020 Data Submission

COVID-19 has overburdened the healthcare system beyond its handling capacity. Doctors do not have time to compile necessary data as per the CMS requirements.

In such tough times, CMS offered flexibilities to ease out the administrative load. The option for applying for “the Extreme and Uncontrollable Conditions” is available until December 31, 2020.

Flexible Reporting Options

AMA (American Medical Association) requested CMS to offer flexible QPP MIPS reporting options and other incentive payment models.

Eligible physicians can choose not to be scored against “Cost” and “Quality” measures. In such a case, CMS only analyzes their performance based on “Improvement Activities (IA)” and “Promoting Interoperability (PI)” MIPS performance categories.

What More to Expect?

CMS is working alongside AMA to address issues related to QPP MIPS data submission during the COVID-19 pandemic.

We, stakeholders of the healthcare industry can expect improvement in the Medicare payments and flexible regulatory guidelines. Let’s see how it goes for MIPS 2020 and the upcoming years.

Medical billing services, Telehealth billing services, MIPS consulting, P3Care, Revenue cycle management

APTA Surveys Physical Therapists against Telehealth

Perhaps the most dramatically impacted area of healthcare as a result of the coronavirus pandemic is telehealth. Previously, the conditions were not in favor of virtual clinics because face-to-face visits were the norm. Now, however, the situation has changed. When other clinicians are making use of telemedicine, PTs and PTAs are, definitely, not far behind.

On March 17, 2020, the Centers for Medicare & Medicaid Services (CMS) allowed PTs to conduct e-visits after which they can reach patients at homes keeping them away from the contagious virus. But it wasn’t easy, to say the least – It took a lot of effort.

It was not until April 30, 2020 – after rigorous advocacy by APTA – that CMS decided to include PTs and PTAs among providers eligible to bill for telehealth services. Such services include virtual visits contrary to real-time, face-to-face meetings.

In other words, COVID-19 persuades the government to make PTs and PTAs eligible for remote patient management, which results in a rapid increase in telehealthcare.

Increase in Video Consults via Live Sessions

Before the pandemic, 98% of physical therapists questioned did not do live video sessions with their patients. Furthermore, out of 2% who did, 69% of them saw only one patient per week on average. As a result of this awful virus, we saw 50% of PTs adopting live video sessions as an outlet to see their patients. In a matter of months, most of the physical therapy switched from real-time visits to remote visits.

Generally speaking, medical billing services, under the new world order, have to readjust keeping in view the regulatory and federal guidelines specifically for e-visits.

One of the PTs said, and I am paraphrasing it: Some of the aspects of video visits are a revelation – seeing positions of patients while they sit and watch TV or examining their postures of sleep. They would like to continue with live video sessions as part of their treatment even after the pandemic.

Uncertainty with Telehealth Billing Returns

Medical billing services, Telehealth billing services, MIPS consulting, P3Care, Revenue cycle management

The survey by APTA brought vital information to the limelight. Of those PTs who participated in this survey, 25% of them were sure their telehealth payments were consistent with in-person visits, while 53% were not sure of it. Similar, uncertainty was there when it came to patient satisfaction with telehealthcare.

As much as there is uncertainty in life, there is vagueness to practicing medicine online because we are all new to it. However, for consistent revenue cycle management, we must adhere to local and federal instructions for telehealth as we follow the HIPAA code of conduct in terms of PHI safety.

There is no denying the fact that telehealth has emerged as a blessing in disguise in these challenging times. When elective medical procedures were restricted, this facility helped many physicians to make up for the loss.

Yes! There were issues related to technology familiarization, but in most cases, there was relief that doctors were available for you. It was particularly beneficial for patients with chronic health conditions, who require regular monitoring.

Zoom to Meet and Treat

Medical billing services, Telehealth billing services, MIPS consulting, P3Care, Revenue cycle management

The survey showed Zoom as the most popular platform for video consults, according to 43% of the participating PTs. APTA’s June 2020 report covers the impact of COVID-19 on physical therapy. We deduce these results from it. The rest of the practitioners among the participants reported using more than a dozen other platforms for video care.

The graph below shows the usage of virtual platforms since the pandemic spread in the US.

Technology Is Both A Blessing and Burden

Technology, on one side, is the facilitator, but on the other, an obstacle. 31% of practitioners said their patients were not technologically ready for an e-visit, while 21% of the PTs said their facility lacked the technology to facilitate patients during the pandemic.

Another common barrier faced by PTs and PTAs was the lack of payments for telehealth services. Telehealth billing services by P3Care supports physical therapists to get them higher reimbursements, fewer accounts receivable, and responsive customer support. Besides, we apply tools and techniques to take our clients up the road of virtual visits resulting in better collections.

Below, you’ll see a graph of what obstacles our PTs face against technology, courtesy APTA’s June 2020 report.

Medical billing services, Telehealth billing services, MIPS consulting, P3Care, Revenue cycle management

Conclusion

PTs and PTAs are part of the frontline workers of the COVID-19 emergency response that have been crucial to the healthcare teams, providing care in private clinics, facilities, nursing homes, and hospitals nationwide. Moreover, it is due to their constant support that the patients in local community settings not affected by COVID-19 receive continuous care.

Mobility, strength, consistency, and patience are fundamental elements of physical therapy in any setting. PTs and PTAs help patients get well sooner with their expertise in musculoskeletal conditioning. Unquestionably, the role of PTs is vital to see us through the COVID-19 pandemic.

Note: At all times, the CDC recommends PPE for the safety of patients and therapists alike.

A Guide to MIPS 2019 Reporting for Physical Therapists is where you can find MIPS consulting essentials for the previous year leading to the year 2020.

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.

tPA drug, COVID-19, anti-clotting drug, COVID-19 Treatment, Health IT Industry, healthcare services, COVID-19 pandemic

There Might be a Breakthrough for COVID-19 Respiratory Failure Cure

COVID-19 has struck everything. From people to the economy, everything is suffering, and the death toll is increasing day by day. While some countries have managed to restrict the risk like China, some are still struggling.

The symptoms of this infection are cough, flu, fever, and fatal respiratory issues. Although, this virus is serious but not every COVID positive person ends up in the hospital, generally, the intense or worse cases require hospitalization. As a result of acute respiratory distress syndrome (ARDS), which is a severe lung injury, these patients seek serious medical assistance.

A concrete cure for ARDS is still not found. Physicians treat the bearer of this disease with mechanical ventilation and supportive care.

What Health IT Industry is doing for COVID-19 Treatment?

A team of physician-scientists is conducting research and testing out the anti-clotting drug for serious COVID infectees with ARDS. After several tests and trials, the scientists have concluded that a drug called tPA has the potential to reduce the death rate among ARDS infectees.

Researchers say that this drug can be life-changing. It can reduce recovery time and with a faster recovery time of patients, there can be more ventilators available.

A Little History

The US Food and Drug Administration in 1996 approved tPA to be used for patients experiencing a heart attack, stroke, and pulmonary embolism.

Therefore, for two decades, researchers have found anti-clotting drugs useful against ADRS diseases.

FDA really didn’t give thumbs up to this method. However, for ARDS induced COVID patients, this drug might work.

How An Anti-Clotting Drug is Expected to Help COVID?

There is major clotting around IV lines in many COVID patients. Researchers are hopeful that tPA drug can show fruitful results in severe patients or at least tell if the assumption is true.

This clinical trial committee is now enrolling patients.

Later on, they will record biomarkers, such as, the medical conditions of each patient to identify under which conditions tPA gives the most advantage. The drug is already approved on a large scale to treat heart patients and people with strokes as an off-label medicine.

The COVID Effect on American Hospitalization Capability

This pandemic is not over. We don’t have any effective treatment for it at the moment, and the number of COVID-19 infected persons is only going to rise.

When the lockdown will lift up, chances are the pandemic situation will get worse. According to a study, many more Americans are expected to use ventilation services in the upcoming months. Looking into statistics, America has currently 200,000 ventilators.

With collective efforts, hopefully, we’ll be able to generate an effective strategy to deal and restrict COVID -19.

Before the pressure of pandemic saturates our healthcare services, it is important to consider the existing therapies and procedures that may help us to accommodate the surge of patients in the future. These procedures/therapies must be widely available so that they serve the purpose of easily accessible healthcare to COVID.