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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.

QPP MIPS, MIPS Quality measures, MIPS reporting services, healthcare industry

How Can Physicians Increase Patient Referrals?

Survival in the healthcare industry is getting tough day by day. The cost factor to provide value-based healthcare services is doing well in patients’ favor, but it’s also been a burden for physicians. While MIPS reporting services, MIPS Quality Measures are the parameters to show progress in terms of interoperability, cost, quality, and improvement activities.

Other than making efforts to earn incentives and bonuses and to remain protected from penalties, MIPS has been a great help. But, first physicians have to meet the criteria of checking 200 patients and bill more than $90,000 for Part B covered services.

Why Referrals are Important?

Referrals are an excellent way to keep up with the high number of patients. Word of mouth from fellow physicians and patients also helps to maintain goodwill in the industry.

It helps to grow the practice and improves the worth of your services rapidly.

How to Increase Referrals for your Practice?

Here are several suggestions upon which medical practitioners can thrive and get referrals without any problem.

  1. Connect with Fellow Physicians

Find those physicians in the industry with which you can build a give and take relationship.

For Instance, if you can refer a patient for any service to another physician, he should be able to do the same for you for your area of expertise.

  1. Increase Patient’s Engagement Level

Make processes easy and less hectic for patients. Such as a simple or automated way of patient scheduling system automatically improves patients’ engagement.

Another way is to send follow up messages to remind patients about their appointments.

These tactics can help to get referrals from patients.

  1. Have a Friendly Behavior at Work

When someone treats you with kindness, it leaves an impact on you. The same rule works for organic referrals. If a physician treats his patients with a smile, listens to them, and take time to make things easy for them, he is more likely to get referrals.

  1. Be Kind to the Staff Working for You

Nurses, physician assistants (PAs), and others spend a major deal of effort and time for the well-being of patients.

Spend time with them, and make small talk to release work stress. In this way, your behavior and kindness will reflect across the board. Not only it does improve your performance but also makes an ideal working environment.

Additionally, it helps to know your staff’s relationships with others in healthcare. Through them comes the goodness for a practice. In fact, physicians can definitely deduce better results from this strategy.

  1. Embrace Technological Innovations

Adopting technology gives points for Improvement Activities (IA) in QPP MIPS. This way you get the reputation of a progressive medical practice and achieve higher MIPS points for incentives.

Medical practitioners can use the following things:

  • Make their own app if possible
  • Create a user-friendly website for their services
  • Figure a way to make the appointment scheduling process easy and automated
  • Use technology to offer support to staff and patients alike
  1. Be Informative & Unique with your Website

The website is the first portal to reach patients. Patients search online about what services they want and what doctor they need.

If you have all the information on your website, it’s easy to get referrals from others against your user-friendliness.

  1. Make Referral Process Easy

Another way to increase patient referrals is by making the referral process easy and simple.

Follow-up services after or during the appointment, thus, play a crucial role. It helps you provide quality healthcare to patients, which you can use to submit MIPS quality measures.

Moreover, if the patient has any problem giving a referral, it is easier for them to seek help from you.

Medical practices can handover a referral form during the treatment, stating the demographics, reason for referral, and other important information. It is indeed an added step for front desk staff or medical billing services can help cater to this process. The response will be quicker. But, in the long run, it will value your referral sheet.

Given above are just a few ideas to improve physicians’ worth in the industry and getting referrals. More referrals mean more patients and ultimately reimbursements and incentives to straighten up revenue cycle management.

So, get started now.

MIPS in healthcare, MIPS consultants, MIPS reporting, MIPS quality measures, MIPS score

Take Advantage Of MIPS 2018 Reporting Standards & Score High!

2018 has been a revolutionary year for MIPS in healthcare. MIPS has faced much criticism as physicians were not comfortable with its payment model. The minimum threshold for a penalty-less spot was unacceptable for many clinicians, as it didn’t seem to bring any improvement in the healthcare industry in any manner. Physicians only worried about saving themselves from negative adjustments and that’s just it.

CMS replaced prior MIPS reporting rules with the new ones to address such reservations and to benefit physicians and the healthcare industry’s growth.

Apart from the changes in the percentages of the performance categories, the changes that CMS proposed for MIPS quality measure reporting; let’s look at them and analyze how we can target incentives and bonuses instead of just worrying about penalties.

Virtual Group Participation is now LEGAL

  • This year, a terrific advancement is seen in MIPS reporting guidelines as CMS is offering virtual group participation.
  • Virtual groups should consist of solo practitioners and an eligible group of 10 or fewer clinicians. They should work together VIRTUALLY for the MIPS performance year.
  • Generally, the participants in a virtual group report against all four performance quality measures and meet all reporting standards the same as any non-virtual MIPS group would.

The requirement for a Virtual Participating Group

  • Groups and solo medical practitioners who want to participate, as a virtual group needs to go through an election process.
  • The election process must end before the performance year and can’t change in-between. For Example, the election date for MIPS 2018 was from October 11- December 31st, 2017.

Low-Patient Threshold Update

The low-Patient threshold has been increased to exclude individual clinicians or groups with less than or equal to $90,000 in Part B allowed charges or less than or equal to 200 Part B beneficiaries. It is done in the determination period or during or prior to the performance year.

Bonuses for Care Services of Complex Patients

CMS grants 5 points as a bonus to the final MIPS scorecard by adding the average Hierarchical Conditions Category (HCC) risk factor. The information is based on the complexity of the medical condition of the patient.

MIPS Favors Small Healthcare Practices

When small medical practices either individually or as a group submits data on at least one performance category, they get an additional 5 points in their final MIPS score. Thus, MIPS 2018 understands the struggles that small medical practices go through and is trying to uplift such practices by favoring them.

Submit Hardship Exception Application for Extreme Cases & Save Yourself from Penalty

If the eligible clinician doesn’t use CEHRT- Certified EHR Technology, due to uncontrollable circumstances, for instance; a natural disaster, he can submit a Hardship Exception Application for reweighting Advancing Care Information (ACA) performance category. It increases the percentage of other remaining categories in the final MIPS score.

An update in this regard is that 31st December 2018 is the last date for hardship application submission.

According to CMS estimation, around 572,000 clinicians will participate in MIPS 2018 reporting. They also propose that clinicians will receive approximately $173million as positive payment adjustments via MIPS consulting services. So, why not report clinical data to CMS, the way it wants and get more payment incentives than expected.

The threshold for Penalty-Less Spot has increased

In its first year, keeping yourself safe was just a matter of three points. Now, the bar has been raised to at least 15 points. This way, clinicians have improved their care standards drastically and the overall pace of the healthcare industry improved.

Keeping track of all the changes is surely hectic for the clinicians; therefore, consulting a MIPS qualified registry becomes a necessity. P3Care has a distinguished name as a professional MIPS consulting service.

MIPS in healthcare, MIPS incentives, MIPS reporting, MIPS quality measures, MIPS qualified registries, MIPS submission Methods,

How P3care Handles Medicare MIPS Reporting For Cardiologists

P3Care.com sort things out with the payers and at the same time keep the communication lines open on behalf of the providers. This way the patients receive the best care and the insurance reimbursement workflow keeps on moving.

Everyone is happy.

In addition, P3Care has a strong grip over the Quality Payment Program under MACRA. The Merit-Based Incentive Payment System (MIPS) track reporting mechanism for both the specialty-specific clinicians and the primary-care physicians brings in both incentives and reputational benefits.

What is P3?

The three “Ps” stands for –

  • Providers
  • Patients
  • Payers

P3Care Simplifies MIPS Reporting for Specialists

A merit-Based Incentive Payment System (MIPS) is an integral part of the value-based system. In addition, CMS recognizes P3Care as a MIPS Qualified Registry vendor in back to back years of 2017 and 2018. That makes it a favorable enterprise for physicians who want to choose a registry as their MIPS submission method.

The recognition puts a bigger responsibility on our shoulders in terms of performance and meeting your expectations.

The US healthcare system revolves around a working relationship between providers, patients, payers, and medical billing services. If there are disparities at any level, at any step, there is a high probability of bottlenecks.

The government has set the course for MIPS in healthcare to go the distance and want all the clinicians to accept it. If they fail to comply with MIPS, they must be ready to face financial penalties along with putting their integrity on the line.

Heart specialists or cardiologists choose quality measures, outcome measures (or high-priority measures) from specialty-specific sets and start their journey for incentives through MIPS reporting. We take a few minutes of your time and finalize measures before submitting them to CMS.

Peace of Mind for Cardiologists

What do the cardiologists say?

First, they are ready to participate in the Merit-Based Incentive Payment System (MIPS). They are actually more excited about it than the general physicians. However, more than half of the cardiologists working in the healthcare industry have reported fatigue and higher stress levels due to excessive documentation.

If IT regulations ease up, it may give them ample time to treat patients and rest as well. P3 Healthcare Solutions is here to help you report MIPS in a timely manner. Connect with us at 909-245-8350 to discuss.

CMS Incentivizes Practitioners

The doctors’ job is to treat the patients, but instead, they work 10 to 20 hours a week on paperwork. That is the fact, unfortunately.

The ground reality is that CMS has allocated $20 million on the smooth transition to the Merit-Based Incentive Payment System. All these initiatives are going to improve healthcare down to the grassroots level. It must do so and silence those voices screaming the phrase, ‘Americans not getting the treatments they deserve’.

To make it more difficult for cardiologists, the data coming out of the EHR system is vague and doesn’t help with the diagnosis. Often it is descriptive rather than suggesting crucial care points. P3Care brings a solution to this problem by synchronizing the medical billing service with the practice management system.

Specialty-Specific Demotivating Factor

There are no standards set for specialty-specific clinicians when it comes to MIPS quality measures. Hence, there is no way to compare the scores of specialists. The result is a low MIPS Final Score, and there may be no bonus payments at all. It is derogatory and depressing.

Quality measures outlined by the Qualified Clinical Data Registry (QCDR) reporting mechanism also have a similar story. Generally, many specialists vote in favor of QCDR.

Data Submission for Physicians and Specialists

After the month of March, CMS takes around 6 months to generate detailed results on MIPS reports.

Medicare MIPS reporting on Quality measures through a registry is highly suitable because it helps to identify and list down probable errors in the report. There is no other way to identify any ambiguities because CMS directly publishes the results. We can’t afford to make mistakes. However, at the end of those evaluations, CMS gives time to practitioners to ask for a review if they are not satisfied with the MIPS final score.

MIPS Cost Measures

Cost is an additional category in MIPS 2018. It accounts for 10% of the composite performance score (CPS). As a cardiologist, you don’t need to worry about it, though. CMS directly manage this category according to your billing to Medicare.

P3Care has a plan in place for the cost category so that CMS gives you the highest ratings on it. We are technologically tenable and keep a close eye on news, views, happenings, and information regarding the US healthcare industry.

When you add the inpatient and outpatient costs, the average of which is compared to the national standard set in the specialist category.  That is an overview of how the cost category is calculated. The lower the cost, the better the ratings!

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.

Medicaid Meaningful Use, Medicare and Medicaid Services, MIPS, MIPS Quality Measures, quality payment program

MIPS Quality Measures 2017 Applicable To LTPAC Medicine

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

Purpose

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

Here is how CMS looks at MIPS.

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

Key Strategic ObjectivesMedicare and Medicaid Services

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

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

Caveats for Individuals and Groups

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

Eligibility Criteria

Here are some considerations to undertake.

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

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

Avenues for Submission

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

Why Consider Registry for Submission?

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

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

Avoiding Penalties is Critical

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

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

How 2017 MIPS Quality Measures Differ?

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

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

Here is how CMS elaborates on this concept.

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

Medical professionals, Medicare services, MIPS, MIPS consultants, MIPS consulting services, MIPS Quality Measures, MIPS reporting

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 of 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!

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.
P3Care, medical billing, MIPS 2020 reporting, Misconceptions about Coronavirus, Coronavirus

P3 Clears Five Misconceptions About Coronavirus

P3Care counters misinformation around topics of medical billing or MIPS 2020 reporting about the much-talked-about coronavirus. Yes, the Wuhan-born virus is breaking news on every news channel in the world.

A session held on Friday in New York City by the Center for Disaster Medicine at New York Medical College (NYMC) about the virus recorded someone from the audience asking, “Is it safe to eat Chinese food?”. That is what news without investigation can do to you. There is much wrong information floating around that it has become hard to differentiate between facts and fiction.

There are 5 common misconceptions about the virus with counterarguments for the greater good of the people.

And, yes, eating Chinese is safe. It is ‘not’ a safety hazard by the World Health Organization (WHO) or the Centers for Disease Control and Prevention (CDC).

Misconception 1: Coronavirus is more dangerous than any other virus and is spreading fast

P3Care, medical billing, MIPS 2020 reporting

Wrong. The measles virus is much more dangerous than coronavirus (2019-nCoV). The only reason it has not spread quickly is that most people are already vaccinated for measles. Voila! It doesn’t make it to the news or social media.

The experts say that this virus can affect 2 to 3 people around. However, this data has a lot of uncertainty because it has not gone through scientific-peer assessment yet.

Misconception 2 – It can kill you

In a session, held by NYMC, Mary Foote, MD, MPH, Senior Medical Coordinator for Communicable Disease Preparedness at the NYC Department of Health said that it is believed that everyone who gets affected by the new virus eventually dies. But people are at greater risk from heart disease, cancer, old age, and any other life-threatening disease than by this virus.

People are at greater risk of influenza and the chances of them ending up in hospitals from influenza are higher. Stating a fact, Flu kills tens of thousands of people every year in the US and 291,000 to 646,000 people in the world (according to a study published in The Lancet). CDC stresses on getting flu shots on their website and social channels for public protection as we speak. Hence, people ought to be more concerned about protecting themselves from the flu rather than the coronavirus.

Misconception 3 – It was manufactured in a laboratory and is being used as a biological weapon

medical billing, MIPS 2020 reporting

The news that was spread earlier by a large number of Russian domestic channels suggested the involvement of the United States behind this outbreak. The misinformation further spread like fire saying the US has created this bioweapon against China and that US pharmacists were making billions from this.

Similar conspiracy theories are creeping up in China and, oh surprise, surprise, some of them are coming from within the U.S. All of these are just conspiracy theories and nothing more. No, there is no evidence that this was a human-designed strain of the virus created to destroy countries or dismantle governments.

Misconception 4 – A cure is available

A vaccine is not developed in the blink of an eye. There hasn’t been a vaccine until now because it is a new virus and producing a vaccine to counter will take some time. Public and private organizations are cooperating to assist scientists in finding a remedy for this virus as quickly as they can.

Misconception 5 – Every person with fever and coughing is infected with coronavirus

This is misinformation #5 on this list. Since the public is unaware of reality, they think every person with the common flu is infected with the coronavirus. CDC has stressed the importance of flu vaccination several times. Medicare offers to reimburse providers if they claim for giving flu shots to their patients. The same facility is for the beneficiaries to get their flu shots on time in which they don’t have to pay any out-of-pocket costs. Health plans are in full support of this cause.