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QPP MIPS 2020, MIPS 2020, MIPS qualified Registries, MIPS Quality measure

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

QPP MIPS 2020, MIPS 2020, MIPS qualified Registries, MIPS Quality measure

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.

Medical billing and coding services, revenue cycle management, Medical billing audits, healthcare service providers, medical billing services, revenue cycle management, medical billing and coding process

Medical Billing Audit – A Way to Optimize the Billing Process

Medical billing and coding services serve as the backbone for any medical practice. If the process does not go as per the latest guidelines, medical practices can suffer from an unstable financial situation.

Thus, to secure efficient revenue cycle management (RCM) and reduced accounts receivable (AR), healthcare organizations must consider medical billing auditing.

What is the Billing Audit?

It is a process that helps highlight the problematic areas in the clinical documentation of rendered services. The goal is to rectify those issues and improve the revenue cycle.

Why Medical Billing & Coding Audit?

Medical billing audits allow healthcare service providers to review their billing practices, coding semantics, and claim submission approach. It is a way to see if your system runs smooth or need an upgrade for improved performance in medical billing and coding.

Moreover, medical billing auditing also gives insights into the inconsistencies that might not be a problem at the moment but can be disastrous after a while.

Save Your Medical Practice from Penalties

If your medical billing and coding services are not compliant with HIPAA (Health Insurance Portability and Accountability Act), there is a chance of a government strike. They can penalize your medical practice if your billing standards are not up to the mark.

Thus, to improve the medical billing and coding standards and streamline the financial situation, billing audits are crucial.

Why Claims Get Rejected or Denied?

Medical billing audits are an opportunity to improve claim performance. Generally, claims get denied due to the following reasons.

  • Improper or false payment adjustments
  • Patient eligibility and verification issues
  • Wrong documentation of healthcare procedures
  • Lack of necessary medical information

There can be many other reasons that can make government or private insurance payers deny the claim. And, if you rectify the potential errors, you can have the following outcomes.

Advantages of Conducting Quality Medical Billing Audits

  • Improved coding accuracy as per the latest guidelines
  • Identification of the potential problematic errors
  • Enhanced reliability and transparency of the billing system
  • The streamlined workflow of your medical practice
  • Strengthened relationship between medical practices & insurance companies

These are just a few general examples of how internal and external audits can help you improve the revenue cycle.

Professional Billing Audit Upgrade System 

We cannot stress how risk analysis of the billing and coding process helps generate revenue. Administrative benefits, coding efficiency, higher claim acceptance rate, clinical benefits, thus, healthcare organizations’ performance owes to the auditing.

Thus, improvement in the medical billing services does not just enhance revenue generation. It also leads to improved quality and transparency in the following manners.

  1. With upgraded billing and coding practices, the claim compilation and submission process become smooth and instant.
  2. The cost-efficiency is improved as there remains no need to invest effort and time in processing claims again and again.
  3. The upgraded system is more reliable to generate timely reimbursements; the workflow becomes consistent.
  4. Data management and documentation become easy.
  5. We can design data-driven medical billing and coding strategies.
  6. A robust system allows a proactive approach towards the medical billing and coding services rather than being reactive (when some problem occurs).
  7. The analysis report helps to take strategic decisions & improve the quality of the medical billing and coding process.

Medical practices stay relevant with the latest billing and coding practices by removing vulnerabilities in the system.

Conclusion

The regulations have become stricter over time, and there is no margin for inappropriate or false services. Even if your medical billing and coding practices works fine, medical billing audits help to avoid mistakes, ensuring reliable revenue cycle management.

Thus, you become compliant with the government’s regulations and policies. Ultimately, the compilation of the claim gets effortless under an expert team.

Healthcare industry, medical billing company, medical billing services, healthcare system, healthcare service providers, QPP MIPS, revenue cycle management, medical practice

Providers’ Guide to Best Practices for Revenue Cycle Management

Healthcare industry doesn’t only have hospitals and large medical practices. There are some medical practices that function in only one specific medical area and consult medical billing companies for reimbursements.

P3 healthcare solutions being a medical billing company has years of experience in medical billing services. We have come across many independent or stand-alone medical practices and well-established hospitals.

How Independent Healthcare Providers Are Coping Up With Changes?

One thing we understood in all these years is that the norms of the modern healthcare industry are changing. The focus has shifted to a value-based healthcare system instead of volume-based care services.

It also leads to structural changes in the progressive healthcare industry. According to the American Medical Association (AMA), physicians having independent clinics cover less than half of the total US doctors’ population. However, this trend of owning personal medical practice was high back in the 1990s.

Reason for Reduced Rate of Independent Healthcare Practices

The declining practice of independent healthcare providers owes to many reasons.

Some observers of the healthcare industry state that independent healthcare providers are forced to join larger healthcare systems as the earned revenue is not sufficient for survival.

Why medical billing companies Can’t Support independent healthcare providers?

Independent healthcare providers don’t meet up with their cost expenditure due to inflation and price surge. The increased administrative burden of MIPS QPP increased the price of surgical hospital admissions, emergency room visits, and drugs, which has caused major problems for independent healthcare providers.

Thus, in recent years, due to low reimbursements, around 22% of the independent clinicians reduced their office support.

Impact of Low Reimbursement Rate

Low reimbursement rate from insurance companies has also damaged this industry. Even hospitals and large medical practices are not safe from the changes in the healthcare industry.

The healthcare providers when unable to cover expenses within earned money, get in-touch with huge healthcare networks. Thus, the amalgamation of large and small healthcare practices has led to low competition in the healthcare industry.

In addition, often patients don’t pay deductibles or the extra amount other than their insurance benefits to independent medical practitioners. This way, independent healthcare providers never really compete with bigger healthcare organizations.

Reservations of Solo-Medical Practitioners

One concern that the solo-healthcare services show is about the unreasonable reimbursement standards of insurance companies. Big healthcare organizations can better negotiate their demands with the increased volume of patients, which is a profit source for insurance companies.

All these issues make it impossible for small independent healthcare providers to stay in the industry. QPP MIPS has also fueled the declining trend of independent health services. Patients want access to top-quality healthcare, which a separate-working medical provider may not be able to provide. Consequently, the doctor doesn’t find a large share of incentives and bonuses.

To keep an independent medical practice, most solo-physicians function as a group outside the hospital circle. It has also helped medical billing companies to get high reimbursement for them as well as offered shared administrative responsibilities and resources over the network.

This might be the only surviving option left for independent healthcare service providers.

As large medical practices are dominating the healthcare industry, it is evident that revenue cycle management has not remained easy for solo-practitioners. However, with little adaption to change and a professional medical billing company, independent healthcare service providers can work their way up the success ladder.

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Medical billing services, medical billing and coding, healthcare industry, CMS released, healthcare service providers, COVID-19 Antibody

CMS Released Billing Codes for COVID-19 Antibody

Medical billing services have always been an important part of the healthcare industry. Also, with the corona pandemic, these services are now crucial to run the revenue cycle.

COVID-19 has tested our every ability, and our healthcare industry is coping with the surge of patients with limited resources. Meanwhile, where there are other administrative issues, CMS (Centers for Medicare and Medicaid Services) is facilitating on the medical billing and coding front.

The New Update about the COVID Antibody

Most of you must know that COVID-19 antibodies would be officially available for everyone from next year. Tests have been running, and vaccine shots are being injected into a group of people to create awareness. To administer the process of medical billing services, CMS released two new codes to document antibodies.

Under the HCPCS (Healthcare Common Procedural Coding System), now physicians can use the following codes:

  • Q0243 for the injection of 2,400 milligrams of Regeneron’s investigational monoclonal antibody therapy cocktail
  • M0243 for intravenous infusion and post-administration monitoring

The new codes reflect on the investigational monoclonal antibody therapy from Regeneron. FDA approved this therapy, and it is authorized for the mild-to-moderate COVID-19 patients with a chance of hospitalization.

Instructions from CMS

CMS has instructed healthcare service providers and medical billing services that as long as they document antibodies as per the guidelines, Medicare will pay for them. Moreover, the payment program will also reimburse medical practices for the other infusions the way they do for COVID-19 vaccines.

The payment allowances for the COVID injections have already been in effect since November 21. CMS further explains that the reimbursement for initial injection is low mostly because physicians do not expect to bear the cost for Regeneron’s therapy.

Initial Antibody Doses are Free

HHS (United States Department of Health and Human Services) is already providing the initial antibodies for free (as per the COVID infected population in each region). Regeneron has signed a contract with the pharmaceutical companies to distribute between 70,000 and 300,000 doses all over the states.

CMS also has mentioned that Medicare will not reimburse for any of the government-allotted free antibody doses. However, they will inform (physicians & medical billing services) beforehand when physicians can expect to bear the expenses.

Conclusion

The therapies are expected to overcome the potential patient visits to hospitals. Moreover, their Medicare coverage will ease the process of COVID treatment, and medical billing services can better cater to physicians’ finances. Having said that, the healthcare industry is expected to face hurdles against adequate access to antibodies.

Electronic Healthcare Records, healthcare industry, healthcare service providers, healthcare services, healthcare system, Medicare and Medicaid Services, MIPS eligible clinicians, MIPS quality score, QPP MIPS

Updates in Stark Law: What It Means for QPP MIPS?

CMS (Centers for Medicare and Medicaid Services) has revamped the Stark Law for healthcare service providers.

The upgraded law will have an impact on the volume and quality of healthcare services. Especially, QPP MIPS eligible clinicians can take notes and design strategies to improve patient satisfaction.

For those of you, who do not know about the Stark Law, here is its definition!

What is Stark Law?

This law prohibits physicians from self-referral, particularly in a situation, when a physician has a financial relationship with a patient and refers to another entity for the provision of designated health services (DHS).

The new laws will also influence the QPP MIPS quality score via a transparent referral process. Without a doubt, it is a great step towards an altogether progressive healthcare system.

Proposed Changes

  • CMS proposed changes that allow exceptions for/among certain physicians.
  • The final proposed rule also applies exceptions in some cases when a physician receives reimbursement for items or services from another clinician.
  • CMS also proposed flexibilities for the funds or donations extended to the cybersecurity technology and services.
  • Moreover, the existing exceptions for the EHR (Electronic Healthcare Records) data, products, and services are also modified.
  • The update in the Stark Law is expected to be effective from next year January 19, 2021.

The Stark Law, since its provision in 1989 was the same, and there were no updates since then. CMS says that these modifications are significant and will change the referral scenario in the healthcare industry.

Conclusion

The new changes strive to encourage clinicians to adopt quality-based healthcare practices as specified by the QPP MIPS without fearing Stark Law violations.

The exceptions are introduced to facilitate the reimbursement process and to improve coordination among different stakeholders in a legitimate manner.