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MIPS 2019 reporting, Healthcare Solutions, MIPS QPP, MIPS 2020 reporting, MIPS quality measures, Medicare and Medicaid Services, MIPS qualified registry, MIPS consulting services

3 Points to Consider Before MIPS 2019 Reporting

Physicians! It’s time to prepare for the MIPS 2019 reporting period. There’s only a little time left.

This time may be hectic and stressful, even for MIPS qualified registries. But don’t worry, P3 Healthcare Solutions has come up with effective tips to target high MIPS scores.

Let’s be honest, MIPS QPP can be a daunting approach to earn incentives for those who are not careful.

On the other hand, it can be rewarding and tends to appreciate clinicians’ efforts for showing remarkable performance.

Now, the bad performance can’t be blamed over a misunderstanding. It’s been three years since MIPS if you still can’t perform well, you should expect financial setback.

Financial Risk Is Increasing!

  • This year, the performance threshold is thirty points.
  • Financial risk is up to 7%.

You can imagine that the reporting complexities will be higher than the years before. Some people will win this game while others will lose. The only way forward is to strategize beforehand and report according to the specified guidelines.

So, just let’s dig into three important points to consider before MIPS 2019 reporting.

Understand the Criteria for the Minimum Performance

Did you know that only by correctly reporting for Improvement Activities (IA) and Promoting Interoperability (PI) categories can give points up to 40? It is at least 10 points more than the minimum threshold that can save from the penalty.

Speaking about the reporting strategy, keep in mind that this year, PI category data submission has especially been strict. Now, it’s not enough to just say that yes! I did it. You have to provide substantial evidence for the performance.

Pay Attention to MIPS Quality Measure

You might be thinking that if reporting for just IA and PI is enough to save your face, why not just stop there.

But we suggest, NO! You should not only be considering penalties but the goal should be incentives and bonuses.

Striving for better opportunities give margin to stay ahead of game from those physicians, who might only have taken measures to prevent themselves from penalties.

So, working not only to save yourself but to earn incentives and bonuses should be included in strategies, and reporting for MIPS quality measure is an efficient way to do that.

Don’t Wait Until the Very End for Data Submission

CMS – The Centers for Medicare and Medicaid require data for 90 days of PI and IA performance categories. The same is not the case with Quality and Cost measures.

CMS also has a specified timeline in which eligible clinicians can report data to them. However, if you consult a MIPS qualified registry, you are able to save data and make relevant changes from time to time.

March 31, 2020, until 8 p.m. EDT is the last date for QPP MIPS 2019 data submission. During this period, eligible clinicians can also update their data if required. So, until the submission window stays open, you have time to make changes to comply with the CMS requirements to score high in the end.

This strategy reduces the chances of errors and data redundancy. MIPS is a bit complex, but the key to success is comprehending the reporting criteria, which is an easy process when collaborated with MIPS consulting services as P3 Healthcare Solutions.

Small medical practices or hospitals need their time to plan, but a smart strategy can go a long way to maximize returns, optimize time, and efforts.

So, start planning today.

Learn about MIPS quality measures specifications 2019 in a nutshell.

A Guide to Medical Billing Services for Podiatrists

There are several medical specializations and for each specialization, there are certain rules and regulations to follow regarding their medical billing. Medical billing services efficiency turns into the financial health of a practice.

Not every medical field has the same diagnostic and surgical procedures. Similarly, each has its own medical billing and coding guidelines. And, podiatry is no different. When the claims undergo acceptance more often than not, it goes in the credit of medical billing companies. However, if there are more rejections reported, it is time to revamp your billing strategy.

Today, we will look at the special circumstances around which the billing partner works for podiatrists.

First Thing’s First, What is Podiatry?

Podiatry is the branch of medicine concerned with the diagnosis, treatment, and study of diseases and disorders of the foot and lower extremity. Treatments are related to regular healthcare issues – neurological, metabolic, and other underlying issues along with injuries, wounds, and infections.

Rules Regarding Billing for Podiatrists

The Centers for Medicare and Medicaid Services (CMS) defines rules and procedures for each discipline of medicine. There are clear instructions on what should be covered under an insurance plan for podiatrists. New medical billing outsourcing companies can take notes from their official website.

Insurance Don’t Pay for Non-Medically Necessary Services

Under CMS rules, insurance companies will only pay for medically necessary foot care services.

A regular foot care service falls into the following categories.

  • Additional
  • Mandatory
  • Supplemental
  • Optional supplemental

What Exclusions Are Involved in Podiatry Medical Billing?

There are certain cases in which fighting with insurance companies for reimbursement doesn’t help at all. Please don’t send claims for the following cases because they won’t be paid:

  • Initial care service
  • Existence of metabolic, neurologic, or other peripheral vascular diseases
  • Mycotic nails
  • When a patient is already receiving primary healthcare
  • Dislocation of ankle joint
  • Subluxation of structures within feet
  • When a patient wears orthotic shoes
  • When a diabetic patient wears special shoes

Medical Billing Services for Small Practices

In case you are a medical practice of 15 or fewer physicians, it is best to search for ‘medical billing near me‘ phrase to find the nearest billing companies. If you are a practice in Ontario, California, P3Care would be happy to have you as a client. Since the field of podiatry takes care of our feet and ankles, we use our feet and ankles along with our mental capacity to good effect to get them paid.

On the contrary, if you are a bigger practice or let’s say a hospital, P3 leaves no stone unturned to get you paid. Accounts receivable are best managed if you don’t let them pile up. Because, once they do, it is difficult to get them reimbursed. Therefore, P3 never leaves today’s work on tomorrow ensuring accounts receivable remain on an all-time low.

Conclusion

To increase the acceptance rate of medical claims, medical billing services have to be precise. An incorrect name of the podiatrist who diagnosed the disease is not acceptable. Moreover, the severity of the condition should be reported apart from the diagnostic procedure.

New medical billers and coders often get lost in the maze of instructions and guidelines. Therefore, this guide includes the basics of medical billing for podiatry to help them as well. Indeed, the creation of claims requires a great level of accuracy because insurance companies can easily deny paying for services.

With little care, necessary paperwork, the right CPT and ICD-10 code, we expedite the claim submission process for our clients. We, at P3 Healthcare Solutions, Ontario, CA, devise medical billing methods for both general and specialty-specific clinicians.

 

MIPS and MACRA, EHR technology, healthcare industry, healthcare provider, Healthcare clinical process, Medicare and Medicaid Services, value based healthcare

The Role Of Clinical Quality Measures For Physicians

Since the healthcare industry has taken serious measures to revamp healthcare services, the emphasis on incentive payment programs has increased. MIPS and MACRA, and more offer facilities to physicians that regular payment method can never provide.

Such incentive payment programs come with various quality measures against which clinical data is needed to report. The number of clinical quality measures is so large that it is difficult to manage them for each healthcare provider. Moreover, the requirements for each program be it Meaningful Use (MU), MIPS or others and the implementation of reporting criteria can be quite confusing.

The Center for Medicare and Medicaid Services (CMS) states Clinical Quality Measures (CQMs) for incentive payment programs. The result is not just to pay physicians but the value-based healthcare improvement efforts. These clinical quality measures also put their part in various government or private development projects.

Need of CQMs

Eligible physicians and hospitals submit data to CMS as in MIPS. In return, CMS estimates their performance and reward accordingly while checking that patients are getting the deserved attention from physicians. In addition, it works in favor of the healthcare industry to improve performance categories, falling short in terms of efficiency and quality.

What factors determine success in Clinical Quality Measures Submission?

As per the CMS website, it checks the following parameters to score CQMs.

  1. Use of available resources
  2. Compatibility to healthcare standards
  3. Healthcare outcomes
  4. Patient’s safety and welfare
  5. Coordination among physicians
  6. Patient’s engagement level
  7. Population & overall health standard
  8. Healthcare clinical processes

To maintain the accuracy and transparency in the healthcare system, ONC, Office of the National Coordinator for Health Information Technology (US Government Health and Human Services), monitors the use of EHR and other technologies.

The Development Process of Clinical Quality Measures (CQMs)

MIPS and MACRA, EHR technology, healthcare industry, healthcare provider, Healthcare clinical process, Medicare and Medicaid Services, value based healthcare

National Quality Forum

Many healthcare industry leaders and stakeholders take part in developing CQMs. However, measures standardized by the National Quality Forum (NQF) are considered as the top priority. Most of the incentive payment programs use their measures because their development process involves extensive research.

Another reason for adopting NQF quality measures is their work and objectives that match with that of CMS. Moreover, their initiative boosts the use of electronic healthcare records (EHRs).

Development Process via CMS

CMS also has its own measure development project known as The Measures Management system. This system is always in its evolution stage and sets values for business processes. The deduced measures also support MIPS and other incentive payment programs and provide an opportunity for their growth.

Real-Life Implementation of Quality Measures

Clinical quality measure reporting accounts for many uses, but its major reliance is on EHR technology usage or Meaningful Use. However, many healthcare providers deem Meaningful Use to be stressful and demanding. Moreover, not every quality measure is for everyone. Thus, there should be some flexibility in the reporting criteria.

CMS has gone to great lengths to overcome reporting issues and streamlined measures under seven categories.  When physicians are reimbursed and incentivize, it becomes obligatory for them to maintain their performance instead of giving quality as a onetime shot.

Clinical quality measures are also a great aspect of Physicians’ Quality Reporting System. Physicians are met with penalties when they don’t report according to the standards.

Thus, MIPS, MACRA, and other payment incentive programs can’t perform their actual functions without efficient marking of clinical quality measures. The key to success is the selection of accurate measures according to the practice and the value-based approach of practicing physicians towards patients.

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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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3 Types Of Payment Models, Physicians Probably Don’t Know!

Value-based healthcare services have not only changed the patients’ healthcare standards but also the physicians’ payment model. Value-based reimbursement models encourage clinicians to adopt methods that make healthcare easy and efficient. Programs like MIPS & MACRA and more depict a value-based care system and allow physicians to achieve rewards and bonuses. The purpose is value-based reimbursement models are too.

  • Straighten up physicians’ revenue cycle management
  • Make patients empower the healthcare system where they choose their desired service

We have heard many of the benefits and the need for value-based healthcare models, but the proper information about the available models is not very common. Let’s review that.

What are the Available Value-Based Care Models?

There are a few types of value-based payment models with a variety of risks attached and the benefits.

1. Accountable Care Organizations (ACO)

It is a system of hospitals, clinicians, and other healthcare providers to provide organized and high-quality services to Medicare beneficiaries. It was started to help patients receive up-to-the-mark services at the most appropriate time. It means that in case of emergencies or other scenarios, patients don’t have to wait to get to the relevant doctor.

This organization ensures that patient only bears expenses for those services that are absolutely necessary to treat an illness. Redundant medical services are reduced by eliminating medical errors that occur while diagnosis or treatment.

Healthcare providers volunteer in this program to get shared savings if the ACO fulfills the standardized healthcare criteria with reduced expenditure.

Risk Factor Involved in ACO

It is not like ACO volunteers always end up adding a bonus to their revenue cycle, but the financial risk is also involved. When able to meet the requirement, physicians have a jackpot, but on the other side, they also have to bear shared losses if any.

For shared loss, healthcare providers have to pay Medicare as compensation for not delivering value-based care to patients.

This value-based reimbursement model is not just about value-based medical procedures but also supports volume-based services. However, the evaluation is based on quality, safety, and experience.

2. Bundled Payment for Rendered Services

This payment model pays physicians not for each service but as a whole series of services. Clinicians receive collective reimbursement for treating a medical condition, including all the charges for physicians and the types of rendered procedures.

For Instance,

If a patient undergoes a surgical procedure, CMS (The Centers for Medicare and Medicaid Services) sets a collective payment for surgeons, an anesthesiologist. It then pays a total amount rather than paying separately to each clinician.

Risks Attached with Bundled Payment Model

A certain level of risk is also involved with this type of payment model same as the ACO. Physicians get to full their pockets when they collectively reduce the incurred cost. Otherwise, they get will have to bear the loss.

Thus, this practice requires standardized procedures so that, all stakeholders get the rightful reimbursements.

3. Patient-Centered Medical Homes (PCMH)

It represents the healthcare payment model in which a primary care physician coordinates the patients’ healthcare. This payment model manages and handles all the needs of the patient in a centralized setting.

It’s certification highlights that the physicians are capable of providing healthcare in a patient-centered setting with team-based methods. Moreover, it also ensures consistent care quality for patients.

Patients are allowed to develop a one-to-one relationship with their physicians, and it governs the medical and environmental factors.

This payment system has shown great potential in reducing the unnecessary cost expenditure. According to a Maryland – based PCMH, via the efficient practice of this reimbursement model, they were able to save up to $98 million and enhance their quality standards by 10%.

Alternative payment methods other than the fee-per-service are not very popular practices. However, physicians are unable to meet their financial requirements. Thus, they are devising ways to incorporate new technologies into their system to speed up the workflow.

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MIPS Track Participation Exceeded 1st Year Growth – CMS

The news just came in last night via the official CMS blog, where Seema Verma, the Administrator of the Centers for Medicare and Medicaid Services (CMS), announced that the participation rate for the Merit-based Incentive Payment System (MIPS) exceeded its 1st-year goal by 1 percent. The early goal was set at 90 percent for MIPS – one of the two tracks under the CMS’s Quality Payment Program (QPP). Furthermore, the announcement stated that the submission rates for ACOs (Accountable Care Organizations) were recorded at a whopping 98%, while those of clinicians in rural practices were found to be 94%. These figures show the results are truly outstanding. Verma says,

“What makes these numbers most exciting is the concerted efforts by clinicians, professional associations, and many others to ensure high-quality care and improved outcomes for patients.”

Patients Over Paperwork Initiative

Furthermore, these high participation rates show significant progress in the organization’s prime objective “Patients over Paperwork.” A patient over paperwork is an initiative by CMS, launched in November last year. The main idea behind the initiative was to streamline regulations by increasing efficiency, thus improving patients’ care and experience.

Steps are taken through this initiative, according to Verma, resulted in:

  • Continued free technical assistance to clinicians in the program.
  • The number of clinicians required to participate in the program reduced, thus making it possible for them to give more time to their patients, instead of worrying about lengthy filing requirements.
  • Addition of new bonus points for small practitioners, or practitioners who treat complex cases or are using the 2015 edition of CEHRT exclusively thus promoting interoperability of health information.
  • A higher number of opportunities for healthcare providers to earn positive payment adjustments.

All of these measures helped CMS in achieving the success in its QPP program.

A Look Forward

Finally, Verma expressed CMS’s continued focus on reducing burden in various areas of MIPS, as has been mandated by the Bipartisan Budget Act of 2018. She further articulated her organization’s eagerness to continue its work on improving clinician and patient experience through their “Meaningful Measure Initiative”, instead of focusing on processes.

Now that the 3rd performance year MIPS 2019 has started, CMS expects even more participation than the previous years. Their efforts to minimize administrative burden and address concerns that clinicians highlighted are appreciated throughout.

An Overview of MIPS 2019

MIPS 2019 and Quality measures

For 2019, positive or negative payment adjustment is raised to 7%. Talking in numbers, if medical practice scores well and bills approximately $1,500,000 in Medicare, it can earn up to $1,605,000. The huge money is surely an attraction.

Moreover, this year, the performance threshold is 30 points instead of 15 points. Achieving double the points than last year is quite easy if you use appropriate resources and the latest tools.

CMS is stepping up each year for incentive payment program MIPS to make things work out for healthcare organizations. The competition is surely getting tougher, but the expected outcomes/incentives are worth putting efforts into the progressive healthcare industry.

While there is still time for MIPS 2019 data submission period, ensure an impactful performance for MIPS performance categories and report data via an MIPS qualified registry as P3 Healthcare Solutions.

For instructions on how to get started call a medical billing service expert today at 1-844-557-3227 (1-844-55-P3CARE) or email at info@www.p3care.com.

MIPS Quality Measures 2017 Applicable To LTPAC Medicine

The following article looks at CMS MIPS quality measures for LPTAC medicine. However, before we go towards the MIPS quality details, we need to look at the underlying purpose and objectives.

Purpose

CMS (Centers for Medicare and Medicaid Services) is always working on improving the policy to provide better healthcare facilities. Therefore, the new measures are aimed to help improve the overall care delivery and also reward clinicians who are better engaging patients, families, and caregivers.

Here is how CMS looks at MIPS.

“To these ends, and to ensure the Quality Payment Program works for all stakeholders, we further recognize that we must provide ongoing education, support, and technical assistance so that clinicians can understand requirements, use available tools to enhance their practices, and improve quality and progress toward participation in APMs if that is the best choice for their practice.” healthcare facilities

Key Strategic ObjectivesMedicare and Medicaid Services

Let us have a look at the strategic objectives set by CMS.

  • The engagement of patients and the improvement of beneficiary outcomes.
  • To further the clinical experiences that offer flexible yet transparent programs.
  • Ensure meeting of diverse needs of the physician practices typically those with small practices.
  • Further the capabilities of the IT systems that meet various data needs of the end-user including reporting and submission.
  • Work on improving information and data sharing to ensure its timely availability.
  • Enable customized communication while keeping MIPS quality measures specifications into perspective.

Caveats for Individuals and Groups

The new MIPS quality measures take into consideration two LTPAC setting codes. These codes are the basis for the MIPS quality measures specifications. These MIPS quality measures are for application on individuals as well as groups.

Eligibility Criteria

Here are some considerations to undertake.

To qualify for the MIPS incentive payments you need to report on the following.

  • There are 6 measures with at least one of them as an outcome measure relating to poor diabetes control. The new quality measures mark high specialty and ambulatory practices.
  • Each measure’s applicability should be up to 90 days.
  • Around 50 percent of your patients have to qualify for one of those 6 measures.
  • The minimum number acceptable for the incentive payments stands at 20 patients.
  • The health practitioner can only report some measures after a specific diagnosis. Therefore, health clinicians have to be careful when selecting these measures.

Avenues for Submission

You can submit your measures to multiple avenues including EHR, claims, QCDR, and Registry. Registry seems to be the most suitable option for groups that aim to report when using the individual measures.

Why Consider Registry for Submission?

Here are the reasons why you must consider submission via Registry.

  • Since you can submit all 2017 QMs via Registry, you do not rely on any other methods.
  • Claims Reporting for 2017 QMs only supports a subset. Therefore, be careful to see the claims if the Claims Reporting offers support for it or you need to use Registry instead.
  • The group gets a measure of review or control when using Registry before you submit the data. Therefore, it gives a buffer, allowing you to remove any errors that you may find.

Avoiding Penalties is Critical

Make sure to always keep the benchmarks in perspective. By following them you can reduce your chances of getting a penalty. It will also help you satisfy base reporting requirements for MIPS.

Make sure that the data you submit for one patient satisfies that particular measure. If you are able to satisfy all six measures, the data would become a prime example for others to follow. In that case, you may be able to find your data published on CMS’s site for Physician Compare.

How 2017 MIPS Quality Measures Differ?

Previously, there was not much detail available. However, 2017 MIPS by CMS offers detailed benchmarking, relying upon the methodology which involves different performance points.

These individual performance points add to make a total score. Therefore, in 2017, you need to focus on performance as it is a critical year for it. Physicians should know the way they are graded to their performance, comparing it with the past year. It is vital to carefully select QMs which would help you score above-average performance.

Here is how CMS elaborates on this concept.

“By developing a program that is flexible instead of one-size-fits-all, we’re trying to meet clinicians where they are so that they can make the choice about how to participate in a way that is best for them, their practice, and their patients. Reducing burden, ensuring flexible program design, and improving how we measure cost and quality performance supports clinicians in doing what they do best – making their patients healthy.”

News

Medicare Payment Increased for 3 Healthcare Providers Says CMS

CMS (The Centers for Medicare and Medicaid Services) decides to upgrade the Medicare payment adjustments for three types of physicians namely:

  • Hospices
  • Skilled nursing facilities
  • Inpatient psychiatric facilities

This step is great in order to reward the healthcare professionals in the respective facilities for their up-scaled services, especially during the pandemic.

How it will impact the Hospices?

Right from the year 2021, hospice payment rates will be raised by the market basket percentage of 2.4%. In numbers, this percentage is around $540 million.

Where CMS has shown support in the payment rate, they also demand quality reporting services. Hospices failed to meet the performance threshold will have to face a 2% decline in the annual payment market basket.

The system also has a statutory aggregate cap that puts a limit to payments made to the hospices.

The final cap amount for FY 2021 is $30,683.93 updated by 2.4% as per 2020.

How it will impact the Skilled Nursing Facilities?

The aggregate payments to skilled nursing facilities are going to increase by 2.2%, in 2021, which is $750 million.

These facilities are upgraded by the routine technical rate-setting updates in payments. The final rule also applies a 5% cap on the wage index, which is lower than in 2020. Hearing the concerns of the stakeholders, CMS also tweaked the ICD 10 code maps, which will be in effect from 2021.

The updated mapping address the care based patient characteristics under  Medicare Patient-Driven Payment Model.

However, the payments for skilled nursing facilities depend on the performance of a single claims-based, all-cause, all-condition hospital readmission measure.

How it will impact the Inpatient Psychiatric Facilities?

Inpatient psychiatric facilities will observe an increase in their payment rate by 2.2%, estimated to be $95 million in 2021.

Office of Management and Budget statistical area delineations will be revised to better estimate the cost born by the healthcare professional.

With this update, the following physicians will be able to practice within the scope determined by the state law.

Advanced practice providers including:

  • Physician assistants
  • Nurse practitioners
  • Psychologists
  • Clinical nurse specialists

They also have to record the progress of their patient along with the medical record.

Further efforts would be required to dissolve the inconsistencies that don’t align with the latest final rules changes and to loosen the regulatory conditions.

We hope CMS brings more innovations to reduce administrative burden and improve payment rates for all physicians.

For more updates, visit our page – https://www.p3care.com/blog

Medical billing services, healthcare system, healthcare practitioners, medical billing companies, healthcare professionals, Medicare and Medicaid Services

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 as 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 in 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.

Medical Billing Services, Medical Billing Companies, Healthcare industry, Medical Billing Company, Medicare and Medicaid Services, QPPMIPS

Guide to the Latest Medical Billing Codes for COVID-19 Test

The constant threat of coronavirus has led the panel of AMA – The American Medical Association to introduce CPT (Current Procedural Terminology) codes for medical billing services.

As the number of infected cases in the USA increased, the need for a separate code for COVID-19 testing emerged. The president of AMA, Patrice A. Harris, MD, MA, announced a unique code to report for laboratory testing of the coronavirus. This information was released on March 13, 2020, in order to translate the advantages of tracking, allocating, and optimizing resources.

What’s New for Medical Billing Services Regarding Corona Test Coding?

The coronavirus code belongs to a new category I of CPT codes.  The details are as follows.

  1. 87635 infectious agent detection by nucleic acid (DNA or RNA)
  2. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), for the examination technique

The codes are now available to use to report on behalf of physicians by the medical billing companies. This code also has short and medium descriptors, which can be accessed on the official AMA website – https://www.ama-assn.org/practice-management/cpt/cpt-releases-new-coronavirus-covid-19-code-description-testing

Coronavirus around the Globe

The situation of the novel coronavirus is serious. President Trump has declared a national emergency in the USA, and the only way to stay safe is by maintaining the social distance.

The Healthcare industry, in almost every country, is under pressure to combat the seriousness of coronavirus pandemic. The number one step for managing this catastrophe is by dealing with hundreds and even thousands of diagnostics procedures, and this code will help deal with the billing matters.

Rick A. Bright, Ph.D., director of Biomedical Advanced Research and Development Authority (BARDA) at HHS stressed the need of increasing the capacity of testing kits to identify and separate infected individuals as early as possible.

Medical Billing Services, Medical Billing Companies, Healthcare industry, Medical Billing Company, Medicare and Medicaid Services, QPPMIPS

There have been delays reported in terms of accessing the diagnostic procedures of COVID-19. The delays and shortage in facilities may affect the frontline fighters (physicians), and ultimately potential patients.

According to AMA, the newly released code is a progressive step towards optimal coronavirus diagnostic services. All along, the physician or medical billing company is required to use the Healthcare Common Procedure Coding System (HCPCS) codes to document public encounters with the health payment programs as Medicare.

The Centers for Medicare and Medicaid Services (CMS) also stated to create two new HCPCS codes to support the coronavirus diagnostic procedure.

The first code released in February (U0001) is for SARS-CoV-2 diagnostic tests performed specifically for CDC testing laboratories.

The second billing code (U0002) released this month will extend medical billing services for coronavirus lab tests, allowing to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV, (novel coronavirus or COVID-19).

QPP MIPS requests everyone to stay strong and be mindful of others around you. Spend this difficult time to connect with yourself and be creative while staying home.  You never know who carries the virus therefore, use hand sanitizers, clean your space, wear gloves, and face mask before going out and keep a safe distance from everyone.