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

How CMS Determines MIPS Eligibility?

The QPP MIPS participation starts from knowing the eligibility status. For MIPS 2020, clinicians can check eligibility via QPP Lookup Tool. Later on, CMS updates if physicians are eligible for MIPS data submission or not.

However, the reporting requirements change each year due to changed policies. So, if we want to succeed in this program, we have to comply with the changes.

MIPS 2020 Reporting Deadline is Due March 31, 2021

We have almost 2 months to submit data to CMS. Most of you must have checked their MIPS eligibility status up until now. However, to ensure quality, go through this article to review the complete process.

Also, remember that MIPS participation is not easy, and the eligibility check is just the start. A MIPS Qualified Registry can take care of the administrative load without you being bothered. So, consult them for a seamless process.

 MIPS 2020 Eligibility Check

According to the official website, interested clinicians must have:

  • National Provider Identifier (NPI)
  • Associated Taxpayer Identification Numbers (TINs)

A TIN is required when you own a practice; belong to a hospital as a medical facility or a medical practice.

In the case of physicians’ reassignment of Medicare Billing Rights to TIN, their NPI gets associated with that TIN, referred to as TIN/NPI combination.

For Instance, if any physician has assigned billing rights to multiple TINs, he/she will have multiple TIN/NPI combinations.

CMS assesses TIN/NPI combination for MIPS eligibility and uses TINs for practices’ eligibility.

Eligibility Determination Period of MIPS

CMS looks into past and current Medicare Part B Claims and Provider Enrollment, Chain, and Ownership System (PECOS) data for clinicians and practices, each year twice.

Data analysis from the first segment is referred to as preliminary eligibility. Data from the second review are then attached to the first segment of data and presented for final eligibility determination. The requirement is to pass the Low-Volume Threshold (LVT) during both reviews.

What is Low-Volume Threshold (LVT)?

LVT includes three aspects of professional healthcare services as follows.

  • Allowed charges
  • Number of services provided
  • Number of Medicare patients who receive services

Other than exempt cases, physicians are required to participate in QPP MIPS 2020, if they:

  • Bill above than $90,000 for Part B covered professional healthcare services
  • Check more than 200 Part B patients
  • Offer above than 200 covered professional healthcare services to Part B patients

It is to consider if physicians report Medicare Part B claims in the second review with a medical practice’s TIN, the eligibility status at that practice will only reflect data from 2nd review.

Who Can Participate in MIPS 2020?

CMS has an eligible clinician type. Clinicians falling into the list and satisfying all the requirements can participate in MIPS.

  • Physicians (including doctors of medicine, osteopathy, dental surgery, dental medicine, podiatric medicine, and optometry)
  • Chiropractors
  • Physical therapists
  • Occupational therapists
  • Clinical psychologists
  • Osteopathic practitioners
  • Physician assistants
  • Nurse practitioners
  • Clinical nurse specialists
  • Certified registered nurse anesthetists
  • Qualified speech-language pathologists
  • Qualified audiologists
  • Registered dietitians or nutrition professionals

MIPS Data Submission Methods

Eligible physicians can report data to CMS as individuals, a group, or a virtual group.

Eligibility Check for MIPS 2020 Participation as Individuals

For MIPS participation as individuals, physicians must:

  • Belong to eligible clinician type on Medicare Part B claims
  • Have enrollment in Medicare before the performance year 2020
  • Surpass the Low-Volume Threshold requirements
  • Not qualify for Alternative Payment Model Participant

Eligibility Check for MIPS 2020 Participation as Group

For MIPS participation as a group, physicians must:

  • Belong to eligible clinician type on Medicare Part B claims
  • Have enrollment in Medicare before the performance year 2020
  • Belong to a medical practice that surpasses the Low-Volume Threshold requirements
  • Not qualify for Alternative Payment Model Participant

The MIPS score and payment adjustment will be awarded as a group in this case.

Eligibility Check for MIPS 2020 Participation as Virtual Group

For MIPS participation as a virtual group, physicians must:

  • Belong to eligible clinician type on Medicare Part B claims
  • Have enrollment in Medicare before the performance year 2020
  • Not qualify for Alternative Payment Model Participant
  • Be associated with a medical practice that surpasses the Low-Volume Threshold requirements & is part of virtual practice

The above-mentioned are all the requirements that a MIPS participant should know beforehand of the MIPS data submission. We are halfway through QPP MIPS 2020, and many professionals already had planned and implemented a strategy for optimized performance in the end.

How to Report MIPS Data?

Physicians have a lot on their plate already, and the pandemic has increased their burden. In such a situation, MIPS quality reporting seems like a challenging task.

If you’re an eligible MIPS clinician, the best advice to you is to concentrate on quality care outcomes. A professional MIPS Qualified Registry will take your efforts into account, and you can target more measures if you have a proper plan of action on board.

Best of luck.

healthcare industry, MIPS performance, MIPS quality measure, MIPS consulting services, healthcare services

MACRA & MIPS: A Closer Look

MACRA

Talking about MACRA & MIPS, it is important to learn that in 2016, MACRA (Medicare Access and CHIP Reauthorization Act of 2015) was officially introduced, ruling out the existing and outdated Sustainable Growth Rate method.

Previously, providers received payments based on the number of Medicare patients they provided care to; rather than being paid for the quality of care they provided. Not only was this method proven to be ineffective for the patients, but drastic effects were observed when it came to receiving financial support for Medicare expenses. Treating a high volume of patients (quality or no quality) basically meant higher payments for providers.

MACRA established a Quality Payment Program (QPP), a method that will motivate providers to deliver well thought out quality care to patients by rewarding them with payment adjustments. Eligible providers are able to choose one of two pathways in the QPP, MIPS (Merit-based Incentive Payment System) or APMs (Alternative Payment Models).

An estimated 500,000 providers will be eligible to participate in the first year of MIPS. The amount MACRA will provide for positive payment adjustments is quite overwhelming, up to 3 billion dollars in the next six years! Let’s take a closer look at MIPS, and how P3Care can provide you with MIPS consulting services to ensure you understand how to take full advantage of this new and improved payment process.

MIPS

In order to take part in MIPS, you must meet the requirements associated with Medicare billing (Part B). Selecting this route of the QPP focuses on receiving payment adjustments based on the specific data you have submitted.

For the 2017 transition year, there are three different categories. To help better understand how you’ll be scored under MIPS, specific weights are given to each category. This will allow you to divide your attention accordingly. You will also need to determine if you are participating in MIPS individuals or as a group.

Here’s a closer look at the MIPS performance categories for 2017.

Quality

60% of the data submitted will pertain to this category; signifying the main purpose of eliminating the previous method, and implementing MIPS. In this category, providers which practice solely are required to report up to 6 quality measures (out of 271), which are the most associated with their specialty.

Clinicians will be scored based on the number of days they have submitted data for (read more below), along with the accuracy and completion of all the required specifications for each measure. Closely assessing each measure helps determine if high-quality healthcare goals are achieved. The total number of points earned on 6 quality measures + any bonus points will determine your final score of the Quality category.

Advancing Care Information

Taking up 25% of the total MIPS score, this category replaces the previous Meaningful Use program. You’ll need to select one of two reporting measure sets, depending on your EHR edition.

Each option is composed of different measures; therefore it’s essential you only report on which option relates to you. There are three subcategories that will determine you’re total score for this category, they include Base Score, Performance Score, and Bonus Score.

Failing to complete all of the requirements in the Base Score category will result in a 0 in the overall Advancing Care Information category.

Improvement Activities

The remainder of the score (for 2017) will come from the Improvement Activities category, weighing at 15%. This category allows CMS to determine if clinicians are improving clinical practice to its highest potential.

A few key aspects include providing quality care by involving the patients in decisions:

  • Continuous coordination between provider and patient
  • Providing self-management techniques
  • Patient/family education
  • Providing follow-ups
  • Using safe technology and being reasonably accessible

You’ll have the opportunity to choose from a variety of activities, that best suit your practice, to report data on. Each activity is categorized as either has High or Medium; high-weighted activities are worth more points. Individual Medicare providers will need to submit data on up to 4 activities for a minimum of 90 days, in order to earn full potential points.

Cost

 

In last but not least, Cost is the fourth category, upon which physicians’ MIPS score is based upon.

Physicians don’t have to report separate data for the cost category. However, CMS calculates this MIPS quality measure by analyzing the submitted administrative data.

For the year MIPS 2017, the cost category had a value of 0% in the final scorecard. MIPS 2018 was the first performance year in which, the cost was set for 10%. This score accounts for the lower cost expenditure while physicians provide high-quality healthcare services to patients.

Right now, we are passing through MIPS 2019, which is the 3rd year of this value-based program.  The cost-quality measure is a significant part of this year as well and accounts for 15% of the final MIPS score.

MIPS is running quite successfully with more and more clinicians taking part in it every year. Its impact on the healthcare industry is progressive and physicians upon realizing its importance for revenue cycle management are subject to adopt modern and cost-effective healthcare ways.