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MACRA, MIPS, MACRA and MIPS, Quality Payment Program, QPP, Merit-based Incentive Payment System, Alternative Payment Models, P3Care, MIPS consulting services, Medicare billing, MIPS performance categories, MIPS score, Improvement Activities, clinical practice, Medicare providers, physicians, MIPS quality measure, healthcare services, MIPS 2017, MIPS 2019, MIPS 2021, revenue cycle management

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MACRA (Medicare Access and CHIP Reauthorization Act of 2015) was officially introduced, ruling out the existing and outdated Sustainable Growth Rate method.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 for the quality of care they provided. So, not only was this method was 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. And it will reward them with payment adjustments. Moreover, 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. Likewise, the amount MACRA will provide for positive payment adjustments is quite overwhelming, up to 3 billion dollars in the next six years! Now, 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 CMS scores physicians under MIPS, we have specific weights per 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. Moreover, in this category, providers which practice solely report up to 6 quality measures (out of 271), which are the most associated with their specialty.

Clinicians will get scores 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. Moreover, closely assessing each measure helps determine if clinicians achieved the high-quality healthcare goals. 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 includes 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%. And 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 CMS measures physicians’ MIPS score.

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. On the other hand, in MIPS 2018, it was the first time that cost category weighed 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.  And the cost-quality measure is a significant part of this year as well. It 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.

MIPS Participation: Pick Your Pace

Depending on the size of your practice, and the outcome goal you’re looking to achieve, you can choose how many days you want to participate in the program.  The MIPS transition year stated January 1st, 2017, and runs until December 31st, 2017. The most efficient and effective way to take full advantage of MIPS is to take part in a full year. However, submitting data for a consecutive 90 days can still earn you a maximum payment adjustment. You must remember to submit MIPS data no later than March 31st, 2018.

  • Full- Submit data for a full year. May earn maximum/positive payment adjustment.
  • Partial –Submit data for 90 consecutive days. May earn positive, neutral, or max adjustment.
  • Test- By submitting the minimum amount of data (for example. One quality measure for 2017), you may avoid a negative payment adjustment.
  • Do Not Participate- By choosing not to submit any data at all for 2017 you will earn a -4% payment adjustment. (go into effect on January 1st, 2019).

*Note: Now that we are less than 90 days away from December 31st, 2017, you MUST submit at least one quality measure or improvement activity data using the Test option, in order to avoid the outcome of a -4% payment adjustment.

Deadline To Participate In QPP MIPS 2017 is Close

DON’T DELAY! DEADLINE TO PARTICIPATE IN MIPS 2017 IS OCTOBER 2ND!

Have you thought of participating in the MIPS (Merit-based Incentive Payment System) program this year, but believed it was too late? Don’t worry, there’s still enough time! The MIPS transition year started January 1st, 2017, and goes through to December 31st, 2017. You’ll need to begin your 90 consecutive days of data collection no later than October 2nd, 2017 in order to be eligible for a neutral or positive payment adjustment. Contact P3 to ensure all applicable data codes are applied to your claims starting no later than October 2nd.

To earn the maximum payment adjustment, it is best to submit data for a full year. If you choose not to submit any 2017 data, you will receive a negative payment adjustment which will go into effect January 1st, 2019. Don’t be discouraged though, if you only submit for 90 days there is still the opportunity to earn the maximum adjustment. Don’t delay, October 2nd is just around the corner, contact your P3 consultant today!

HOW TO PARTICIPATE:

For 2017, you can participate in one of three ways:

Submit:

  • data covering a full year
  • for a consecutive 90-day period
  • a minimum amount of data (<90 days)

The MIPS 2017 reporting categories consist of Quality, Advancing Care Information, and Improvement activities; all of which require immense attention and may be time-consuming. Our experienced team of analysts and MIPS consultants at P3 are dedicated to reporting the high-quality care you have provided to Medicare patients. We take all the necessary steps to ensure providers are eligible for earning the maximum adjustment including, selecting all applicable quality measures and applying quality data codes to claims.

Time is running out! If you plan on submitting less than 90 days of data you must do so before December 31st, 2017 to avoid a negative payment adjustment. Contact our experts at P3 at 909-245-8350 for further guidance. We can provide you with solutions that will increase the chances of a positive outcome.