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The 2020 CMS Quality Conference Speaks of Objectives & Accomplishments

CMS has come up with practical solutions for the healthcare industry; it has constantly fought against the burnout epidemic by reducing reporting requirements. We, as a MIPS Qualified Registry, appreciate their efforts and of their administrator, Ms. Seema Verma.

In the recent CMS Quality Conference 2020, the captain spoke herself and mentioned the achievements of the agency and what lied ahead. Starting with the accountability of her team across the board, she said she has identified the set of objectives. She further stressed on quantifying and measuring progress as they gradually realize the 16 strategic initiatives.

The Three Objectives

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CMS has a mission and a goal to achieve. Irrespective of the obstacles ahead, according to administrator Verma, CMS is going to be relentless in their approach to accomplish the following objectives:

  1. Improve the quality and bringing healthcare within the means of all Americans;
  2. Drive healthcare towards a value-based system from a volume-based system;
  3. And, don’t let the bubble of American healthcare spending go bigger.

Quality is the top objective CMS is looking to nail. Without good quality, Ms. Verma indicated, efforts to lower cost and improve healthcare availability are fruitless. What good is a health plan, when the care you get is below par?

The Unique Role of the Government

Similar to the rules for the airline industry or the food sector, the government must set for the healthcare industry. Not only do they ensure a high standard of care, but these guidelines will protect the patients’ rights from the very beginning.

The consumers have to know and have to be sure that the hospitals are safe for them; nursing homes are places where their loved ones are taken care of; laboratory tests are accurate, and dignity is alive in hospice care.

CMS has an overall responsibility to oversee quality not because they are the nation’s largest insurer, but because people look up to them for setting the safety and quality standards for every facility that receives Medicare reimbursement. They believe that the government has a unique role to play to create and preserve an unbiased rulebook for a healthy competition.

In that sort of environment, patients are protected and providers compete against each other to provide the highest quality of care. Soon after MIPS 2019 reporting, we have MIPS 2020 to look up to, so that high-quality care prevails across the country.

The physician compare or hospital care portals populate for the sake of patients to make informed decisions. Choose the right clinician with reviews and performances in the Quality Payment Program (QPP).

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Trump Administration’s Take on Quality

Trump administration has a keen interest in healthcare, and over the past three years, it has come up with several Presidential executive orders to ensure quality and price transparency, Advancing American Kidney Health, and redefining Medicare.

To realize Trump’s vision, CMS is the enforcing body to implement these orders for better quality outcomes. Since the elections are near, Trump administration’s stance on quality of care in hospitals, facilities, and practices are going to be key in his win in the relevant constituencies. Whether Bernie Sanders or Joe Biden, in my opinion, whoever takes a bold initiative on healthcare will make the underlying difference.

 

CMS’ New Quality Strategy

In this recently held conference, Ms. Seema Verma unveiled the new quality strategy that will implement the Trump administration’s vision in letter and spirit. It was a proud moment for her and the agency that dedicates most of its time to healthcare management, improve patient experience, and focuses on patient engagement for distinct results.

Last year, the framework that was initiated for the safety and quality of nursing homes was incredibly successful. As a result, CMS has announced to apply the same framework in other areas with room for improvement. The MIPS in healthcare is a step in that direction in which we can have a close to a perfect system.

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The Four Pillars of the New Quality Strategy

  • CMS will establish government standards for quality care along with measures such as the MIPS Quality measures.
  • Improve the knowhow of the system and enforce quality protocols for accountability.
  • Share quality information with the public to promote transparency and competition. More so, empowering patients with grand patient experience.
  • Modernize quality activation efforts by the use of technology and data analytics.

MIPS Value Pathways in 2021 will Navigate the Quality Measures

One of the ways the new quality strategy will see the face of implementation is in the form of Merit-based Incentive Payment System Value Pathways in 2021, according to Medscape. Instead of using the six quality measures, MIPS Value Pathways will allow physicians to choose measure sets most relevant to their specialty or patient population.

Meaningful Measures 2.0

The next thing lined up on CMS’ to-do list is to announce its meaningful measures 2.0 framework in a few months from now. What it will do is automatically send the data from the clinician’s EHR system to a centralized submission system, so physicians are relieved from the burden of submissions altogether.

Concluding Remarks

Quality is a major concern here. The system in which value has become the no. 1 driving factor instead of volume, quality is bound to improve. More so, MIPS in healthcare has an impact on the system in which clinicians constantly try to improve patient outcomes.

In the end, we would also like to thank Ms. Seema Verma for her speech, CMS and the Medicare reimbursement system for taking such staggering steps. Sometimes, the system may not respond as early as we would like it to. But that doesn’t mean it isn’t working. Nevertheless, for it to remain functional, we all must collaborate with CMS and show our support in the upcoming months.

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Report & Edit MIPS 2019 Data before March 31, 2020

A MIPS Qualified Registry is one of the collection types to submit data on behalf of clinicians. In 2020, CMS recognizes P3Care as a MIPS registry for the fourth time in a row since 2017. In an effort to maximize incentives for physicians, we work to produce the best MIPS results for eligible clinicians to seal their authority as value-based clinicians.

From day one, it is our motto to encourage clinicians to do their MIPS data submissions as early as possible and not delaying them to the very end. Because at the very end, it becomes difficult to recognize and omit errors with less time on our hands.

In this article, some of the factors directly related to MIPS 2019 reporting are highlighted comprehensively. To have a go at it without any ambiguities, we have organized information to help you report the year 2019 in a winning way. You get to score high; incentives come with performance as if it were meant to be yours in the first place.

Submission Type & Collection Type

As students of value-based care phenomenon, we have often noticed at times that we confuse a collection type with a submission type. So, in this section, we’d like to get some weight off our chest by discussing them.

A submission type is a doorway to report MIPS 2019 to CMS. Such methods include –

  • Medicare Part B Claims
  • Certified Electronic Health Record Technology (CEHRT)
  • Qualified Clinical Data Registries (QCDRs)
  • Qualified Registry (Like P3 Healthcare Solutions)
  • CMS Web Interface
  • CAHPS for MIPS Reporting Survey Vendor

While collection types are types of measures MIPS eligible clinicians can use to submit data. For instance, you can use the following types of measures to report MACRA MIPS.

  • Electronic Clinical Quality Measures (eCQMs)
  • MIPS CQMs or Registry Measures
  • QCDR measures
  • Claims measures
  • CAHPS for MIPS survey

Improve Your MIPS 2019 Measures Performance Reporting by P3 Healthcare Solutions

It seems odd but you still have time to edit, delete or replace it with more accurate data. As a third-party intermediary, we have our agents dedicated to these corrections on behalf of clinicians to make their lives easier if their previous submissions were inadequate.

At least six Quality performance measures have to be reported to fulfil MIPS 2019 Quality component requirement. If the same Quality measure is reported multiple times through the same collection type, then CMS will evaluate only the most recently submitted data for that measure.

Similarly, when a single measure is reported using multiple collection types, CMS uses the measure with the highest achievement points. Hence, the scoring system works in favor of the clinicians no matter what one thinks.

P3 Healthcare Solutions works to benefit clinicians, therefore, if you think your data can be more accurate, get in touch with us and we’ll help you optimize your MIPS final scores. Report MIPS 2019 for each category including Promoting Interoperability (PI) and Improvement Activities (IA) like a pro.

For Improvement Activities, the process of aggregation occurs for the activity submitted via attestation, file upload, and/or direct reporting.

For PI, we suggest using a single mode of submission. If CMS receives conflicting data from various submission methods, it will automatically result in a score of 0 for this performance category. We advise each of you, clinicians, to be careful while reporting PI in 2019.

Last Date of Submission is March 31, 2020

In order to report, edit or delete your previously submitted data, new data is acceptable until March 31, 2020, before 8 p.m. EDT. It feels great to be part of the MIPS 2019 reporting system because up to 5% of incentives and reputation on Physician Compare are waiting for you on the other side.

All we require is your NPI; phone number; practice’s name; and 5-10 minutes of your time to discuss and finalize measures. You can also choose from one of our affordable packages, to achieve a score you prefer the most. Packages include MIPS Essential, MIPS Budget Neutral, and Benchmark MIPS.

To talk to us, you can call us for a free consultation on this number: 1-844-557-3227. We wrote an article specifically on the Quality performance category a few months ago in which we discussed some quality measures in detail. You can take a look here: 7 most reported MIPS Quality measures – A technical guide.

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MIPS Quality Measures 2019 Vs. 2020 – Registry Investigates

Merit-based Incentive Payment System (MIPS) has entered 2020, and, so have the Quality, Promoting Interoperability (PI), Improvement Activities (IAs), and Cost categories. It is a no-brainer to write a thoughtful comparison between the two years regarding MIPS quality measures.

Hence, we are here to discuss the Quality category in detail; the six measures adding up to the final score; any new requirements; and why P3 Healthcare Solutions is a smart choice to report registry-specific measures.

It’s not about the passing years that we have managed to make it to the next year of value-based care, but the essence of MIPS in Medicare lies in its delivery. Each year calls upon MIPS eligible clinicians to adopt a certain set of measures and activities and report them to the Centers for Medicare & Medicaid Services (CMS). 2020 is no different as long as you are on the right track of submission.

The reporting occurs through legitimate submission methods only, the result of which conforms to performance evaluation and incentive payments.

 MIPS Quality Measures 2019 and 2020 – The Types

I have to admit there are more similarities than differences between the two, because, for starters, they have the same collection (measure) types.

In MIPS 2019 and MIPS 2020, participants get to submit 6 quality measures data for 12 months (from January 1 to December 31, 2019, and January 1 to December 31, 2020, respectively). The amount of data to undergo submission depends on the collection (measure) type.

CMS finalized 6 collection types for both 2019 and 2020 CMS MIPS Quality measures. These measure types include:

  • Electronic Clinical Quality Measures (eCQMs)
  • MIPS Clinical Quality Measures (CQMs)
  • Qualified Clinical Data Registry (QCDR) measures
  • CMS web interface
  • Medicare Part B claims measures, and
  • The CAHPS for MIPS survey

As a rule, participants must submit a total of six quality measures from the above types.

General Reporting Requirements Vary

If you talk about 2019, the data completeness factor was 60%, i.e. clinicians were to report performance data for 60% of their patients eligible for a chosen measure. For MIPS 2020, clinicians are required to report data for 70% of their patients eligible for a certain measure. It is 10% more than the last year which means CMS plans to cover a wider population of patients and bring them into the fold of value-based care.

 MIPS Submission Types

In the case of MIPS submission types, there are 4 ways to submit quality measures. These include:

  • Medicare Part B claims
  • Sign in and upload (a MIPS consulting service can report on your behalf)
  • CMS web interface
  • API submission which is the direct method of submission

Six Measures

A total of six quality measures was the requirement back in 2019, and in 2020, it hasn’t changed much. We have a total of six MIPS quality measures in 2020 as well. It includes one outcome measure, but in case, the outcome measure is absent, go for a high-priority measure instead.

Practices, groups, and virtual groups with 16 or more clinicians will be automatically calculated on a 7th measure, the All-Cause Hospital Readmission Measure.

The Curious Case of Bonus Points

Bonus points sound charming enough to know more about their details. Therefore, we will try to find out how to make those bonus points ours and maximize our rewards in 2021 and 2022.

For MIPS Quality measures 2019 and 2020, you can earn bonus points on the following terms.

  • Submit 2 or more outcomes or high-priority measures. It doesn’t apply to the outcome measure or high-priority measure that is already there, but two separate measures are required to get your hands on bonuses. P3, as a MIPS consulting service, reports Quality measures for its clients across the US. Opioid-related measures are part of the high-priority measures list.
  • In MIPS 2020, measures that are part of the CMS web interface don’t qualify for bonuses, but if you report the CAHPS for MIPS along with the CMS web interface, you have a chance to win bonuses.
  • Submission using Certified Electronic Health Record Technology (CEHRT)
  • Besides, six additional points are there for small practices that submit at least one quality measure. Practices include individuals, groups, and virtual groups.
  • 10 additional points for practices that exhibit improvement in their Quality reporting from the previous year.

Conclusion

Before I end this article, I want you to stay illuminated by the present and the future requirements of reporting as long as you have us on your side. P3 Healthcare Solutions prides itself on reporting MIPS for clinicians across the United States. To get in touch, please call 1-844-557-3227.

We have a comprehensive piece written on MIPS 2020 on our LinkedIn page. If you have some questions related to it, you may go through it when you have some time. Here’s the link to it: Getting to know the changes in MIPS 2020 ahead of time.

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Reimbursement Trends of 2020: MIPS Vs. Fee for Service

As we enter the year 2020, reimbursement challenges also enter another phase. They are getting more and more complex for independent physicians with each passing year. The reasons for this complexity are the ever-changing reporting requirements from regulatory authorities like the CMS, and the differences in contracts among commercial insurance companies.

First, the Merit-based Incentive Payment System (MIPS) in 2020 poses a new set of requirements for clinicians. Second, Insurance companies, in general, require more and more data to draft patient outcomes.

So, there is not one, but two pressures inherited by clinicians as they step into the New Year.

When we talk about the Quality Payment Program (QPP), some new Advanced Payment Models (APMs) are in the development phase regarding Primary Care. Based on them, the decisions that doctors make today can directly reflect on their future revenue.

Let’s see some of those reimbursement trends now.

CMS Focuses on Primary Care

In 2020, CMS sets the same E/M coding requirements for office and outpatient E/M activity as the American Medical Association (AMA) CPT Editorial Team. The four levels of E/M codes remain intact for new patients, and 5 levels for regular patients.

Another slight change occurs in the conversion factor for Medicare Physician Fee Schedule (PFS) which increases from $36.04 to $36.09. This factor isn’t expected to grow to a greater extent in the next six years.

According to Andres Gilberg, Senior Vice President Government Affairs, Medical Group Management Association (MGMA), the reason for this slight increase is due to the lack of adoption of MIPS and APM by clinicians at the pace Congress wanted when it sanctioned MACRA.

Clinicians concerning MIPS in 2020 face serious penalty consequences for not reporting MIPS 2020. They won’t be able to get away with it if they don’t participate resulting in a 9% deduction from their yearly Medicare payments.

MIPS 2019 reporting determines the potential bonus percentage to be 1.65.

To state a strategy that will work, I’d advise clinicians to report MIPS Quality measures in 2020 to come out as a winner in 2022.

APMs Expected to Increase in Number

CMS intended MIPS to lead into APMs eventually, resulting in less reporting burden and a seamless system of financial incentives. However, the number of APMs needs to increase. There was a notion that CMS would revert to fee-for-service and reset the payment model. But that didn’t happen, and we are stuck with MIPS.

Conclusively, we need to have more APMs to accommodate the growing number of clinicians. As a MIPS Qualified Registry, P3Care speaks for and on behalf of clinicians to value their unconditional and invaluable service to the people of the United States.

Private Insurance Companies Push for Quality

To show compliance and participate in value-based care systems, private payers continue to pay more attention to outcomes. It is not expected to change in 2020. What the Quality Payment Program has done is that it has increased the risk-sharing capability of the healthcare industry. Consequently, there is never a dull moment with value-based care.

Additionally, provider networks will expand to bring in-home care, pharmacy, and other fields categorically. Thus, changing the whole outlook in a meaningful way. In the past, it used to include inpatient, outpatient, and primary care areas only.

Private payers looking up to Medicare reimbursement models, as a result, pay attention to patient access, engagement, cost, and quality measures. If doctors are doing all of that they would be on the A-list of providers.

By examining closely what the doctors are doing to their patients, private payers will decide to keep the provider or cancel their contract altogether. For instance, if they are sending their patients to a far-away imaging center only because it is in their health plan, they won’t go unnoticed by payers for long. Insurance companies are allowed to terminate their contracts in such instances without prior notice, as United Health has done in the past.

Those who do exceptionally well and create a better patient experience are bound to get special invites from provider organizations tagged with bonuses as a reward.

Smaller Practices to Face Payment Difficulties

Mergers are likely to continue in healthcare as payers find cost-effective ways to navigate value-based care. You see, larger organizations have the power to provide better infrastructure to follow MIPS 2020 requirements. In comparison, smaller practices have a lesser chance to comply with what the program requires.

Nevertheless, bigger systems have other issues to deal with. As more and more physicians join mega hospitals and provider networks, getting them to follow QPP guidelines and execute coordinated care are two of the challenges they face.

Therefore, you focus on either fee-for-service model or value-based care because if you do both incentives won’t match with one another.

The next threat to small practices is the rise of retail clinics. A retail clinic is a doctor’s office at the shopping mall where you can get primary care services instantly. You are looking at revolution so to speak. For now, experts are unsure of the affect retail clinics will have on reimbursement rates, so it’s a waiting game from here on. Comment below and share your thoughts if you’d like to.

To show you a list of top MIPS consulting firms, we wrote an article titled – Top 3 MIPS Consulting Services in the U.S.

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5 Key Takeaways from the Quality Payment Program by Year’s End

Before we go into the details, the Merit-based Incentive Payment System (MIPS) comes under the direct obligation of the Medicare Access and CHIP Reauthorization Act (MACRA), the law that regulates the incentive program across the US.

Eligible clinicians who have a responsibility to report MIPS 2019 include physicians, osteopathic practitioners, chiropractors, physician assistants, nurse practitioners, and registered dietitians or nutritionists among others. They have to fulfill the low-volume threshold to qualify for MIPS 2019 reporting apart from their assigned job in healthcare.

MIPS in healthcare gauges a clinician’s performance in terms of care delivery and reduced expenses. In this article, we come to an understanding of five key elements that have surfaced as a result of this program. This data correlates with the preliminary data findings released by CMS on July 11, 2019.

  1. Two Branches for Positive Payment Adjustments

The Quality Payment Program (QPP) 2019 branches out into MIPS and Advanced Alternative Payment Models (APMs). Which branch to choose is at the disposal of clinicians, clinician groups, and virtual groups. However, MIPS & MACRA go side by side making it the next famous incentive branch after the Physician Quality Reporting System (PQRS).

The system divides into four performance categories such as Quality, Promoting Interoperability (PI), Improvement Activities (IA), and Cost. Each category has certain measures that have to be reported through a MIPS Qualified Registry, CMS Web Interface, EHR, or Qualified Clinical Data Registry (QCDR). Not to forget, there is another catch to it in the form collection types which are the actual measures according to their submission systems.

  1. Participation Level Increases Each Year

Since the start of the program in 2017, the participation level has gradually increased. The program showed an increase from 95% in 2017 to 98% in 2018. And, MIPS 2019 is only going to give us more eligible clinicians participating in it. The whole program suggests progression with higher participation levels across the country.

  1. Small Practices Clinician Participation Status

According to the Centers for Medicare & Medicaid (CMS), 90 percent of clinicians from small practices engaged in MIPS 2018 which was 81 percent in 2017.

The primary flexibilities introduced in the Physician Fee Schedule rule for the 2018 performance year included an increase in Medicare patient count and Medicare Part B allowed charges which meant fewer clinicians from small practices would be eligible to report MIPS in 2018. However, they decided to report it anyway. It also goes to show that the system has adjusted itself with the practitioners’ convenience.

It was mentioned in a blog post by Seema Verma, Administrator CMS on July 11, 2019.

  1. Advanced APMs Are Not Far Behind

Alternative Payment Model (APM) participation level isn’t far behind that of MIPS. CMS reports twice an increase of participants in 2018 as compared to 2017. There were 99,076 total participants in 2017, while the number doubled to 183,306 in 2018. This sudden jump was attributed to new participation opportunities in 2018, especially through ACOs in the Medicare Shared Savings Program.

Even if we are out there to condemn this program, I can’t see any downside to these opportunities and hope they continue for clinicians.

  1. Spectacular Results So Far

The program collects incentives for the participating clinicians year after year, but the payout occurs one year after the performance year. For example, the payout for MIPS 2017 happened in 2019 in which 93 percent of the participants received positive payment adjustments.

Similarly, MIPS 2018 participants will receive a payout in 2020 which is almost here. CMS reports that 97 percent of the clinicians will be the owner of positive payment adjustments in 2020 based on their performances in 2018.

P3 Healthcare Solutions, Ontario, CA keeps an eye on what goes around as the MIPS performance period 2019 enters the final stages.

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3 Points to Consider Before MIPS 2019 Reporting

Physicians! It’s time to prepare for the MIPS 2019 reporting period. There’s only a little time left.

This time may be hectic and stressful, even for MIPS qualified registries. But don’t worry, P3 Healthcare Solutions has come up with effective tips to target high MIPS scores.

Let’s be honest, MIPS QPP can be a daunting approach to earn incentives for those who are not careful.

On the other hand, it can be rewarding and tends to appreciate clinicians’ efforts for showing remarkable performance.

Now, the bad performance can’t be blamed over a misunderstanding. It’s been three years since MIPS if you still can’t perform well, you should expect financial setback.

Financial Risk Is Increasing!

  • This year, the performance threshold is thirty points.
  • Financial risk is up to 7%.

You can imagine that the reporting complexities will be higher than the years before. Some people will win this game while others will lose. The only way forward is to strategize beforehand and report according to the specified guidelines.

So, just let’s dig into three important points to consider before MIPS 2019 reporting.

Understand the Criteria for the Minimum Performance

Did you know that only by correctly reporting for Improvement Activities (IA) and Promoting Interoperability (PI) categories can give points up to 40? It is at least 10 points more than the minimum threshold that can save from the penalty.

Speaking about the reporting strategy, keep in mind that this year, PI category data submission has especially been strict. Now, it’s not enough to just say that yes! I did it. You have to provide substantial evidence for the performance.

Pay Attention to MIPS Quality Measure

You might be thinking that if reporting for just IA and PI is enough to save your face, why not just stop there.

But we suggest, NO! You should not only be considering penalties but the goal should be incentives and bonuses.

Striving for better opportunities give margin to stay ahead of game from those physicians, who might only have taken measures to prevent themselves from penalties.

So, working not only to save yourself but to earn incentives and bonuses should be included in strategies, and reporting for MIPS quality measure is an efficient way to do that.

Don’t Wait Until the Very End for Data Submission

CMS – The Centers for Medicare and Medicaid require data for 90 days of PI and IA performance categories. The same is not the case with Quality and Cost measures.

CMS also has a specified timeline in which eligible clinicians can report data to them. However, if you consult a MIPS qualified registry, you are able to save data and make relevant changes from time to time.

March 31, 2020, until 8 p.m. EDT is the last date for QPP MIPS 2019 data submission. During this period, eligible clinicians can also update their data if required. So, until the submission window stays open, you have time to make changes to comply with the CMS requirements to score high in the end.

This strategy reduces the chances of errors and data redundancy. MIPS is a bit complex, but the key to success is comprehending the reporting criteria, which is an easy process when collaborated with MIPS consulting services as P3 Healthcare Solutions.

Small medical practices or hospitals need their time to plan, but a smart strategy can go a long way to maximize returns, optimize time, and efforts.

So, start planning today.

Learn about MIPS quality measures specifications 2019 in a nutshell.

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A Guide to MIPS 2019 Reporting for Physical Therapists

Physical therapists are included as one of the groups of healthcare practitioners eligible for MIPS reporting in 2019. It was time their duties were rewarded with an open heart and a clear head. Physical therapy is a serious branch of medicine that, now, comes in the quality circle of the government where physical therapists (PTs) can receive incentives based on their performances. Moreover, MIPS measures relevant to their line of work highlight the broader spectrum of the US healthcare system.

Merit-Based Incentive Payment System (MIPS), as some of the PTs must already know, is where the disadvantaged gets rewarded equally as one with advantages. By advantages, I mean those clinicians who have to face geographical constraints or practices working in the countryside where there are fewer facilities as compared to ones in the city.

So, a system that speaks of justice is a system that works for people everywhere in the world.

MIPS is a combination of programs such as the Physician Quality Reporting System (PQRS), the Meaningful Use (MU) program and the Value-Based Modifier (VBM). Promoting interoperability (PI) category correlates with the MIPS meaningful use.

The four categories in which the performance of clinicians and clinician groups are measured are –

  • Quality,
  • Promoting Interoperability (PA),
  • Improvement Activities (IA),
  • And, Cost

Generally, PTs will only be scored in two categories in 2019 – Quality and Improvement Activities. The American Physical Therapy Association (APTA) participates actively in every provision of the Quality Payment Program (QPP).

MIPS 2019 Reporting for Physical Therapy Made Easy by P3Care

With the pre-designed MIPS 2019 reporting packages in the form of MIPS Essentials, MIPS Budget Neutral and Benchmark MIPS, P3 Healthcare Solutions is tailor-made for it. Doctors falling across various specialties, now, adopt one of these packages to report data. Their MIPS final scores in the 80s and 90s are a clear manifestation of the efficiency of P3 Healthcare Solutions.

Give it a try by talking to us at this number: 1-844-557-3227.

Being a MIPS Qualified Registry gives us an edge to report with consistency and data completeness. The latter qualifies as one of the factors judging the quality of data by the Centers for Medicare & Medicaid Services (CMS).

The Deadline

Another important factor that keeps us on the edge of our seats is deadlines. In this case, Physical Therapists (PTs) can report MIPS measures until December 21 as far as improvement activities are concerned. However, the submission of Quality occurs all over the year, P3 Healthcare Solutions, Ontario, CA has done it in the past and continues to report MIPS Quality measures for eligible clinicians year after year.

Submission deadlines vary according to the submission types. For those who undergo MIPS claims-based reporting in 2019, the claims must get processed “no later than 60 days after the performance year ends”. Groups using the CMS web interface option have to submit within 8 weeks after the performance year. The time window for this 8-week reporting opens from January 2 to March 31.

As a general rule, participants must submit measures before March 31 of the year after the performance year.

MIPS Consulting Services with Results

Physical Therapists (PTs), Occupational Therapists (OTs) and Speech-Language Pathologists (SLPs) are three crucial branches of health care. All of them can make use of P3Care to report MIPS performance categories, score high, and get a chance at incentives. That’s right. Leverage our services to convincingly compete in the Quality Payment Program 2019.

Improvement Activities (IA) category measures their performance in terms of practice improvement over an elaborate period. Ideally speaking, a MIPS Qualified Registry is suitable for reporting IA for

PTs and OTs as they can work on measures such as enhancing care coordination, expanding patient access to care, and improving patient-doctor decision-making. All of this to land the best score out of a total of 40 points.

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

Please comment to assist the other readers.

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MIPS Qualified Registry VS Qualified Clinical Data Registry

There are not many agencies in the US healthcare system that earns the status of MIPS qualified registry. Each of the seven MIPS submission methods has its own advantages, and eligible clinicians can choose to submit data via anyone.

However, healthcare organizations or physicians often confuse MIPS qualified registry and Qualified Clinical Data Registry (QCDR). Particularly, physicians who don’t have much knowledge about the MIPS 2019 reporting process and mechanism, find it difficult to decide the submission strategy.

P3Care being the MIPS qualified registry for three years now has the expertise and knowledge to know how things work with different submissions methods.

Here’s a quick overview of the two most confusing terms in the MIPS QPP.

A MIPS registry reports clinical data on behalf of eligible clinicians or healthcare organizations.

While QCDR is a CMS-approved entity that collects clinical data for CMS on physicians’ behalf. This entity is generally not managed by an individual. It also differs from the former submission method, as it is not restricted to certain measures for data submission.

The qualified clinical data registry is also allowed to host non-MIPS measures, which are approved by CMS.

The categories for QCDR reporting measures are as follows:

  • National Quality Forum (NQF) endorsed measures
  • Current 2019 MIPS measures
  • Measures in regional quality collaborations
  • Other measures approved by CMS
  • Measures used by boards or specialty societies
  • Clinician and group consumer assessment of healthcare providers and systems (CAHPS), measures reported by CAHPS certified vendor
  • National specialty societies administer or endorse registries/ QCDRs

Reporting Mechanisms

Depending upon the reporting type and category, physicians can submit data via any mechanism.

Either as a group, individual, or virtual group, there are four performance categories to report on, Quality, Improvement Activities (IA), Promoting Interoperability (PI), and Cost.

For the cost category, you specifically don’t need to submit data, but CMS will use administrative claims data.

Both submission methods, qualified registries for MIPS and QCDRs can report for a total of six measures and all-cause readmission measures for groups of sixteen or more.

Which Method to Choose?

Either whatever method you choose to report, the decision should not be supported by the number of available measures. Instead, it should be well thought of to score high in the final score of MIPS in healthcare.

Think of the following points before finalizing the submission method.

  • If measures are related to your practice
  • The benchmark for available measures for each submission method
  • Performance rate achievable for selected measures
  • If there are bonus points available for the selected measures
  • Information about which measures are topped out

A correct decision can make all the difference. The path to get incentives and bonuses leads to improved revenue cycle management.

Medical practices when improving the quality of healthcare services move towards progression, and MIPS QPP is a way to measure and judge the performance of how far we have come across.

Either you report via a MIPS qualified registry or any other method, the thing is to clear mind, put forward pros and cons, and then strategize to report clinical data to MIPS via the most suitable method.

MACRA MIPS – Get Ready For These Changes In 2019!

For those covered by Medicare, the paperwork requirements wait for your attention, as a physician, and you can’t take a step back from those duties.

Why has this become crucial for medical practices? Because the Medicare Access and CHIP Reauthorization Act of 2015 and MIPS incentives depend on fulfilling these requirements in the new value-based care system!

And, once you have followed these requirements in letter and spirit, 5% incentives add to your 2020 Medicare payments. Those of you, who don’t think much of this payment adjustment, think again! Because the adjustments increase your finances by huge numbers!

Not all of us are in it for monetary benefits. Nevertheless, the reputational advantage as a clinician will take your practice to the next level. People are going to recognize you as a clinician with superior healthcare knowledge and consider you as an authority in the industry.

To consider MACRA into your practice, upgrade your outdated EHR system to the 2015 certified EHR technology edition. And, consider doing so in case you are an old-fashioned paper-based practice. In addition to that, ensure the technology vendor is trustworthy and has a history of meeting government proposals. A tip to remember here is that proper training of the staff goes hand in hand with the newly installed EHR system.

Prepare yourself for the few changes regarding exemptions under extreme conditions, an increase in the cost category’s weight, an increase in low-volume thresholds, and a boost to the cost performance category in 2019.

Change 1 – Exemptions under Harsh and Uncontainable Situations

Get ready for changes in The MIPS

CMS owns the fact that extreme conditions can affect gathering, storing and submitting patient information. Hence, in 2019, it gives more space to such clinicians under intense circumstances. According to Clinician Today, in the performance year 2017, the clinicians were not scrutinized for any lack of information if they had to face extreme conditions such as California wildfires.

The automatic exemptions expect to continue going forward in 2019. God forbid, if there are any acts of God or natural disasters, as a MIPS reporting physician, CMS will not put you on a penalty list. First, we pray that neither a flood nor a wildfire breaks around your practice. Second, choose P3 Healthcare Solutions MIPS consulting service for Quality measures and reporting other categories properly 1-844-557-3227.

info@p3care.com is the address you’ll be emailing your queries to.

Change 2 – Expect an Increase in the Weight of the Cost Category

As the Medicare reimbursement model transforms into the value-based care model, MIPS in healthcare will have the cost category hold more weight than in 2018. It was at 10% of the total weight in the previous year and it is going to stay that way or go higher in 2019.

Clinician Today mentions that the cost category is going to accommodate 30 percent of the total MIPS score (CPS) by the year 2022. By preparing early and maximizing on this category, your practice can achieve a decent MIPS final score. Consequently, everything falls in line with quality-based care.

To maintain the balance between categories, expect a formidable decrease in the weight of the Quality category at an equal level.

Change 3 – Expansion in Low-Volume Thresholds (LVT)

A Low-Volume Threshold (LVT) depends on the number of allowed Medicare Part B charges and the number of patients cared by an eligible clinician. There is a consistent increase in the LVT in subsequent years until 2018. And, 2019 is not going to be any different.

Currently, the LVT has more than or equal to 200 Medicare patients or your practice/group has billed more than or equal to $90,000 in Medicare Part B allowed charges. It was an uptick to MIPS 2017 requirements of 100 Medicare Part B patients or $30,000 Medicare Part B allowed charges.

You may not be eligible in the past year, but there is a high probability of your eligibility for MIPS submissions in 2019. Therefore, be well aware and as soon as you reach the Low-Volume Threshold, P3Care being an MIPS qualified registry, reports on your behalf so that you receive high incentives.

Change 4 – MIPS Cost Category to Experience a Boost

We can see the cost category weight rise to 15% in 2019. MIPS 2019 reporting is not going to be a child’s play because the focus on trimming healthcare expenses is now more than before. CMS suggests adjusting this raise by offsetting the Quality category from 50 to 45%.

Hence, be on the lookout for any changes in government regulations around Medicare reimbursements! Quality reporting aims to improve healthcare delivery and better compensation to physicians.

We try to give you insight into the world of medicine as it crosses paths with medical billing. P3 Healthcare Solutions deals with the revenue cycle management process efficiently when it comes to MIPS consulting and medical billing service in general. One remedy to stay updated with the latest Medicare MIPS reporting requirements is to follow the company page on LinkedIn – 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

Qpp Mips Penalty for late reporting

Small Medical Practices Can Save Themselves from QPP MIPS 2019 Penalty

QPP MIPS participation offers a golden opportunity to target incentives and bonuses. Especially when the CMS has been favoring and rewarding small medical practices then why not take advantage of this chance.

Small Medical Practices! If you’re wondering how to play safe and avoid a penalty in MIPS 2019 reporting. We have come up with a few tricks that help you to achieve your goal.

The first step would be to check the eligibility status of the small group. Verify your Tax Identification Number (TIN) under which you’re participating.

You can enter your National Provider Identifier (NPI) on the QPP Participation Status Lookup Tool https://qpp.cms.gov/participation-lookup to know about the details.

Reporting for MIPS Quality measure is crucial in MIPS 2019 reporting, and it is a requirement that can’t be missed. Therefore, submit data for at least one patient that fulfills all the quality performance requirements with six quality measures.

Physicians are required to report data for “Improvement Activities” (completed for ninety days) with two medium or one high-weighted measure of the respective category.

While reporting for MIPS performance categories, make sure to document every procedure accurately. For Instance, while reporting for medication, document procedures with the up-to-date list of medication.

Small Practices! MIPS 2019 reporting is not complex to the extent where you can’t achieve a total of thirty points. MIPS Qualified Registry such as P3 Healthcare Solutions offers affordable packages for QPP MIPS reporting. If you don’t find any way out, consult us for a FREE consultation. Read more in this article.