Posts

MACRA MIPS, QPP MIPS, MIPS Reporting, MIPS program, MIPS data submission, MIPS Qualified Registry, MIPS consultants, MIPS solutions, How to Report MIPS Data, healthcare services, Promoting Interoperability

MACRA MIPS – What it Means for Physicians?

MACRA MIPS (The Medicare Access and CHIP Reauthorization Act of 2015 – Merit-based Incentive Payment System) is a program that caters to physician finances under Medicare. Not only that, but it determines the quality of care within hospitals, practices, and clinics should meet certain standards.

The program is now in its fifth year (started back in 2017) and it would be right to say that it facilitates the whole physician reimbursement process. MIPS 2020 submission is not rocket science; however, it requires a certain skill set to achieve good scores.

Key Elements of QPP MIPS

MIPS program has four categories that cater to meaningful quality healthcare services.

  • Quality
  • Improvement Activities (IA)
  • Promoting Interoperability (PI)
  • Cost

The quality category replaced the PQRS (Physician Quality Reporting System) and reflects the efforts to improve the quality of care.

Improvement activities translate patient convenience and satisfaction in quality healthcare delivery.

Promoting Interoperability replaced Advancing Care Information (previously known as the meaningful use program) to integrate technology in healthcare.

The cost category replaced the value-based modifier program and translates the efficiency of the cost factor.

Each category has different weights. The respective percentages change each year under MACRA MIPS. Eligible clinicians, who exceed the minimum performance threshold get positive payment adjustments and avoid a penalty of a certain percentage.

MIPS Full Form in Healthcare

Large medical practices already know the implications of MIPS data reporting. However, it is small healthcare organizations or non-eligible clinicians that need to understand MACRA MIPS to the core.

Now, the performance bar has gotten high. Although CMS (The Center for Medicare & Medicaid Services) facilitates small/rural/underprivileged medical practices to much extent, the appropriate approach is to consult a MIPS Qualified Registry for MIPS solutions.

What Physicians Can Get from MIPS Reporting?

There are many advantages that eligible physicians can get by submitting data to CMS under MACRA MIPS.

  1. Physicians get to improve care quality.
  2. They can improve ranking among fellow physicians via the Physician Compare portal, thus, improves patient rate.
  3. Against the exceptional performance, physicians can receive incentives.
  4. High achievers can even receive a share from the $500 million bonus pool.

However, MACRA MIPS requires consistent efforts, but practices could get help from MIPS consultants to guide them through the process. In case you are one of the practices with pending MIPS 2020 reporting, there is still time for you to submit until March 31, 2021.

How to Report MIPS Data?

Eligible clinicians can choose different ways to report MACRA MIPS. However, the easiest and comprehensive way is to report data via the MIPS Qualified Registry as P3Care.

We choose specialty-specific measures to submit data from the list as per the final rule proposed by CMS.

Conclusion

MIPS data submission under MACRA is a lot to take in, but as the years went by, it is in the best interests of physicians to attest to the quality payment program.

Especially with COVID, clinicians have lost millions of bucks to cater to the surge of patients. In such times, incentive payment programs are a ray of hope as they facilitate in many ways. Moreover, CMS also offered flexibility in the administrative load. So, there is no point in avoiding participation in such programs, right?

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 Rules

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 dissect changes that are expected to appear 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 cycles. How to report MIPS data is what add to your revenue year after year, especially for clinicians associated with Medicare.

Physicians Services Translate into Patient Care

As physicians, your first responsibility is towards your patients. For a fact, you would not have time to manage the MIPS reporting 2021 requirements, given the situation with COVID. With all of what’s going on, I am sure you want to begin 2021 on a high note. The help of MIPS consulting services, make the process of MIPS data submission easier and less hectic.

Besides 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 the quality of care rather than the volume of patients. 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.

Therefore, a delay in the implementation of MIPS Value Pathways (MVPs) for 2021 seems only reasonable.

Additional reporting flexibilities are also in consideration in response to the COVID-19. Talk about MIPS incentives, they are by far the most as compared to the previous years. Realistically speaking, P3Care can get you up to +5% positive payment adjustments for its clients. Fill the form that appears in the pop-up and we’ll get back to you shortly.

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.

Until now, you must have a good idea of the minor changes that are expected in QPP MIPS 2021. Now, it’s time to look into details of (Centers for Medicare and Medicaid Services) CMS-published Proposed Rule. Some adjustments are made to simplify administrative data while others in response to the corona pandemic.

Let’s get started!

Proposed Sunset of Web Interface Mechanism

CMS in the Final Rule aims to facilitate groups and virtual groups with MIPS data submission 2021. They proposed a sunset of the CMS Web Interface as a new reporting method.  It is particularly useful for larger group participants of QPP MIPS 2021, APM (Alternative Payment Model), and the MSSP (Medicare Shared Savings Program).

It is because of the CMS data indicating a 45% reduction in the usage of the mechanism. Moreover, there is a 40% reduction in utilization of CMS Web Interface.

If this rule comes into effect, MIPS eligible groups and virtual groups can then report relevant data via a MIPS Qualified Registry or EHR (Electronic Health Records).

Crucial Changes in APM Reporting

Many APM participants may use APP (APM Performance Pathway) for quality reporting.

CMS also suggests setting six quality measures for APM reporting naming:

  • Controlling High Blood Pressure
  • Diabetes: Hemoglobin A1c Poor Control
  • Preventive Care and Screening: Screening for Depression and Follow-up Plan
  • Risk Standardized, All-Cause Unplanned Admissions for Multiple Chronic Conditions for ACOs
  • Hospital-Wide, 30-day, All-Cause Unplanned Readmission Rate for MIPS Eligible Clinician Groups

This step aims to simplify the administrative load to help focus physicians on quality patient outcomes.

ACO (Accountable Care Organization) Reporting

Under QPP MIPS 2021, the proposed rule suggests Shared Savings ACOs reporting with the following changes.

There is an availability of several data submission methods for ACOs stating who will submit what data to CMS. For Instance, instead of the ACO entity submitting data by itself, allowing participants to submit data at the individual level.

The operational and strategic changes will allow ease in the reporting process. Of course, data collection and aggregation is a problem that often hinders the pace of MIPS reporting. However, with this step, we can observe potential improvement in data submission and the MIPS score.

How to Adjust with the Changes in MIPS Data Submission Process?

Here to remember that the proposed rule might be different from the final rule. But, even if the reporting requirements changes, they must be somewhat similar. The best option is to get in touch with professional MIPS consulting services to comply with the required changes.

Conclusion

QPP MIPS 2021 is different from the previous years in terms of quality reporting. The pandemic is still not over yet, and the focus on patient empowerment through value-based outcomes has increased noticeably.

We also understand that adjusting to new reporting requirements takes time. However, the comprehension process of MIPS reporting 2021 criteria becomes easy when you have professional MIPS consultants with you.

To begin with, medical practices should design their strategic goals to align their efforts. It is just the start of the performance year, so you can experiment with different measures. It is an opportunity to compensate for the lost revenue during the pandemic emergency by delivering QPP MIPS 2021 performance. We should not miss it.

MIPS Quality Measures 2020, MIPS incentives, MIPS Quality measures, MIPS data submission, MIPS quality reporting, submit mips data, MIPS registry, healthcare Solutions, MIPS 2020, MIPS consulting firm, MIPS consultant, MIPS data via clinical quality measures, MIPS solutions, MIPS CQM

MIPS Quality Measures 2020 and Specifications for MDs and DOs

Am I eligible for MIPS incentives in 2022?

The question that we hear a lot. And, I have to say it is your right to know.

Whether you are a general physician or a surgeon, submission of MIPS Quality measures leads the way to incentives.

Why?

The government started MIPS back in 2017 to incentivize eligible clinicians, and in return, improve the quality of healthcare. In short, it ensures ECs submit measures for the good of their patients – they will have permanent access to quality care.

The purpose here is to write down a MIPS Quality measures list that includes at least some measures and leave the rest to update in the future. Therefore, you’ll see some of them if not all; we’ll keep updating it, hopefully.

I also hope to provide info not only for family and general physicians but for specialists too. In an ideal system, the MDs, and DOs work in rhythmic harmony for better care coordination and patient experience.

Difference between an MD and a DO

For those of us who don’t know what an MD is, it is short for Medical Doctor, while DO stands for Doctor of Osteopathic Medicine.

Although they may use all the available methods to treat their patients, including drugs and surgery, DOs believe in a more holistic approach. By definition, DOs emphasize preventive medicine, musculoskeletal health, and holistic care. It doesn’t mean MDs are any less skilled or vice versa. Both are equally capable.

The Expertise of Both Specialists

Both specialists, MDs and DOs, can choose to practice in any specialty. Both lend their expertise to promote the quality of healthcare to patients translating CMS MIPS quality measures.

AMA (American Medical Association) studied that in 2018, up to 57% of more DOs preferred to practice in primary care compared to 32% of the MDs.

The total statistics for DOs participation in primary care were:

  • 9% went for family physicians
  • 8% went for internists
  • 8% went for pediatricians

However, both programs offer a license, thus, it does not matter what program a student pursues.

Define the Quality Performance Category

One of the categories of the Merit-based Incentive Payment System (MIPS) is the Quality performance category! It holds a 45% weight in the total score.

What does it account for?

It measures your performance in clinical activities and patient outcomes. MIPS data submission through Quality measures helps assess health care processes, manage results, and patient experiences. As a result, we can expect the highest quality of care while keeping expenses to a minimum. Hence, the achievement of the value-based care purpose.

Understanding CMS MIPS Quality Measures

  1. Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%) 

Diabetes, a menace, to say the least, shadows quite a part of the US population. How can we put a lid on it? Well, the answer lies in value-based care. More importantly, it is MIPS quality reporting that will eventually decrease the number of diabetics across the country.

This particular measure says to submit data on your patients from the age of 18-75 with diabetes who had hemoglobin A1c > 9.0% during the measurement period.

A CMS eCQM is available for this outcome measure. The collection types for this measure include:

  • Medicare Part B Claims
  • eCQM (electronic-clinical quality measure)
  • CMS Web Interface
  • MIPS CQM (clinical quality measure)

Since one of the collection types of this measure is MIPS CQM, you can submit it through a registry. It is one of the most effective of all the MIPS data submission methods thus far.

You can submit it if you are part of the following areas, provided you fulfill the low-volume threshold for MIPS:

    • Family medicine
    • Internal medicine
    • Preventive medicine
    • Nephrology
    • Endocrinology
    • Nutrition/dietician
  1. Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)

Measure number 2 is related to the heart. American Academy of Cardiologists

It includes people aged 18 and above who were diagnosed with heart failure (HF) with a present or past left ventricular ejection fraction (LVEF) < 40% and were prescribed beta-blocker therapy either within a year of procedure in an outpatient setting or at each hospital discharge.

Reporting MIPS through this measure sets the tone for the management of chronic conditions. Gladly, it is available in both eCQM and CQM type, thus acceptable through various sources.

Specialties for which this measure is suitable to include:

  • Cardiology
  • Family medicine
  • Internal medicine
  • Hospitalists
  • Skilled nursing facility
  1. Anti-Depressant Medication Management

Psychiatrists act as pillars of healthcare when it comes to mental health treatment. Especially, their role is critical through the COVID-19 pandemic. Could there be a worse time for mental health issues to rise? Well, it could be worse!

Being grateful and using empathy as a tool to interact with people around us is needed for sure. The description of this measure that we have with us is mostly for eligible psychiatrists. MIPS 2020 presents numerous measures to report with accuracy and data integrity as the two requirements.

It is quality measure #9, according to the official fact sheet released by CMS.

How do we describe it?

It aims to find a percentage of people aged 18 years and above who were treated for mental illness and prescribed antidepressants. As per their depression symptoms, they have prescribed medication for months. You should report the following two types:

  1. First, the percentage of patients who were on antidepressants for at least 84 days (12 weeks)
  2. Second, the percentage of patients who were on antidepressants for at least 180 days (6 months)

Why is this measure meaningful?

It is in line with the prevention and treatment of opioid and substance use disorders. A MIPS consulting firm helps you select the right measures to report. More importantly, it is the accuracy and data completeness that matters to maximize MIPS incentives.

The collection type available for this measure is eCQM. Moreover, the specialties that this measure services include:

  • Family medicine
  • Internal medicine
  • Mental/behavioral health
  1. Age-Related Macular Degeneration (AMD): Dilated Macular Examination

Eyes let us see the beauty around us, thankfully. They show us the world as it is. In this quality measure, people aged 50 years and above are to participate. As an EC, you are to report it once they are diagnosed with age-related macular degeneration (AMD), followed by a dilated macular examination.

Further, it led to the recording of the presence or absence of macular thickening or geographic atrophy or hemorrhage and the intensity of the damage caused during one or more office visits within the 12-month assessment period.

Henceforth, this measure assesses the chronic conditions management area. Ophthalmologists are to report it through their MIPS consultant. MIPS solutions and to send MIPS data via clinical quality measures type is doable with plenty of support from qualified registries.

The collection type for this measure includes:

  • Medicare Part B Claims
  • MIPS CQM

In fact, it is only available for the ophthalmology specialty.

  1. Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care

As the title clearly says, the measure goes against the menace of diabetes and its effect on the eyes. Value-based care becomes viable to bring back quality into healthcare, and at the same time dial-down, healthcare costs.

The measure specifications for clinicians help in its understanding. Our research concluded this measure to be part of the MIPS Quality measures list released officially by CMS.

Essentially, MIPS 2020 covers the continuing process of our healthcare, moving in the right direction. Let us see what the measure means:

“Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once within 12 months.”

Willing to go after MIPS data submission for this measure? It is most likely to score high if reported accurately. That is where P3 comes in to report to CMS on your behalf. The basics of this measure put it amongst the CQMs and eCQMs. Moreover, it is a high priority measure applicable to the ophthalmology specialty.

  1. Communication with the Physician or Other Clinician Managing On-Going Care Post-Fracture for Men and Women Aged 50 Years and Older

It is a measure that directly informs of the health of our seniors as far as their fractures and overall health is concerned. The meaningful area under discussion here is the Health Information Exchange (HIE) and Promoting Interoperability.

What does the measure exactly mean?

According to CMS, it derives the following explanation:

“Percentage of patients aged 50 years and older treated for a fracture with documentation of communication, between the physician treating the fracture and the physician or other clinician managing the patient’s on-going care, that a fracture occurred and that the patient was or should be considered for osteoporosis treatment or testing.”

It is submitted by the physician who treats the fracture and who therefore is held accountable for the communication. A high priority measure, to begin with, you can use Medicare Part B Claims and MIPS CQMs as its collection types.

As an EC, if you are part of the following specialties, you can choose to report this measure.
• Family medicine
• Internal medicine
• Orthopedic surgery
• Preventive medicine
• Rheumatology

  1.   Advance Care Plan

The Advance Care Plan deals with many branches of healthcare, including Cardiology, Family Medicine, Gastroenterology, General Surgery, Neurology, Obstetrics/Gynecology, and more.

How Do We Describe this MIPS Quality Measure?

MIPS in healthcare defines this measure by the percentage of the patients aged 65 years or older with an Advance Care Plan. This measure is also valid for those patients who document another decision-maker on their behalf as a surrogate on authentic medical records.

Another situation is when the medical records show that the Advance Care Plan was discussed with the patient, but they could not provide a surrogate neither they wished to.

MIPS 2020 Reporting Instruction for Advance Care Plan

MIPS eligible clinicians can submit this quality measure for just one patient seen throughout the performance period. There is no specific diagnosis attached to this MIPS Quality Measure. However, the MIPS Qualified Registry on behalf of physicians can submit data for the quality services provided to the patient based on the measure-specific denominator coding.

It is to note that that this measure applies to all healthcare settings, be it nursing home, etc., except for emergencies.

Measure Submission Type

Individual clinicians, groups, and third-party intermediaries such as a MIPS Qualified Registry submit the related data to CMS. However, only those third-party intermediaries can submit data, which used Medicare Part B claims.

Conclusion

Thus, paying special attention to the MIPS quality measures can maximize the chance to earn positive adjustments and even incentives.

It all depends on the CMS MIPS quality measures that you submit to CMS. Therefore, MDs and DOs, take time to strategize MIPS solutions properly and improve your financial situation.

MIPS 2020, MIPS Qualified Registries, MIPS consulting service, MIPS eligible clinicians, MIPS performance, final MIPS score, Electronic Healthcare records, Professional MIPS Reporting, MIPS Consultants, MIPS data submission, how to submit mips data, healthcare services

Why Your Medical Practice Needs a MIPS Qualified Registry?

The stressful time of the year for MIPS eligible clinicians has arrived.  We are going towards the end of the performance year MIPS 2020.

It is the time when MIPS Qualified Registries help you check all boxes of reporting requirements.

They not only simplify the MIPS 2020 data submission but also optimize your performance and help you stay ahead in the game with useful tools and strategies. Of course, the merits of submitting data via a MIPS Qualified Registry knows no bound.

Given below are some of the reasons why should your medical practice choose to consult a MIPS consulting service.

Merits of Consulting a Professional MIPS Consulting Firm

All-in-One MIPS Services

MIPS Qualified Registry submits data for all MIPS performance categories via an efficient and optimized system.

  • Quality
  • Promoting Interoperability (PI)
  • Improvement Activities (IA)
  • Cost

For the Cost category, physicians do not have to submit data but CMS estimates its score based on the submitted claims.

With a state-of-the-art infrastructure to manage data in one place, it is easier to estimate the final MIPS score. The process goes smoothly, and reporting objectives are easily achieved. Moreover, professional companies also estimate the cost incurred in quality healthcare services. So, you can make better strategies to counter issues.

Specialty-Specific Quality Measures are Easy to Choose

Do you know that eligible clinicians were allowed to report only fifty measures via EHR (Electronic Healthcare records) in 2019? Whereas, with a MIPS Qualified Registry, there were 232 quality measures to choose from.

With professional help, clinicians can choose from a wide list of measures and report data for MIPS 2020 as per the specialty expertise. For Instance, at P3Care, we ensure each client reports data for higher points and not just for the sake of it.

  • The list of quality measures are fully researched and analyzed
  • The team segments measures that strictly relate to the practice
  • MIPS Consultants discuss the prospect of each measure and prepare data as per the CMS’s standards

Professional MIPS Reporting

MIPS Qualified Registries have the experience and clientele to report QPP MIPS appropriately. Their clientele ranges from clinics, hospitals, and medical billing companies, small and large groups. They know how to present data that translate efforts to CMS for maximum score and help stay away from penalty as per the requirement.

An Electronic Management System

Smart electronic management systems at MIPS Qualified Registries help eligible clinicians to plan, analyze, and discuss plans with the consultants. You can easily keep a check on the MIPS 2020 performance and suggest changes that you want.

Estimate Financial Estimations

If you are working on your own, you cannot estimate the financial implications of your MIPS data appropriately. However, with professional help, you can easily do the entire Math to avoid any surprise element in the end.

For penalty estimation, incentive calculation, and other estimations, P3Care is there for you.

MIPS Reporting Support 24/7

A professional MIPS Qualified Registry guides you at each step from the beginning to the end. Whether you have any questions or need assistance in solving any matter, the team is there at your service.

You can also seek our help for any MIPS related question, contact P3Care at https://www.p3care.com/ | 1-844-557-3227.

Timely MIPS Data Reporting

When MIPS Qualified Registries compile all data, they allow medical practices to review data to the fullest. Once you are satisfied, the process goes further. They ensure that data for every MIPS performance category is in order and then submit it on time.

We know submitting data to CMS is complex. Therefore, a MIPS Qualified Registry is the perfect option to ease this process. If you have any concerns related to a smart reporting strategy, effective tools, and an efficient team, we are here to answer your queries.

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.

Health IT, Healthcare, healthcare industry, MACRA, medical billing company, MIPS in healthcare

Switching to Cloud Isn’t Easy for Pharmaceutical Industry

The modern healthcare industry is the amalgamation of technology and medical services. With this growing trend of health IT, data security and privacy have become the main concerns for physicians. Be it, medical billing, MIPS & MACRA, electronic healthcare records (EHRs), digital collection and storage have taken the paramount place.

To take advantage of technology and to support MIPS in healthcare, pharmaceutical companies are interested in going cloud-based. However, they want surety to have a secure transition, which is not as simple as it seems.

The professional mapping of the data flows, frameworks and technology implementation requires amazing efforts. While doing all this, a proactive approach, anticipating the potential threats is compulsory.

What steps should be taken to have a safe cloud-based technology?

  • Take Measures for Security Breaches

Same as physicians have to protect patients’ data, and other sensitive information from hackers in the MIPS program, the pharma industry has to pay attention to security threats.

It is estimated that during the shifting process of the hand-written data to the cloud-based database, many incidents of data breaches will be experienced. Security experts that are well-aware of the data sensitivity and actively take measures against breaches are one of the major hurdles in implementing this migration.

A connected and heterogeneous cloud-based storage system is a complex process. Therefore, not just a secure database is to be designed but also with an efficient backup system.

Security failures can only be prevented when there will be the right personnel with the right expertise for this job.  Therefore, before moving towards cloud-based technology, the pharma industry needs to have a proper execution plan.

  • Be Prepared To Manage Risks

Translating the manual database to a cloud-based database may disturb the entire pharma company. Therefore, the calculation of the internal and external risks is equally important for the effective functioning of cloud-based technology in the pharmaceutical industry.

A reasonable solution is to convert data step-by-step until the whole staff gets comfortable with it. Test the cloud technology implementation and highlight errors that don’t meet the standard. Manage risks and measure return-over-investment.

  • Research about the Implementation Protocols

The Pharma industry will not just face problems regarding the right technology.  In addition, it needs to research all the pros, cons, and the working process of technology implementation. Vulnerabilities come across as major setbacks in an efficient running system. If there will not be a proper channel or sequence of operations to enter, fetch, and share data from the system, what will be the point?

In order to support MIPS in healthcare, which is one of the leading value-based incentive programs, pharma companies need to have a front role in understanding all the implementation details.

The Healthcare industry is already sensitive, and pharma being its part can’t be separated from its rules and obligations. There is a reason that the regulatory authorities highly govern this industry.

SaaS – Software as a Service model is getting popular in the pharma industry. However, there is a need to develop the understanding that the implementation of cloud-based services without seeing the capability of the system will cost more than ever.

Thus, flexibility is required but with the hint of sensibility to predict different case scenarios and the associated cost to check if this is the best-suited solution.

Surely, the pharma industry should move forward with the changing times. Nevertheless, the change should be transitive and be able to generate constructive results while making sure of all the security aspects.

In your opinion, what steps should be taken to ensure the reliable implementation of cloud technology in the pharma industry?

MIPS data submission, MIPS quality measures, MIPS submission method, MIPS qualified registry, quality measures

Right MIPS Submission Methods Lead To Successful MIPS Reporting!

MIPS – a quality payment program for physicians is one of a kind and progressive step that benefits both, physicians and even the patients. The prior tangled and twisted reimbursement method failed to contribute to the healthcare industry via any advancement. Thus, MIPS came as light at the end of the tunnel for physicians to direct their financial matters in the right direction.

Reporting accurate data, according to the medical practice and with the appropriate submission method is inevitable to score high in the MIPS scorecard. The period for submitting MIPS qualified measures is already short so there is no time to waste.

This article discusses all the queries regarding MIPS submission methods so that physicians successfully report clinical data to CMS.

First, Do Your Research Well!

The first step in MIPS reporting is to recognize what submission method will suit your practice, the best. The right decision will have a huge impact on your submission. Otherwise, you’ll end up scratching your head for unnecessary delays caused by poor research, as many factors are important for a professional MIPS submission.
In addition, MIPS data submission seems easy. However, it is not as simple as one may estimate. Let us briefly explain the MIPS reporting process.

How to Report MIPS?

Physicians work day and night treating patients to deliver quality-based medical services. MIPS eligible clinicians report their performance data on a yearly basis to CMS. There are four performance categories for MIPS:
• Quality holds 50% of the total MIPS score
• Promoting Interoperability (PI) holds 25% of the total MIPS score
• Improvement Activities (IA) holds 15% of the MIPS score
• Cost holds 10% of the total MIPS score

As per the CMS submission requirements, physicians report against three categories. However, the CMS authorities themselves measure the cost category. They calculate performance for this category by administrative claims data.

Now, Choose Between MIPS Submission Methods!

Clinicians can choose from a number of submission methods as per their requirement,
• CMS Web Interface
• Administrative Claims
• Electronic Healthcare Records (EHRs)
• Qualified Clinical Data Registries (QCDR)
• Qualified Registry
• CAHPS for MIPS Reporting Survey Vendor
• Attestation

Another factor that plays an important role in the successful MIPS data submission is finding the right and specialty-specific MIPS quality measures to report.

Physicians can consult MIPS qualified registries, which help them choose the measures relevant to their practice. Reporting data against the relevant measures gives the chance to score high.

How to Report MIPS Data?

Physicians have the freedom to report either as an individual or in a group.

As an individual identified by individual National Provider Identifier (NPI) with a single Taxpayer Identification Number (TIN)

In a group of two or clinicians with a single TIN, identified by NPI

There is also another option to report via a virtual group.

Consider the Following Points When Choose a Submission Method!

  • While considering what submission methods will result in your favor cost-effectively, you also need to ponder upon their limitations.
  • Clinicians are only allowed to report data via a single submission method for a single performance category.

Look out for all possible scenarios that can occur with the submission method. As each MIPS submission method has its benefits and limits as per the medical practice. Therefore, carefully check all the logistics and your organizational structure before submitting data. It may leverage your performance score for positive or negative payment adjustment.

Not only deciding the right submission method is time-consuming, but it also requires thoughtful planning, resourceful implementation, and the ability to incorporate progressive steps of your organization.

All this Process is Hectic but you can Stay Stress-Free with P3Care!

Physicians may be worried about how they’ll manage to choose the right MIPS submission method along with their responsibilities. Don’t worry and let us share your MIPS reporting burden. P3Care has been MIPS qualified registry for two years. Our specialized methods, resources, and experience in this field speak for itself. Moreover, we as an H I.T consultants help to choose you the right quality measures and the submission method.

For further information, visit https://www.linkedin.com/company/p3-healthcare-solutions

MIPS healthcare, MIPS solutions, QPP MIPS program, MIPS quality measure, MIPS cost measure, MIPS Submission Methods

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

Back in 2018, the American Medical Association (AMA) stated that the only way to avoid penalties regarding MIPS 2018 was to report on a few of the MIPS quality measures.

Now, that we are about to conclude 2019, reporting PI and IA are deemed crucial aspects of MIPS 2019 reporting. Eligible Clinicians (ECs) have the right to bonuses from the $500 million pool set aside in 2019 if they score more than 75. In this way, ECs get to avoid negative payment adjustments waiting to happen in 2021 by a distance.

Until now, the four approved performance categories to attest to include:

  • Promoting interoperability
  • Quality
  • Improvement activities
  • Cost

How Reporting Criteria Changed Over Time?

Eligible clinicians can avoid the penalty by following a reporting strategy as per AMA’s advice. In 2017, physicians needed to score at least three MIPS points to avoid a penalty. It means that they only needed to report one quality measure to overcome the penalty risk.

Nevertheless, now the rules are stricter and the focus on value-based services is now more than ever. With this advancement and the modified requirement criteria in the healthcare industry, the new threshold for MIPS 2018 reporting is fifteen points. The clinicians having a score of 15 can avoid penalties in 2020. As ECs, if you fail to report the minimum amount of quality measures governed under the Quality Payment Program’s specifications, it results in a definite 5% decrease in reimbursements.

Therefore, scoring equal to 15 is essential for those eligible in this program.

The tips below can help you avoid a financial penalty in 2020 and 2021 and a chance at a high Composite Performance Score (CPS)

Report on Improvement Activities (IAs) to Score Higher

The best way to meet the required threshold is to report Improvement Activities (IAs) immediately.

The Centers for Medicare & Medicaid Services (CMS) defined 113 measures under this performance category in MIPS 2019. Each performance measure has further subcategories in the form of medium and high-weighted activities. The high-weighted activities carry more points and can get you closer to the maximum score.

Similarly, MIPS 2019 has 118 Improvement Activities from which clinicians have to select and submit. It is a constant process of reporting for 90 days. Let’s be compliant with P3Care because we can get you the right combination of medium and high weighted measures to score in the 80s or above.

How do You Calculate Performance Categories?

The activities for the performance categories function around care coordination, population healthcare, beneficiary engagement, and health equity factors. To score in any category, eligible clinicians are required to collect and submit data for 90 consecutive days in 2018.

How to Submit MIPS to the CMS?

Healthcare providers can submit clinical data for MIPS 2018 via:

  • Quality payment program 2018 (QPP) data submission system
  • Electronic health record (EHR) system
  • MIPS qualified registry
  • The qualified clinical data registry (QCDR)

Improvement Activities – Small Practices Have an Edge

Reporting Improvement Activities (IAs) under MIPS 2019 can improve revenue cycles of small practices. The program rewards small healthcare practices with double the points as compared to well-established healthcare facilities.

Another advantage of smaller practices is a bonus of five extra points when they score a total of 15 points. It ranks them above the others on the MIPS scorecard with 20 points. Therefore, if you report for one high-weighted improvement activity, you are bound to earn more points.

For the same MIPS score, ECs working for large medical practices must submit data for two or more improvement activities to get up to the threshold limit of 15 points.

MIPS Quality Measures Shield You from Negative Payment Adjustments

Negative payment adjustments can be a big setback for your profit journey. Therefore, use quality measures wisely and promptly. To stay on top of your game, you must fully understand the performance measures to make to turn it into a lucrative opportunity.

There are 275 quality measures and clinicians can select from among them the most suitable measures to meet the MIPS 2018 threshold score. Each Quality measure has further sub-categories as per the following factors:

  • Efficiency
  • Outcome
  • Patient engagement

Moreover, CMS has developed a specialized set of quality measures to help physicians identify appropriate quality measures. Clinicians can report data for 12 months on six quality measures. However, one of the quality measures must be an outcome measure or a high priority performance measure.

Clinicians participating in the form of virtual groups can use CMS Web interface or Consumer Assessment for Healthcare Providers and Systems (CAHPS) for the MIPS survey.

Report At Least Two Performance Categories in 2018

To stay away from negative payment adjustments, report at least two performance categories. For instance:

  • Improvement Activities and Quality
  • Or, Promoting Interoperability and Quality

Report One of the Categories in 2019

Even though you have to report in one of the categories in 2019, but there are certain criteria set for each category. For instance, small practices with 15 or fewer clinicians, when they are reporting solo or as a group will have to attest to 1 high weighted and 2 medium-weighted improvement activities. That’s one example. And, the list goes on.

Call us to discuss more on our toll-free number: 1-844-557-3227.

Score Comparison

Ordinarily, we see small medical practitioners reporting one medium-weighted improvement activity and one quality measure. This reporting tactic earns you 10 points and with an extra 5 bonus points, you may achieve a total of 15 points. This was back in 2018.

Now, you need a score of 30 points to avoid penalties.

Promoting Interoperability (PI)

MIPS Quality Measure and Interoperability

 

Another way to earn 50 out of 100 points is by reporting on the Promoting Interoperability performance category. It investigates the patient and physician engagement level and makes the patient information available to other clinicians via EHR technology.  ECS is required to submit data for 90 days or more on the base score of four or five measures in this category. The base score measures take their value from the certified EHR edition.

Large medical facilities can achieve high scores by reporting on PI and quality categories. However, they must report on the PI category to score 50 and two quality measures to get to 70 points and target the bonuses out of a $500 million pool.

In 2019, the score to achieve bonuses moves up to 75 and beyond.

EHR Technology – One Step Ahead

Each EHR edition has a different set of performance measures. For instance, the 2014 EHR edition allows reporting on the Promoting Interoperability Transition Objectives and measure set.

Tricks of the Trade

The data submitted on quality measures for at least 20 patients fulfill the data completeness requirement.

Two medium-weighted improvement activities and four quality measures can get you a score of 16 points in 2018.

It is only possible when the physicians earn 12 out of 70 points in the “Quality” performance category and score 20 out of 40 points in the Improvement Activities.

Vote for Better Healthcare

As 2018 is about to end, the evergreen slogan for the welfare of Americans is to vote for a better healthcare system. That truly goes in favor of the Americans.

If you still haven’t done anything to avoid the penalty in 2020, it is time to connect with a reliable MIPS registry for submissions. America needs you to come out as a winner and a reputable practitioner.

Most of the performance categories require data for 90 days. Therefore, reach out to P3Care and report QPP measures efficiently and be free from the worries of non-reporting.

News

CMS Update, healthcare system, MIPS 2020, MIPS Qualified Registry, MIPS data submission, MIPS incentives

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.