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Accountable Care Organization, ACO Reporting 2021, QPP MIPS, MIPS Qualified Registries, MIPS data submission method, MIPS quality measures

CMS Proposed Changes for ACO Reporting 2021

From the next performance year (2021), Accountable Care Organizations (ACOs) expect different reporting requirements under the Medicare Shared Savings Program.

CMS (Centers for Medicare and Medicaid Services) has recommended changes for ACO reporting criteria.  The requirements are somewhat the same as for QPP MIPS.

The purpose of the new proposed rules is to lower down the administrative burden of ACOs and to improve the quality of patients’ outcomes.

In light of the expected changes, ACOs can partner up with MIPS Qualified Registries to share their load and meet the reporting requirements efficiently.

CMS Is Eliminating Its Web Interface

The QPP MIPS data submission method, CMS will eliminate Web Interface starting from the next PY 2021.

This MIPS data submission method will no longer be available even for QPP MIPS (Quality Payment Program – Merit-based Incentive Payment System) and (Shared Savings Program) SSP reporting.

The Alternative Reporting Method

Instead of the regular reporting via CMS Web Interface, ACOs will now report data via a new APM Performance Pathway (APP).

All of these rules are proposed in order to include ACOs in the MIPS Value Pathways (MVPs).

Eligible clinicians submitting quality measures via the new APP do not have to submit them again for the QPP MIPS Quality category.

The administrative load for data collection and submission will reduce significantly for both SSP and QPP MIPS reporting processes. Moreover, we can expect improved quality care for Medicare patients as an outcome.

Compact MIPS Quality Measure Set

There is one good news for ACOs that will take effect from next year. They have to report only six measures in total (previously twenty-three measures).

The subcategories include:

  • 1 Diabetes: Hemoglobin A1c (HbA1c) Poor Control
  • #134 Preventive Care and Screening: Screening for Depression and Follow-up Plan
  • #236 Controlling High Blood Pressure
  • #321 CAHPS for MIPS Survey
  • Hospital-Wide, for 30 days; All-Cause Unplanned Readmission (HWR) (administrative claims)
  • Rate Risk Standardized; All-Cause Unplanned Admissions for Multiple Chronic Conditions for ACOs (administrative claims)

Score Assessment

ACOs can receive from 3 to 10 points against each measure.

However, points will be rewarded only when the data meets the data completeness rule and the performance threshold.

It is also to keep in mind that the performance threshold for eligible clinicians participating in the SSP has been raised. At least forty percent of the score or more than thirty percent is required for each performance category to earn the incentive and to avoid penalty.

It is indeed a great step towards the progressive and value-based healthcare system.

Quality of Care by ACOs

The idea behind ACOs is to improve the quality of healthcare with collective efforts.

A volunteer group of clinicians, healthcare providers, and hospitals come together to improve care standards for their Medicare patients. The coordinated efforts compensate for the shortcomings that they have to face individually while enhancing patient satisfaction.

Apart from the other changes, several data submission methods will be available for them.

They have the option to submit quality data to CMS for QPP MIPS or SSP as:

  • ACO by participating under the same TIN (Tax Identification Number), or
  • Individual clinicians

Data Submission Methods

ACOs can also choose to report via several methods as:

  • Directly
  • Via login and upload
  • A third-party intermediary such as MIPS Qualified Registry

Advantages of Submitting Data to CMS via MIPS Qualified Registry

It is always easy to hire a third-party intermediary to not lose the essence of the program in between the administrative burden. These intermediaries cater to the entire load, comprehend details of your specialty, segment data as per the CMS rules, and timely submit it to authorities.

Accurate Data Compilation

Most organizations still use different platforms to collect different types of data. A MIPS Qualified Registry caters to all such reporting challenges efficiently.

For Instance, they have the resources to collect data effectively and aggregate it as per the reporting requirements for accurate data submission.

Analyze Your Performance

The technology help solves half the problem for QPP MIPS data submission or SSP. Seeking a third-party intermediary helps you optimize, plan, and analyze your performance record.

For Instance, if you get in touch with P3Care, our specialist helps you gauge your performance via data analysis, so you improve your score by adjusting changes in the delivery of care services.

It allows ACOs to refocus on points that are limiting their high score.

Quality Data Reporting to CMS

The more accurately you submit data to CMS, the more chances you have to score high and target incentives and bonuses.

It all comes down to the expertise of the third-party intermediary that if they have resources to cater to the administrative load. Eligible clinicians or ACOs should choose a registry that has the experience to deal with all physician types, i.e. individuals, and groups respectively.

Another factor is the training of resources to cater to the administrative data. With a qualified team at your disposal, you have access to techniques that work reliably to help you avoid penalties.

Conclusion

CMS has offered several data submission options for the ACOs. Now, it is up to them to start planning their incentive payment model participation soon such as for QPP MIPS to maximize their performance.

Another update is also expected later this year. So, maybe there are further changes that we have to work upon.

However, the best approach is to consult a MIPS Qualified Registry as P3Care for the submission process.

We are using a QPP JSON file upload and API submission method for reporting the data to Medicare. Our process is efficient and complies with all quality reporting requirements.

For more information on ACO reporting, contact our MIPS consultants.

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

In the last quarter of 2020, CMS (Centers for Medicare & Medicaid Services) announced the performance scores for clinicians of QPP MIPS 2019 on its official site.

Clinicians who participated may review their MIPS 2019 scores via a secure portal allotted to them. That along with your participation in MIPS 2020 reporting is going to add up to your revenue. God willing, you deserve every bit of it!

Ordinarily, the performance scores depict the percentage by which clinicians receive positive, negative, or neutral payment adjustments. However, for 2019, payment adjustments will be furnished in the year 2021. Once you have them, you are all set for incentives in 2022.

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. Due to the pandemic, CMS enforced a policy to not penalize 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 incentive payment models with a goal. It accounts for quality healthcare services, that CMS recognizes and rewards for.

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

Mostly, physicians who submit MIPS data through a MIPS Qualified Registry have an idea of their final score. Because registries like ours possess the right resources who follow a set roadmap to report quality measures, and in doing so, they can predict the scores.

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 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).
  • Not being 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 offers flexibility to ease out the administrative load. The option for applying for “the Extreme and Uncontrollable Conditions” was available until December 31, 2020. However, the deadline for MIPS 2020 submission still has some time left. If you are among the practices, that are eligible yet non-compliant, P3 may submit on your behalf. It protects you from a 9% penalty while brightening your chances towards 5% MIPS incentives.

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, Healthcare IT experts

4 Approaches to Managing Old Homes to Minimize COVID-19 Community Spread

Medicare promotes and safeguards the health of senior citizens. A survey reports that by 2030, every 1 in 5 people will be 65 or above. As a result, exhaustion of the Medicare program is more than likely to happen.

However, with the recent COVID-19 spread in full-bloom, to protect the senior citizens and managing old homes is more important than ever before.

We see hospitals and practices, in general, are equipped with the latest certified EHR systems aiding a new-age healthcare system to evolve, sustain, and respond to improved outcomes – technology is now an essential part of the healthcare system. In such times, optimal use of tech is where it all begins and ends.

Furthermore, medical billing services have a responsibility to play in these critical times. They have to support healthcare providers who are fighting on the frontlines with coronavirus disease. As our healthcare heroes risk their lives, we, as healthcare IT experts, have a responsibility to fully support them in this time of crisis.

For the most part, growing old isn’t easy, but due to innovations in technology and new inventions, caregiving has become more manageable. As a senior citizen, you deserve all the care out there as it is your right to have that. We are here for you as a provider’s systemic support during the coronavirus pandemic. You mustn’t go on blaming yourself for running a cold, persistently coughing, or sneezing without a break because it is no one’s fault.

Let’s look at a few approaches we can adopt to minimize the COVID-19 community spread.

  1. Reunite seniors with their Professions   

We don’t realize our growing age, but others do not let it go unnoticed. The slow deterioration of health; the gray hair; the wrinkles on the face & neck give it away and have a story to tell the others. The fact of the matter is that the number of gray hairs tells us the number of years you have cared for others. Therefore, never feel the shame in being old. It is the exact opposite – you are the wisest of all!

As we reach the latter part of our lives, we grow fonder and closer to our memories, especially the most-cherished ones. We may not be able to perform even the basic tasks like going to the bathroom and back, but those memories are what hold us together during the darkest of times.

If you want the senior citizens to listen to you, you must respect their memories during the COVID-19 lockdown. A big part of their survival depends on the good times they had in the past. Make use of those memories as part of the place where they sit and spend most of their time. For example, put a movie on which they like from the past to take off the edge from this whole pandemic situation buildup.

Let them do what they do best. For instance, if someone is a carpenter, include semi-finished wooden shelves in their skills room. They can use tools under supervision to create the next masterpiece. This way they get to be happy and kill some time as well.

Similarly, a professor will be happy with books and students in a class.

On the whole, to keep coming up with ideas to engage them is a difficult but necessary process.

  1. Make them Feel Ageless

They are our seniors, and we have to give them respect more than anything else.

To never let them feel old should be one of our goals.

From where we see them, they are young and energetic souls and will forever remain like that. To stop the COVID-19 community spread, much needed along with the stay at home part is the motivation for them every hour of the day; and words of love and support to look past their problems could just be it.

In an old home, look for ways to make them feel young. It’s not a piece of advice but an opinion that we would do the same thing if we were in your place. When we feel happy, we feel young inherently; it helps in mental and emotional stability. (which we need at the time)

  1. The crippling old age demands a perfect meal during the coronavirus pandemic

A way toward happiness is to eat delicious meals. You must equip the facility with nutritionists who are ready to prescribe corona-friendly weekly diet plans to residents. Foods that add variety to the menu and also strengthen their immune systems.

Something delicious but allowed in their age brings color to their faces and puts an end to the routine doom & gloom. Hence, have a plan in place to prepare a variety of foods for them – Foods that do not interfere with their healing cycle, of course.

Since food is a natural motivator, to ask each of them of their favorite food item is a good start. Moving forward, set up diet charts for them with the help of nutritionists.

An example of food can be scrambled eggs; a name everyone understands. I am not a food specialist or an old home administrator, but I say these things out of my experience with elders at home and materials I read on the web.

  1. Ensure the flooring has no apparent obstacles

This is one of the factors we must take into consideration in a caregiving facility. It can be a real game-changer. The flooring should be plain and simple without any speedbumps. So, if you find some flooring that needs repair, it could help them from tripping over and falling. Since corona is in full effect, we don’t want hospitals to fill up with non-corona patients.

Stairs should not be part of an old home with seniors. If there are stairs, keep them locked at all times.

At an older age, we tend to fall without rhyme or reason. Hence, stairs present a big threat or an injury that is waiting to happen. Keep elders away from stairs and only let them use them as tools for exercise. A supervised trip to level one and back to the ground floor once a day can be a good workout for them.

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Medical billing, Medical billing company, healthcare system, healthcare services, Medical billing outsourcing

A healthcare System without Surprise Medical Bills is a Progressive System

Health is an important asset to human beings. Patients, physicians, medical billing companies, insurance companies, clearinghouses, all are connected in one way or another to offer quality services. Physicians are then reimbursed for their services and that’s how the process flows.

Patients are particularly free from the burden of paying for healthcare expenses by themselves when they get a healthcare plan. They just have to pay their premiums, and the rest is the work of medical billing outsourcing companies.

In recent times, the payment system in the US healthcare system has especially been under scrutiny to facilitate patients and clinicians alike.

Healthcare Costs Have Gone Up

Due to inflation and in the name of empowering patients, costs have gone up severely. Deductibles and copayments have increased, and patients can’t do anything about it as they have to maintain their monthly healthcare package in check.

Increasing expenses for care services have left patients financially vulnerable. According to an estimate, patients paid around 35% of the medical bill charges in 2019. Looking into it, this percentage is quite high as compared to the previous years.

The patients have to endure surprise medical bills, and medical billing services are not to blame for this. Stats show that two-thirds of American adults, have savings less than $1000, and it is not enough to pay surprise bills sent by medical billing companies. Believe it or not, surprise medical bills are one of the causes of making families bankrupt.

All Stakeholders of the Healthcare Industry will Suffer If the Issue of Surprise Medical Bills is Not Resolved!

  1. A poll conducted by Kaiser Health Tracking in 2018 reflected that sixty-seven percent of Americans are somewhat worried about bearing unexpected healthcare costs for themselves or family members.
  2. Another study showed that forty percent of the Americans who had insurance received surprise bills in 2019.
  3. Forty-one of the Americans showed their concerns about how unexpected it was for them to see the bill going overboard.

The problem is huge. If patients are unable to pay for the rendered services, how will physicians survive? Medical billing services will not be able to get clear bills for physicians. Moreover, the inability to pay bills and deductibles has increased seventeen percent from 2012 to 2016.

The US government has also noticed this issue, and there are multiple solutions into consideration.

What is the Solution?

If authorities take proper action, negative payment cycles can be reversed.

Offer Customized Healthcare Plans to Patients

One way to restrict the ever-increasing cost factor in the healthcare industry is to offer customized/personalized experiences to patients.

Educate Patients About their Financial Responsibilities Beforehand

The healthcare and billing process can be confusing for patients. A professional medical billing company on behalf of physicians should demonstrate each payment obligation clearly to patients. Right from the appointment session to the final medical billing step, everything should be clear to exclude the surprise element.

Estimate Healthcare Expenses Accurately

The first step of accurate billing services is to estimate the cost of healthcare.

Medical billing outsourcing companies should break down each step for physicians to give them an idea of what patients can bear from their health plan and whatnot.

Listing payment options is also useful for patients when it comes to out-of-pocket expenses.

Considerate Clinicians & Medical Billing Services Should be Rewarded for their Services!

Another suggestion is to incentivize those healthcare providers and medical billing companies who ensure quality without surprise bills.

It will encourage everyone to take measures to empower patients while improving their revenue cycle management.

Conclusion

Providers who work in efforts to improve the quality of healthcare and reduce surprise billing can enjoy a significant improvement in revenue cycle management. One can’t expect a sudden change in the healthcare industry, but a seamless billing process without surprise bills is only possible via offering tailored payment models based on the patient’s financial situation.

MIPS reporting in 2019, Physical Therapist, MIPS meaningful use, healthcare system, Quality Payment Program, QPP, MIPS Qualified Registry, Medicare & Medicaid Services, Healthcare Solutions, CMS

A Guide to MIPS 2019 Reporting for Physical Therapists

Physical therapists are included as one of the groups of healthcare practitioners eligible for MIPS reporting in 2019. It was time their duties were rewarded with an open heart and a clear head. Physical therapy is a serious branch of medicine that, now, comes in the quality circle of the government where physical therapists (PTs) can receive incentives based on their performances. Moreover, MIPS measures relevant to their line of work highlight the broader spectrum of the US healthcare system.

Merit-Based Incentive Payment System (MIPS), as some of the PTs must already know, is where the disadvantaged gets rewarded equally as one with advantages. By advantages, I mean those clinicians who have to face geographical constraints or practices working in the countryside where there are fewer facilities as compared to ones in the city.

So, a system that speaks of justice is a system that works for people everywhere in the world.

MIPS is a combination of programs such as the Physician Quality Reporting System (PQRS), the Meaningful Use (MU) program and the Value-Based Modifier (VBM). Promoting interoperability (PI) category correlates with the MIPS meaningful use.

The four categories in which the performance of clinicians and clinician groups are measured are –

  • Quality,
  • Promoting Interoperability (PA),
  • Improvement Activities (IA),
  • And, Cost

Generally, PTs will only be scored in two categories in 2019 – Quality and Improvement Activities. The American Physical Therapy Association (APTA) participates actively in every provision of the Quality Payment Program (QPP).

MIPS 2019 Reporting for Physical Therapy Made Easy by P3Care

With the pre-designed MIPS 2019 reporting packages in the form of MIPS Essentials, MIPS Budget Neutral and Benchmark MIPS, P3 Healthcare Solutions is tailor-made for it. Doctors falling across various specialties, now, adopt one of these packages to report data. Their MIPS final scores in the 80s and 90s are a clear manifestation of the efficiency of P3 Healthcare Solutions.

Give it a try by talking to us at this number: 1-844-557-3227.

Being a MIPS Qualified Registry gives us an edge to report with consistency and data completeness. The latter qualifies as one of the factors judging the quality of data by the Centers for Medicare & Medicaid Services (CMS).

The Deadline

Another important factor that keeps us on the edge of our seats is deadlines. In this case, Physical Therapists (PTs) can report MIPS measures until December 21 as far as improvement activities are concerned. However, the submission of Quality occurs all over the year, P3 Healthcare Solutions, Ontario, CA has done it in the past and continues to report MIPS Quality measures for eligible clinicians year after year.

Submission deadlines vary according to the submission types. For those who undergo MIPS claims-based reporting in 2019, the claims must get processed “no later than 60 days after the performance year ends”. Groups using the CMS web interface option have to submit within 8 weeks after the performance year. The time window for this 8-week reporting opens from January 2 to March 31.

As a general rule, participants must submit measures before March 31 of the year after the performance year.

MIPS Consulting Services with Results

Physical Therapists (PTs), Occupational Therapists (OTs) and Speech-Language Pathologists (SLPs) are three crucial branches of health care. All of them can make use of P3Care to report MIPS performance categories, score high, and get a chance at incentives. That’s right. Leverage our services to convincingly compete in the Quality Payment Program 2019.

Improvement Activities (IA) category measures their performance in terms of practice improvement over an elaborate period. Ideally speaking, a MIPS Qualified Registry is suitable for reporting IA for

PTs and OTs as they can work on measures such as enhancing care coordination, expanding patient access to care, and improving patient-doctor decision-making. All of this to land the best score out of a total of 40 points.

How to Avoid Penalties in MIPS 2018, 2019 and Beyond?

Please comment to assist the other readers.

HIPAA medical billing, HIPAA medical billing and coding, healthcare services, healthcare system, outsource HIPAA medical compliance, Protected Health Information, PHI, billing companies, Medical Billing and Coding Companies, HIPAA violation, HIPAA compliance, HIPAA rules and regulations, HIPAA compliant medical billing, medical billing services, medical billing companies

HIPAA Medical Billing Is More Important Than You Think

If you belong to the healthcare industry in any capacity be it as a physician, nurse, surgeon, pharmacist, or health IT specialist, you would know the importance of privacy protection and confidentiality obligations.

HIPAA medical billing needs no introduction. The practice of HIPAA medical billing and coding has proved only to be fruitful for a progressive healthcare system.

Therefore, taking casual measures to ensure data protection and using ordinary software to store data is now just not enough.

Private Data is at Risk!

We say that healthcare services have progressed and we have gone automated, but so have data hackers.

Medical Billing and Coding Companies need to upgrade their systems and take standardized measures.

Lots of sensitive data is transferred from physicians to insurance companies to patients.

As billing companies are directly responsible for data handling, they are held accountable for any mishap.

Why HIPAA Compliance Is Important?

Because the expense for data breaches go far beyond fines and penalties.

No matter what the reason may be for healthcare organizations to outsource HIPAA medical compliance. We should keep in mind the following perspectives.

HIPAA Medical Billing Is Compulsory for Healthcare Organizations

According to the HIPAA Omnibus Final Rule, medical billing companies would be penalized for risking Protected Health Information (PHI). Any violations will not be entertained at any cost, and the company responsible for even minor negligence will have to bear heavy fines. Of course, it would also dent a company’s reputation leading to low revenue.

Data Security Threat Has Not Remained To Just Data Manipulation/Stealing

Not long ago, accidental exposure of sensitive data was considered a HIPAA violation. It means a situation in which you have to bear the financial loss.

However, the modern definition states that even unauthorized access to data is a threat to HIPAA compliance.

The following factors build the base for the damage of HIPAA violation.

  • The scope and type of healthcare data compromised
  • Characteristics of the party or person that accessed the data or violated the HIPAA rules
  • The measures, taken to avoid vulnerable areas to protect PHI

A medical billing company can only be successful by following the HIPAA rules and regulations. The best approach is to include clauses in the BAA – Business Associate Agreement.

Moreover, the Office of Civil Rights (OCR) also allows a bit of relaxation in HIPAA regulations to promote the trend of HIPAA compliance.

Things to Remember

To safeguard the interests of HIPAA compliant medical billing, it is important to not over-commit responsibilities to clients. The things, which, medical billing services are unable to commit can be strictly stated to the physicians.

Here’s a List of Things Medical Billing Should Perform

  • Perform thorough risk assessment
  • Design and implement a full-proof security plan
  • Secure Privacy policy
  • Dedicate trained resources for operations

The accuracy of billing procedure is the second priority; the first remains the infrastructure that supports the cause of HIPAA compliance. Thus, meeting security parameters and confidentiality clause is the only way forward for medical billing companies.

4 Reasons to Outsource Credentialing by a Medical Billing Company

Medical billing companies save revenue cycle management for clinicians. Without the assistance of medical billing services, we doubt the efficient running of medical practice.

The Healthcare industry is quite sensitive and responsible. Physicians are supposed to practice their skills for the ideal health status of individuals. Especially in the on-going approach of the value-based healthcare system, physicians need to modernize their treatment methods now more than ever. Hereby, medical billing companies create medical bills and handle the billing tasks to get the reimbursements. Consequently, physicians can pay attention to their actual work.

However, in addition to the billing process, a professional medical billing company also offers credentialing services for clinicians, which is a vital part of revenue generation.

What is Credentialing?

It is a process, in which hospitals, insurance companies, or healthcare authorities verify and legitimize the educational background, expertise, and qualification of a clinician. Generally, this process takes place before including a physician in the working network.

Why is Credentialing Important?

When physicians are credentialed, they get timely and rightful reimbursements from the insurance companies.

Medical credentialing is not an easy process and requires extensive focus from the start of the process to the end.

No Immature can look into clinicians’ past and derive professional outcomes. The credentialing process is legal and can result in penalties if done unethically. Hence, this responsibility should only be given to medical billing companies.

What are the Challenges that Occur During This Process?

Credentialing Takes Time

Medical billing companies and healthcare industry

Checking one’s background is a complex process. Therefore, it requires at least 60-90 days to fully credential a clinician.

Medical billing services when enlisting a physician for credentialing, are required to complete the whole process before he takes up a new patient. There is no room for error as the process involves the verification of sensitive fields such as employment history, education, medical training, licenses, and more.

Peers Don’t Cooperate

It is obvious that physicians are always tight on their schedule. Hence, there is little possibility that peers, who can give a vote of confidence for the physician will be able to respond to inquiries on time.

To avoid this delay in the credentialing process, physicians can inform their peers prior to the process. Moreover, they can also set a time to complete this task.

No Access to the Latest Information

Physicians need to have access to up-to-date information. However, medical practitioners are so busy in their lives that they remain oblivious of the latest information. For Example,

Clinicians working in the ambulatory surgical centers (ASCs) have to reevaluate their credentials after 1-3 years. When different clinicians have a different schedule for credentialing, it becomes hard for ASCs to manage all.

Thus, no access to the information at the right time creates issues for the credentialing service providers and the confirming authorities.

Inability to be Compliant with Value-Based Healthcare

Different states have different healthcare plans and so physicians are supposed to stay true to all the state exchange and federal healthcare plans.

Another challenge that a credentialing medical billing company faces is that physicians have to treat a reasonable number of patients to handle revenue cycle management. Moreover, medical practices should implement the right healthcare strategies. Otherwise, they’ll not be able to get reimbursements for the rendered services.

Considering the difficulty, medical practitioners choose to outsource for credentialing services. There is no way that unprofessional individuals should not take responsibility for this task. After all, physicians’ revenue generation is based upon it. Thus, only, a medical billing company as P3 Healthcare Solutions can outrun all the above-mentioned challenges for credentialing and insurance enrollment and offer an efficient solution.

https://www.linkedin.com/company/p3-healthcare-solutions

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.

EHR system, EHR technology, EHRs, Healthcare, HIPAA, Meaningful Use of EHR

The Future of Meaningful Use (MU) of EHR Systems

The Healthcare industry is moving at a fast pace via Healthcare Information Technology (HIT). Everybody knows that electronic healthcare records (EHRs) are the most advanced practice of innovation in the healthcare industry. The meaningful use of EHRs (MU) is not limited to a certain sector of healthcare, which is capable of heavy investment. In fact, it is widely accepted by physicians of every scale and expertise.

Healthcare Chief Information Officers (CIOs) are making sure that their organizations maintain a certain standard of interoperability. Only this way, the actual progression in the industry will be observed.

HIT leaders’ investments in EHRs are not substantial only for today’s use, but they have an eye on the future of meaningful use of EHRs. EHRs are already an advanced form of technology, making patients and physicians empowered.

So what is the Future of Electronic Healthcare Records (EHRs)?

According to the officers of Healthcare IT and the leading EHRs vendors, automation, telemedicine, and advanced analytical tools will have a huge impact on EHR technology.

Impact of Automation and the Advanced Analytical Tools

The automation in the care services in diagnostic, treatment procedures, and in administrative processes has cut down costs. It helps physicians to focus their attention on the work of their expertise, rather than on managerial issues.

The same is the case with Genomics – Informed Medicines which require the genomic information of a patient for his treatment. This approach is quite useful in understanding the diseases’ causes and their impact on patient’s health. This type of medicine also facilitates preventive medicines. Thus, the dimension of reporting of medical records will change drastically.

Telemedicine is the discipline, in which patients and physicians are not present in front of each other. As this technology will strengthen its place in the near future, the way one access, and views EHR will be changed. The virtual delivery of healthcare services has transformed, and this will affect the outcomes of the interoperability measures.

In short, there are different ways to leverage healthcare services. Thus, the devices and algorithms to process or detect illnesses will require a different recording method.

For Example,

How EHR will react towards diagnostic procedures conducted in a home setting, but the test result been given back to the medical organization, especially, when they are to be given to an algorithm or machine as well.

How Increased Interaction Influences Meaningful Use of EHR?

With technology advancement, the virtual diagnosis will move towards increased interaction and user satisfaction. In addition, it will reduce unnecessary cost expenses.

The accommodation of innovation techniques will be difficult to manage as tangible results. Thus, the Meaningful Use of EHR in the future will be helpful in recognizing serious health areas, and it will be using machine learning and predictive models to support the latest technology.

Developing such, intelligent EHRs will be challenging when there is a big issue that is the complexity of the EHR system to handle a large amount of data.

Health IT leaders predict that human-centered designs will resolve this problem. Cloud-based service and aligning work operations to support mobile services will increase the efficiency of electronic healthcare records (EHRs).

With a cloud-based EHR platform, interoperability will also increase via improved security features and the HIPAA-Compliance will be possible to a greater extent.

Mobile-Based EHR Systems

Even today, many professional EHR vendors have developed systems that offer specific functionality of EHRs on smartphones. Everybody knows the accessibility and the scalability of mobile-based systems. By completely incorporating this method into reality, medical records will be at their fingertips and the physicians-patients engagement will be easy.

The main purpose of EHR technology is to support a large population of data without any redundancy. The second purpose is to streamline artificial intelligence to increase a better understanding of healthcare data and remove vulnerabilities in the healthcare system.

Get Ready for the Highest Level of Interoperability via Meaningful Use EHRs

Cloud-based APIs will have a great say in the progressive healthcare system. Smart applications and the additional medical components will form the base of a more secure healthcare system.  The only need is to accept change with open arms.

Looking Back At EHR Meaningful Use From A New Perspective

ARRA – The American Reinvestment & Recovery Act was legalized on February 17th, 2009. It aimed to revolutionize many economic and social sectors including healthcare. Health Information Technology for Economic and Clinical Health (HITECH) Act was also one of its considerations. This act was in great support of the meaningful use of the electronic healthcare records (EHRs), an initiative by the Centers for Medicare and Medicaid (CMS) and the Office of National Coordinator for Health IT (ONC).

Its emphasis on the implementation of EHR technology throughout the USA. Moreover, it is also in accordance with the MIPS quality measure Promoting Interoperability (PI) in which physicians use innovative methods to improve the quality of care services. It requires the use of certified EHR technology to provide a secure exchange of healthcare information.

Plays an Important Role in MIPS Data Submission

The meaningful use of EHR technology also helps physicians to efficiently submit MIPS data to CMS. On the other hand, physicians using this technology can also report measures regarding value-based services to the Secretary of Health & Human Services (HHS) and get incentives.

The Need for Meaningful Use (MU) Act

This act is helpful in generating five possible outcomes for the betterment of the healthcare industry.

  • Improvement in public health
  • Improved coordination in healthcare sectors
  • Increased engagement of physicians and patients
  • Protect patient’s private data from unauthorized use
  • Improved services, safety, and efficiency of the healthcare system

What benefits physicians have for meaningfully using EHR technology?

Meaningful use of EHR

The incentive payment ranges from $44,000 for 5 years to $63,750 for 6 years (Starting from 2011).   Eligible physicians (EPs) and eligible hospitals (EHs) demonstrating adaptation and efficient use of EHR, get valuable rewards. To encourage physicians to go for EHR meaningful use and reduce the burden for healthcare providers, it is classified into three stages.

Stage 1 of Meaningful Use

The requirements of this stage are divided into the 15 core set and 10 menu set objectives. There is an option of choosing 5 out of 10 menu set objectives with the compulsion of at least one population/public health measure.

Stage 2 of Meaningful Use

CMS and ONC have also set standards for the second stage of meaningful use (MU). It released the final rule for incentive programs of Medicare, Medicaid and EHR technology in August 2012.

For this stage, eligible physicians are required to meet for the exclusion to 17 core objectives and 3 out of 6 menu set objectives.

Whereas, it was a must for eligible hospitals and Critical Access Hospitals (CAHs) to qualify for an exclusion to 16 core objectives and 3 out of 6 menu objectives.

Stage 3 of Meaningful Use

In the modified version of stage 2 meaningful use for 2015-2017, clinicians attest to any combination of 2 measures out of 3, while EHs and CAHs attest for any combination of 3 measures out of 4. For stage 3, submitting data for meaningful use was obligatory in 2018.

ONC along with HHS (Department of Human Health & Services) released a final rule in the context of meaningful use and gave certification to the 2015 edition of electronic healthcare records (EHRs). This initiative allowed diverse types of healthcare organizations to get access to healthcare IT.

Thus, medical practices that adopted EHR technology in previous years are now in benefit and can target more incentives, as they have completely understood this method. To get incentives and adopt healthcare IT, physicians should invest their efforts in this system respectively.

HITECH provides high opportunities for healthcare providers to improve their medical practice. The phased approach of three stages allows room for improvement in the public health sector. Moreover, it sets the base of the healthcare system with fewer discrepancies and controls chronic diseases.

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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.

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CMS Announces A Decline of $15 Billion in Medicare Fee-For-Service Improper Payments

Both patients and physicians are in for a treat. A few days ago, CMS happily announced the continued decline in the Medicare Fee-For-Service improper payment rate.

It is a clear statement in the name of transparency. More importantly, it is the proper accreditation of taxpayer money and an effort to strengthen the Medicare program in general. Undeniably, such are the efforts that pave the way for a rewarding healthcare system.

If you see it in another manner, once you hold fraudulent activities to account, there is more to give to those who deserve it. It automatically translates into value for quality programs like the MIPS 2020 and for other value-based care programs. Through such strategic actions, we will cement the positive reflection of value-based programs, both materially and conceptually.

In fact, once CMS saves taxpayer money by stopping improper payments made on account of frauds, overpayments, and underpayments, it converts into quality care and fewer expenses for the common man.

Four Years of Remaining on Point Saves the Day

It was not an overnight thing, but it took four constant years to come to this point. CMS corrective measures led to an estimated $15 billion reduction in Medicare FFS improper payments in FY 2020. It was part of the agency’s action plans that helped reduce and prevent illegitimate payments over the years.

During this journey of consistency and hard work, the agency’s capacity to address risks improved substantially through group activities and interagency collaborations.

For a fact, it was the Trump administration that made a clear commitment to protect Medicare for our seniors. To achieve this purpose, we must ensure that frauds, abuse, and waste do not happen as they will rob the program of its efficacy, Ms. Seema Verma expressed in her brief talk.

The Trump administration doubled the efforts to protect taxpayer money, and this year’s continued reduction in Medicare FFS improper payments is a direct effect of those actions.

Historic Win for Taxpayers

The reduction in improper payment rate means a win for taxpayers. Their hard-earned money is safer this year by quite a margin from the previous year. Due to the constant efforts in this sector, in 2020, CMS managed to decrease the improper payment rate further down – to 6.27%. Back in FY 2019, this rate was 7.25%. It is the start of an era of taxpayer savings to ignite the flames of a flawless healthcare system.

The improper payment rate threshold has to be under 10%, and, rightly so, we live to see it become a reality. In the past four years, we made this progress under the Payment Integrity Information Act of 2019 for our present and future generations.

Progressive Areas

  • Home Health department saw improvements, including clarifying documentation requirements and raising awareness among providers through the Targeted Probe and Education program. The resulting situation was no less than incredible. It led to a $5.9 billion decrease in improper payments from 2016 to 2020.
  • Skilled Nursing Facility Claims was the other area that saw improvement. There was an approximate reduction of $1 billion in improper payments in the last year due to a policy shift. It happened due to an adjustment made to the supporting information for physician certification and recertification of the skilled nursing facility services. Moreover, CMS’ Targeted Probe and Educate programs reaped its fruits.

Healthcare costs are soaring as we speak, and they are going to increase going forward. According to an estimate, by 2026, one out of every five tax dollars will go into healthcare.

To have sustainable cost growth, CMS must continue to strive for a system that accepts only proper payments. Improper payments only destabilize the cost balance. Stating the obvious, they are illegal payments – intentional or otherwise – going against the sustainability of affordable healthcare. They also represent false spending of American taxpayer dollars; however, not all of them represent fraud. The definition of improper payments includes overpayments, underpayments, or payments made under insufficient information.

Action Plan

CMS has developed a five-tier program integrity plan to mark the agency’s approach to reducing improper payments while safeguarding its programs for future generations:

  1. Bring Bad Actors to Justice: CMS works alongside law enforcement agencies to bring people who have defrauded the system under law.
  2. Prevent Fraud Before It Happens: Rather than the costly and ineffective “pay & chase” model, CMS eliminates fraud proactively by reducing the opportunities to exploit vulnerabilities in healthcare.
  3. Mitigate Risks to Value-Based Programs: CMS continues to explore ways to identify and reduce integrity risks to value-based care programs. MIPS 2020 and Advanced Alternative Payment Models (APMs) are the two programs currently underway. With the help of experts in the healthcare community, their lessons learned, CMS pledges to run these programs smoothly.
  4. Reduce Provider Burden: It is in line with reducing providers’ burdens who make claim errors in good faith; CMS wants to assist them by giving them easier access to coverage and payment rules. In addition to that, CMS is educating them on compliance programs. P3 Healthcare Solutions becomes a part of this effort via MIPS data submission to CMS as a MIPS Qualified Registry.
  5. Leverage Artificial Intelligence and Machine Learning: CMS looks to leverage technology like AI and machine learning to allow the Medicare program to oversee compliance on claim submissions. It eventually calms the providers down, and taxpayers get to pay less.
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QPP MIPS 2020 Reporting Flexibilities amidst Pandemic

CMS (Center for Medicare and Medicaid Services) has proven to be an authority that addresses physicians’ concerns in an effective manner.

With the pandemic situation going on, the pressure on physicians only got worse, which the authority took notice of.

Flexibilities for MIPS Eligible Physicians

To ease the administrative load for MIPS 2020 data submission, CMS announced to facilitate clinicians amidst the corona pandemic.

CMS announces QPP MIPS reporting Relaxations for 2020

Extreme & Uncontrollable Circumstances Application

Many medical practices have been affected by the surging corona positive cases.

Such practices, whose conditions have gotten worse during this period can apply for “Extreme and Uncontrollable Circumstances Application”.

In case of acceptance of this application, CMS will reweight any or all MIPS performance categories. However, the applicants have to provide a solid reason for this relaxation and justify the impact of COVID-19 on their practice.

This is done in order to offer relief for QPP MIPS 2020 data submission.

COVID-19 Clinical Trials for Improvement Activities (IA)

Now, under the MIPS program, eligible clinicians can also report COVID-19 related data for Improvement Activities (IA).

Any of the following conditions are to be fulfilled in order to participate in MIPS 2020 IA clinical trials.

  1. The interested clinicians must submit data to a relevant platform for research purposes, then, they can apply for the clinical trial.
  2. The interested physicians must submit COVID-19 patients’ data to a clinical data registry for research purposes without any change.

One thing worth mentioning here is that CMS has clearly stated in its notification that no data from Jan 1, 2020, through June 30, 2020, will be used to excuse the MIPS 2020 reporting requirements.

This restriction applies to all Medicare Quality Reporting programs as well as the Value-Based Purchasing programs.

Thus, data related to respective dates will be served to reduce the administrative load.

Visit our website for more information on QPP MIPS 2020 relaxations.

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CMS Plans to Expand RSNAT All Across America

CMS (The Center for Medicare & Medicaid Services) works for quality care and optimized performance in the healthcare industry. The healthcare industry leaders are focusing on every aspect and taking measures step-by-step to simplify operations.

Apart from announcing advancements in medical billing services and other healthcare operations, they also consider aspects of non-emergent care.

Recently, CMS announced to expand Medicare Prior Authorization Model for Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) across all America.

According to CMS, before the expansion process, RSNAT Prior Authorization Model will test the need for prior authorization of services.

What will be the outcome if outsourcing medical billing services seek approval before the service is rendered or before they send the due claim to the payer? Will it save cash for Medicare while trying to achieve quality healthcare for repetitive, scheduled non-emergency ambulance transportation?

Let’s find out.

CMS implemented this model in several states of America

An Overview

Such as New Jersey, Pennsylvania, South Carolina, North Carolina, Virginia, West Virginia, Maryland, Delaware, and the District of Columbia during different years to test out its implications.

The results were quite astonishing and encouraging to say the least. The quality of care and easy access to essential services were maintained as expected. Statistics show that Medicare Prior Authorization Model for Repetitive, Scheduled Non-Emergent Ambulance Transport saved around $650 million over four years.

The Need to Implement a New Model

Medical billing services used to face problems related to improper/inconsistent Medicare payments for non-emergent ambulance transports. There was a much-needed room for a new payment model that promotes cost efficiency and counters risks related to payments.

And, CMS wants to ensure proactive measures that minimize fraudulent activities.

Is the New Model Successful?

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The first evaluation report of this program came under analysis in 2018 and based on that, CMS is hopeful to expand it nationwide to curb down Medicare Spending. The recently released second evaluation report also highlighted that the use of RSNAT is reduced by 63% and its respective spending is reduced by 72% overall. (The report results were concerning the end-stage renal disease and/or severe pressure ulcers during the first four years of the model.) However, it supported the previous assumption that it is safe to implement this program everywhere. There was also no evidence against this system that reflected poor healthcare quality.

CMS has made clear that across the board accountability, lesser loopholes for frauds, simplified solutions, and expanses in check will make a progressive healthcare system. Moreover, with the new plan, medical billing services, physicians, and patients, all will be benefitted in one way or another.

CMS administrator, Seema Verma says that although medical billing experts complain about the complexity of prior authorization. But, with a proper plan of action and accurate deployment of the model, Medicare can ensure that its requirements are met even before the start of the service.

One more advantage of this system is that billing experts on behalf of physicians don’t have to indulge in extra administrative work afterward.

Henceforth, the program will continue to run in the currents states although they were expected to end this year. But, the success of the new model of non-emergency ambulance transportation changed the whole view.

CMS will release new guidelines regarding the expansion in every state. The model will remain the same as the existing model.

It is expected that medical billing outsourcing companies will find this new model accommodating with respect to maintaining cost.

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CMS Prioritizes Surveys Post Pandemic for the safety of patients

Every business came to a halt with the COVID-19 pandemic. Now, everything is settling back to normalcy, and CMS is getting back to business with its full strength.

They have officially asked state survey agencies to get on with the normal operations.

According to the CMS (The Centers for Medicare and Medicaid Services) memo, they will be inspecting and regulating quality and safety measures for patients of their authorized healthcare professionals, medical billing services, and other care suppliers. They are to resume their enforcement activities and other surveys in order to get an idea of their performance having patients being the priority.

How Is It Going to Work?

The last few months were hectic for the CMS. They were conducting surveys about the virus control and response in particular, virtually from all nursing homes in America.

However, now non-emergency onsite revisit surveys will be conducted. Compliant surveys and annual certification surveys will now be more focused upon, as soon the right resources are accessible to the team. The on-hold enforcement cases will also see the light of day and be resolved.

CMS also says that they will continue with the desk review policy to ensure that survey parties comply with the federal rules for an onsite survey.

Even during the catastrophic pandemic situation, CMS only focused on patients’ satisfaction.

“They have imposed more than $15 million in civil money penalties (CMPs) to more than 3,400 nursing homes during the public health emergency for non-compliance with infection control requirements and the failure to report coronavirus disease 2019 (COVID-19) data.” (Source: CMS)

Protect the Residents of Nursing Homes

The penalties were an extension to Trump’s vision of safeguarding the residents of nursing homes during the pandemic. However, CMS ensures some comfort via relaxing the strict quality measures requirements based on the critical situation in any particular state.

Provider Surveys in Progress for a Stable Healthcare System

Given below is the list of types of surveys that would be the top priority.

The idea is to give healthcare professionals and medical practices the ease to estimate their survey turn and plan accordingly.

The FY 2020 Mission & Priority Document highlighted how survey agencies should resume back to normal work.

  1. Initial surveys of new providers
  2. Special Purpose Renal Dialysis Facilities (SPRDFs)
  3. Past-due recertification surveys without a statutorily required survey interval
  4. Unfinished complaint surveys triaged as non-immediate Jeopardy level or higher
  5. Revisit surveys for past non-compliance that do not otherwise qualify for a desk review
  6. Past-due recertification surveys with a statutorily required survey interval (home health agencies and hospices must be surveyed every 36 months)

(Source: AAPC)

As medical billing companies and healthcare practitioners, we should be ready for audits and surveys, which will also help us to see where we stand in a progressive healthcare system.