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MIPS 2020, MIPS consultants, MIPS reporting, MIPS data submission, QPP MIPS, MIPS 2021, MIPS Value Pathways, MIPS consulting services, MIPS Quality measures, QPP MIPS 2020

P3Care Investigates: QPP MIPS 2021 Proposed Rule

CMS (The Centers for Medicare and Medicaid Services) released the proposed rule for QPP MIPS 2021 via the Medicare Physician Fee Schedule (PFS) Notice of Proposed Rulemaking (NPRM).

In this article, we will be dissecting changes that are expected in MIPS 2021. However, keep in mind that the changes are just proposed until now and are not final yet.

Each year, CMS proposes various guidelines to facilitate physicians with their payments.

How MIPS consultants take care of the administrative data to report to the authorities affects revenue management.

As a physician, your first responsibility is towards patients. We are sure that you certainly would not have time to manage the MIPS reporting requirements.  However, with the help of MIPS consulting services, the process of MIPS data submission becomes easier and less hectic.

Besides the accurate data reporting, we also have to understand the QPP MIPS requirements every performance year.

What can we expect in the MIPS 2021, and how it will impact the data submission process.  Let’s follow-through.

But, first, we must analyze the COVID-19 Impact!

2021 QPP MIPS might come with challenges. We can expect time delays (which we also experienced during MIPS 2020 performance period).

The implications of the pandemic are going to go a long way with us. For Instance, CMS asks physicians to focus on quality care rather than volume care. However, with the pandemic, there was no choice left other than catering to the volume of patients while being careful and value-driven to every extent possible.

We are expecting a delay in MIPS Value Pathways (MVPs) for 2021.

Additional reporting flexibilities are also in consideration in response to the COVID-19.

MIPS Value Pathways (MVPs)

The proposed rule stated that MIPS Value Pathways (MVPs) will be delayed until 2022.

However, they will be available as options, and eligible clinicians can choose to report through them alongside the other MIPS data submission options.

APM Performance Pathways

Participants of MIPS APMs are allowed to report via APPs, which function the same as MVPs.

CMS is also considering sunset the current APM score standards in 2021.

Keep in mind that only the following audience can use APPS.

  • Individual eligible clinician
  • Group (TIN) or APM Entity
  • MIPS APM participants

The above-mentioned specialists have the option to use APP, but it is compulsory for ACOs participating in the Medicare Shared Savings Program to report quality performance via the APP.

The performance category for the APP will be scored as follows upon the fixed set of quality measures.

Quality Category: Weighs 50%. It contains six measures that focus on population health.

Improvement Activities (IA) Category: Weighs 20%. CMS will automatically assign its score based on the requirements of the MIPS APM.

All APM participants reporting through the APP will earn a 100% score for 2021.

Promoting Interoperability (PI) Category: Weighs 30%. Compulsory for all QPP MIPS data submissions.  It is reported and scored at the individual or group level.

Cost Category: Weighs at 0%

Moreover, it is also automatically used for the Medicare Shared Savings Program (MSSP) quality scoring.

QPP MIPS Program Updates

For MIPS 2021, various data submission options will be given to MIPS consulting services to help eligible clinicians get through the program.

Physicians have the option to report QPP MIPS as:

  • Virtual Group
  • Solo eligible Clinicians
  • Group
  • APM Entity

Note that the virtual group has the highest hierarchical priority when CMS receives multiple scores for it.

APM Participation

Participation through APM participation is available for eligible clinicians. They can report QPP MIPS data for both Quality and Improvement Activities (IA) performance categories.

Moreover, you can select and report MIPS Quality measures in the same manner as eligible clinicians choose and report for QPP MIPS.

However, generally, the APM Entity group calculates the performance for the Improvement Activities (IA).

The Cost category has a slight change in the data reporting mechanism. If you do not report this category via APP, the APM Entity Group will automatically score it.

The above-mentioned are the little details that QPP MIPS participants must know beforehand they enter the MIPS 2021.

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.

P3Care: Medical Billing Service Speeds Up Reimbursements for Providers

Welcome to P3 Healthcare Solutions, fundamentally, a medical billing company. We provide Medical billing services apart from other services such as credentialing, HIPAA security risk and analysis, and MIPS consulting services. As we move past 2020, the process of billing gets sophisticated and tech-savvy with new updates coming at frequent intervals.

The presence of electronic health records will soon replace the old manually maintained records because it is becoming difficult for medical practitioners to be able to get a grip on procedural necessities leading to obstacles in the collection.

Previously, PHI documents were manual and transferred through the traditional mail, but since the advent of the internet, the exchange of documents happen through email. However, the latter has its own set of complexities with hard-to-understand software functionalities. All of this technology is there to facilitate rather than to complicate workflow.

Core Objective: Medical Billing Service Company

Our primary focus is on medical billing, but our goal is to support the healthcare industry by leveraging technology in their best interest. The physicians and specialty-specific doctors are lifelines of patients across the US. As a result, we consider it our duty to come up with ground-breaking health IT techniques.

We always work hard on delivering for the providers and add to their revenue. Generally, the high claims acceptance percentage first time relieves both the providers and the payers. In fact, it is our priority to get the job done before it gets complicated is accomplished through experience, dedication, skills, and staying on our toes.

Deft Handling of Billing Issues

P3Care’s consultants undergo extensive training and thorough seasoning along the way. Because of the availability of skilled personnel, it gives us an upper hand in understanding medical operations and procedures in comparison with our competitors. Moreover, the staff keeps a close eye on any changes in rules with implications directly on the US healthcare industry.

For instance, we see frequent ICD-10 updates. As a medical biller, if you fall behind, denials on account of incorrect coding are inevitable. Therefore, consistency and readiness are key to overcome claim rejections.

Give us a call today – 909-245-8350 – to help reduce claim denials and service our clients.

Billing Rates for Consultants

The rates of medical billing outsourcing are always lower than in-house billing and coding. An organization is worth all the praise if it is willing to solve any situation promptly and cost-effectively. Generally, the medical billing service fee of P3Care is quite reasonable and physician-friendly.

Characteristics

Let’s take a look at the two qualities of a medical billing company:

  • The top-most quality of a medical billing service is to offer full support on reporting a claim according to the latest medical coding guidelines(for instance – ICD-10). A company that fails to keep tabs on current rules eventually fails in getting the claims approved. With P3Care, everything is synched – any rule updates are well-received, understood, and implemented by the medical billing & coding staff.
  • Sending incorrect medical bills result in 80% denials. A company knowing its reputation is at stake will keep qualified coding staff with experience or certifications to back their skills. The insurance companies are meticulous. Even a slight error results in immediate denial. Therefore, the correct filing of claims is necessary to speed up reimbursement. On the contrary, if your Accounts Receivable is piling up, you need to revisit your overall billing strategy.
  • P3 believes in double-checking claims on every step, ensure the billing codes are correct as it allows them to sail through the complexities of the RCM process. It isn’t easy, but if you choose us, we will take care of the issues in revenue cycle management while you continue to focus on treating the patients.
  • With the necessary addition of EHRs into the medical system under QPP, the practices or providers have to implement and ensure the reporting is based on them. These are patients’ health records in digital form. Your in-house practice management system should be efficient enough to handle EHRs. But if you are having trouble, P3Care would lend a helping hand. We are technically aware and technologically sound to deliver and file medical claims via EHR.

Conformity with HIPAA

P3 Healthcare Solutions are HIPAA compliant. HIPAA (Health Insurance Portability and Accountability Act) regulations ensure the protection of patient’s private health data. The patient’s health information is always kept confidential and only shared with the relevant medical personnel.

The medical billing services by P3Care complies with HIPAA. HIPAA security rule is applied to companies dealing with Protected Health Information (PHI) – PHI is any information about a patient’s health condition; it can be healthcare payment details or other sensitive information utilized by covered entities (healthcare providers, clearinghouses, etc.), to identify a patient.

RCM

Revenue Cycle Management with P3Care includes –

  1. Writing claims and submitting to insurance companies after screening them for errors
  2. To keep in touch with the insurance companies for any pending claims.
  3. Customer service promptly responds to patients’ billing queries
  4. Take care of Clearinghouse handling and collection of payments
  5. Reviewing the denials amending those mistakes and refiling the claims
  6. Going for repeals to minimize accounts receivables

Charge Codes

The medical billing services fee schedule for P3Care repeats on a monthly basis. As you know medical billing & coding is not an easy task, but Revenue Codes or Charge Codes for medical billing make the whole process understandable. They explain the treatment and the exact amount due at the payer’s end.

A list of CDM charge codes helps identify the services rendered by the providers. They are a summary of patient care activities along with the respective charges sent out to payers and patients.

Medical Billing Costs

Medical billing cost is not much of a bother because we are working tirelessly for positive outcomes. Our charges are fair and realistic!

Furthermore, medical billing services cost is brought down by speeding up the revenue cycle management and not postponing claims. You will witness the number of accounts receivable decreasing.

Medical biller rates vary from specialty to specialty. Some specialties require more effort and resources to get their claims through.

ICD-10 Capable Coders

P3Care coders have made sure all the current claims are by the latest coding guidelines. Hence, our claims acceptability ratio is higher than most.

Beware of Discounting Vendors

A proposal by the low-cost medical billing vendors may sound intimidating, but not everyone understands the complex, mind-boggling and draining world of medical billing. However, their lack of experience and skills can hurt your business interest. Whichever company you choose to sign up with, make sure you get the list of tasks that you want to be taken care of.

Simplifying the Process

P3 medical billing consultant services include –

  • Verifying the patients with the insurance companies
  • Checking if the provider is listed on payer’s panel
  • Keeping the patient records up-to-date
  • Processing all claims within a specific time frame
  • Keeping a check on each claim until it is approved and collected
  • Email and phone correspondence with the payers and patients
  • Handling the collection process and managing copayments
  • Sending weekly or monthly reports to providers for analytical purposes.
  • Executing each step according to the rules set by CMS

We are committed to the US healthcare industry to deliver what’s rightfully yours. Moreover, aiming to be one of the top medical billing companies isn’t easy and doesn’t happen overnight. It takes all the energy and skills to deploy favorable results to our customers.

Agreement

Outsourcing medical billing only relieves the burden on you and your practice. However, a written medical billing services agreement explaining the contractual details between the provider and the biller is required.

Farsighted Approach

There are hundreds of online medical billing companies out there but choosing a reliable and trustworthy partner to handle your finances is a tough decision. P3Care falls on the list of medical billing companies in the USA with credibility and farsightedness to see denial in advance. It takes appropriate steps to make the claims error-free.

We are offering specialty-specific billing services to the specialists along with primary-care physician billing services. The specialties include almost all of them including chiropractic and radiology billing services.

For questions out of this knowledge base, or on instructions on how to get started call a MIPS specialist today at 1-844-557-3227 (1-844-55-P3CARE) or email at info@www.p3care.com.

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 the 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 the 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 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.

MIPS 2017 – THE P3CARE WAY

MIPS Consulting Services

At P3Care, we understand the importance of participating in MIPS and achieving positive outcome goals. We go the extra mile, to ensure we are there to assist you every step of the way, no matter how big or small your practice is! From determining eligibility to explaining MIPS core requirements, to providing progress reports, we are committed to eliminate the stress associated with performance data and allow you to focus on providing high-quality care to patients.

P3Care’s analysts and consultants are trained and have comprehensive experience with Medicare Quality Care Programs. Our professional team of MIPS consultants will closely work with you to determine which quality measures are best suited for your practice.

In addition, we will apply all applicable codes to claims, provide you with monthly analysis and feedback reports, submit your performance data to Medicare by appropriate deadlines, and provide you with the best solutions to gain a positive or neutral payment adjustment. There is still time to avoid a negative payment adjustment for the transition year 2017.

Contact P3 today to find out how!

P3Care Tips on MIPS

  • Selecting measures that are the most applicable to your practice plays a key role in earning positive or neutral payment adjustments.
  • P3Care will go out if its way to make sure you earn full potential points in all the categories, along with bonus points!
  • Submit at least one quality measure or improvement activity, to avoid a potential -4% payment adjustment.
  • P3Care helps you in the distribution of work connected with the demonstration, making sure you have maximum time for patients. If you ignored quality reporting in the past due to workload, P3 is the place for you!