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Surgeons: Tips for Successful MIPS 2020 Reporting

One thing that we learn from the year 2020 for sure is uncertainty. COVID-19 pandemic has left us in a state of doubt, where we can’t be too sure of our present, and, clearly, not the future.

QPP MIPS reporting program of 2019 also had to face delays due to this catastrophe with overburdened staff, doctors, and suppliers associated with them any capacity. The closing date for MIPS 2019 went one-month further to facilitate clinicians busy dealing with the surge in COVID-19 patients. It was indeed a rollercoaster ride for them from the very first day.

MIPS 2020 reporting, however, is still very much happening and clinicians are required to submit data as individuals, groups, and virtual groups to receive positive payment adjustments. One of the ways to receive incentives is to score above 45.

Contrary to the previous years, MIPS 2020 program requires clinicians to submit data for all the reportable categories and avoid negative payment adjustments. Regardless of the method you use, it is not possible to score above 45 by submitting only the Quality measures.

  1. Check Your Participation Status

The first thing to do while reporting MIPS 2020 is to check whether you are eligible for the program or not. Special statuses qualification also awaits certain surgeons. Once you are there, include your NPI to display the required participation status.

Surgeons with special statuses may get bonus points and also have their categories reweighted.

Physicians can outsource MIPS 2020 reporting to a MIPS Qualified Registry. They will ask you for the required information and check your eligibility status from the CMS portal.

  1. Select Quality Measures Carefully

Instead of being casual about the Quality measures, my next tip is to be careful about them. It is crucial to choose only those Quality measures with benchmarks that do not limit your points that you may score on that measure.

For example, many surgery-driven measures are topped-out, and you can score as much as 7 points through them, which may tempt you to look for other measures, outcome measures, or high-priority measures resulting in bonus points.

A MIPS Qualified Registry makes the quality measures selection easy for you. Physicians do not have to stress upon looking into the list of measures, but an experienced team conducts analysis on your expertise and picks out the most appropriate measures.

  1. Participate in COVID-19 Clinical Trials Improvement Activity

While the COVID-19 pandemic has left us with many questions, it poses a challenge to humanity as we speak. Thankfully, MIPS 2020 reporting, now, has a new high-weighted COVID-19 clinical trial activity. Accordingly, it adds to the total scores for MIPS eligible clinicians. While it is an opportunity to score high, it can help you receive recognition for the COVID-19 breakthroughs.

The two ways you can utilize this IA and receive credit for it:

  • Participate in a COVID clinical trial and have that data become part of a data portal for an ongoing study; or
  • Caring for COVID patients, you may submit clinical data to the clinical data registry for future references.

National Institutes of Health (NIH) hold Covid-19 clinical trials, and that is where participation starts. The goal of this Improvement Activity (IA) is to innovate and improve the collection of COVID-19 information that the clinicians have and develop best practices in patient care as COVID-19 drags on.

Let’s hope for the best outcomes shortly. MIPS Qualified Registries submit measures for all the reportable measures. Therefore, signing up with one of those registries is a good start.

Scoring Cases for Clinicians with Special Statuses

The cost category is excluded from the examples below because the category uses complex claims data to calculate scores.

  • Scoring example for clinicians who are eligible for PI exemptions

    • 25% of the weight of the PI category transfers into Quality, reweighting it to 70% of the total score.
    • (26 measure points in Quality are equal to 30 MIPS points approximately) + (IA’s complete submission is equal to 15 points) = 45 points
  • Scoring example for physician groups of 15 or fewer

    • If they report at least one Quality measure, they receive six bonus points for the Quality category.
    • (20 measure points + 6 bonus points in Quality = around 30 MIPS points) + (IA’s complete submission is equal to 15 points) = 45 MIPS points

Recommendation of the American College of Surgeons

45 is the safest score for MIPS 2020 submissions regardless of the method you use. Moreover, the American College of Surgeons recommends the above techniques to score higher. In addition to that, clinicians breeze through the compliance program.

There are no changes in eligibility status and opt-in determinations. The criteria are simple, and with the COVID situation going on, MIPS eligible clinicians can also report their preparation and planning in regards to receive reimbursements.

The threshold is certainly high this time, but clinicians who are prepared and have good specialty-specific measures to report can show outstanding performance.

So then, there’s nothing to fear. It’s just a program for clinicians to get incentives as a reward to improve their quality care delivery.

How CMS determines MIPS eligibility?

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How CMS Determines MIPS Eligibility?

The QPP MIPS participation starts from knowing the eligibility status. For MIPS 2020, clinicians can check eligibility via QPP Lookup Tool. Later on, CMS updates the eligibility status that if physicians can report data to them or not.

However, the reporting requirements change each year due to changed policies.

 MIPS 2020 Eligibility Check Requirements

According to the official website, interested clinicians must have:

  • National Provider Identifier (NPI)
  • Associated Taxpayer Identification Numbers (TINs)

A TIN is required when you own a practice; belong to a hospital as a medical facility or a medical practice.

In the case of physicians’ reassignment of Medicare Billing Rights to TIN, their NPI gets associated with that TIN, referred to as TIN/NPI combination. For Instance, if any physician has assigned billing rights to multiple TINs, he/she will have multiple TIN/NPI combinations.

CMS assesses TIN/NPI combination for MIPS eligibility and use TINs for practices’ eligibility.

Eligibility Determination Period of MIPS

CMS looks into past and current Medicare Part B Claims and Provider Enrollment, Chain, and Ownership System (PECOS) data for clinicians and practices, each year twice.

Data analysis from the first segment is referred to as preliminary eligibility. Data from the second review are then attached to the first segment of data and presented for final eligibility determination. The requirement is to pass the Low-Volume Threshold (LVT) during both reviews.

What is Low-Volume Threshold (LVT)?

LVT includes three aspects of professional healthcare services as follows.

  • Allowed charges
  • Number of services provided
  • Number of Medicare patients who receive services

Other than exempt cases, physicians are required to participate in QPP MIPS 2020, if they:

  • Bill above than $90,000 for Part B covered professional healthcare services
  • Check more than 200 Part B patients
  • Offer above than 200 covered professional healthcare services to Part B patients

It is to consider if physicians report Medicare Part B claims in the second review with a medical practice’s TIN, the eligibility status at that practice will only reflect data from 2nd review.

Who Can Participate in MIPS 2020?

CMS has an eligible clinician type. Clinicians falling into this list and satisfying all the requirements can participate in MIPS.

  • Physicians (including doctors of medicine, osteopathy, dental surgery, dental medicine, podiatric medicine, and optometry)
  • Chiropractors
  • Physical therapists
  • Occupational therapists
  • Clinical psychologists
  • Osteopathic practitioners
  • Physician assistants
  • Nurse practitioners
  • Clinical nurse specialists
  • Certified registered nurse anesthetists
  • Qualified speech-language pathologists
  • Qualified audiologists
  • Registered dietitians or nutrition professionals

MIPS Data Submission Methods

Eligible physicians can report data to CMS as individuals, a group, or a virtual group.

MIPS 2020 Participation as Individuals

For MIPS participation as individuals, physicians must:

  • Belong to eligible clinician type on Medicare Part B claims
  • Have enrollment in Medicare before the performance year 2020
  • Surpass the Low-Volume Threshold requirements
  • Not qualify for Alternative Payment Model Participant

MIPS 2020 Participation as Group

For MIPS participation as a group, physicians must:

  • Belong to eligible clinician type on Medicare Part B claims
  • Have enrollment in Medicare before the performance year 2020
  • Belong to a medical practice that surpasses the Low-Volume Threshold requirements
  • Not qualify for Alternative Payment Model Participant

The MIPS score and payment adjustment will be awarded as a group in this case.

MIPS 2020 Participation as Virtual Group

For MIPS participation as a virtual group, physicians must:

  • Belong to eligible clinician type on Medicare Part B claims
  • Have enrollment in Medicare before the performance year 2020
  • Not qualify for Alternative Payment Model Participant
  • Be associated with a medical practice that surpasses the Low-Volume Threshold requirements & is part of virtual practice

Physicians are required to report their data as a virtual group.

The above-mentioned are all the requirements that a MIPS participant should know. We are halfway in QPP MIPS 2020. Many professionals already had planned and implemented a strategy for optimized performance in the end.

If you’re an eligible MIPS clinician, the best advice to you is to concentrate on quality care outcomes. A professional MIPS Qualified Registry will take your efforts into account, and you can target more measures if you have a proper plan of action on board.

Best of luck.

MIPS, MIPS Quality measures, MIPS incentives, MIPS reporting, MIPS qualified registry, CMS, EHR System

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 physician burnout 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 lies ahead. Starting with the accountability of her team, she said she has identified the set of objectives moving forward. In fact, she stressed on quantifying and measuring progress as they go through the 16 strategic initiatives.

The Three Objectives

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CMS has a mission and a goal to achieve. According to administrator Verma, CMS is going to be relentless in their approach. In brief, they will accomplish the objectives below:

  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 as well. Not only do they ensure a high standard of care, but the 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, thus the government’s role is crucial now more than ever.

On the whole, a lot depends on nursing homes in the years to come. They are places where our seniors go on to live their lives. Their safety has to be A-grade. Similarly, when we talk about laboratory tests, a lot depends on their accuracy. It is all about dignity when it comes to 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. Moreover, they are responsible 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).

mips 2019 reporting, MIPS 2020, mips quality measures, mips qualified registry

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, the Trump administration’s stance on the quality of care in hospitals, facilities, and practices is going to be key. As a matter of fact, healthcare is going to be the difference in his win. 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. They will set measures such as 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. In short, it promotes a 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.

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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 the 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.

MIPS 2020, MIPS 2019, MIPS Medicare, Mips submission methods, MIPS submission types, Mips qualified registry, Qualified registry for mips, Cms mips quality measures, MIPS consultants, Mips consulting service, medical billing services, health IT

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.

Quality measures refer to the improved standards of care delivery and patient satisfaction, and the data completeness constraint is an extension of expending one’s expertise to most patients. The increasing performance thresholds also reflect CMS’ vision of encouraging everyone to opt for quality healthcare.

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

Although CMS requires improved quality, it doesn’t mean that they don’t want clinicians to target incentives and bonuses. You can qualify for the strict criterion with the help of a Qualified Registry and improve revenue.

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.

MIPS 2019, MIPS 2020, MIPS Qualified Registry, MIPS Quality measures, MIPS consulting firms, Medical billing

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 instructed by the American Medical Association (AMA) CPT Editorial Team. The four levels of E/M codes remain intact for new patients with five levels dedicated to 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

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. It is the practical start of the value-based care model.

Eligible clinicians (ECs) have a responsibility to report MIPS 2019; they include physicians, osteopathic practitioners, chiropractors, physician assistants, nurse practitioners, and registered dietitians or nutritionists among others. To summarize, providers are to fulfill the low-volume threshold to qualify for MIPS 2019 reporting. Moving on to MIPS 2020, your next goal has its own set of requirements.

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 in relation to this program. In fact, the following 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). Whichever path you choose, it results in incentives for eligible clinicians, clinician groups, and virtual groups.

Furthermore, MIPS & MACRA go side by side; it is the popular track with stats and reports going in its favor. MIPS incentives for 2019 are less as compared to incentives in MIPS 2020. On the whole, the program is evolving, but once it does, it will be the birth of an improved healthcare system.

It 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 of 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. It showed an increase from 95% in 2017 to 98% in 2018. Moreover, 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 Services (CMS), 90 percent of clinicians from small practices engaged in MIPS 2018 which was 81 percent in 2017. So, that’s a 9% increase.

The primary flexibilities introduced in the Physician Fee Schedule (PFS) rule for the 2018 performance year included an increase in Medicare patient count and Medicare Part B allowed charges.

What did it mean?

It meant fewer clinicians from small practices were eligible to report MIPS in 2018. On the contrary, they decided to report it anyway. It goes to show that the system adjusted itself with 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’s (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. We attribute this jump to new participation opportunities in 2018, especially through ACOs in the Medicare Shared Savings Program.

Even if we are to condemn MIPS in general, I can’t see any downside to opportunities and hope that clinicians continue to grab MIPS incentives year after year.

  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.

News

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P3 Investigates: Trump Administration Plans to Reopen Nursing Homes

P3, as a medical billing service and a MIPS Qualified Registry, keeps in touch with CMS news as it happens. CMS, yet again, informs the public of the plans, the government has for nursing homes to reopen safely with the pandemic still around. While state and local officials follow it to ensure safe beginnings for nursing homes across the country, they are a part of President Trump’s Guidelines for Opening Up America Again.

Why were the restrictions put in the first place? The government had to take stern action against nursing homes and put them under quarantine to prevent the spread of COVID-19, including severe infection prevention, ample testing, and investigation.

This plan that the government has come up with will be a guide through troubling times as life gets back to normal for nursing homes.

When stats suggest that 8 out of 10 COVID-19 deaths are of citizens 65 and above, the more careful we are the better. We owe it to the seniors of this country more than we owe it to anyone else.

By acting upon this guide, nursing homes will be able to mitigate the risk of COVID-19 exposure and prevent its spread within facilities.

In light of these issued recommendations, states should observe if nursing homes are taking the appropriate and necessary steps to ensure resident safety; moreover, they should know the right time when to reopen doors to the public.

In finality, the information you find here should support states and nursing homes bring families together, reunite them with their loved ones in a gradual manner.

Administrator Seema Verma has led from the front during the crisis; this time, she said and I am paraphrasing it; the coronavirus has had a shocking impact on our nursing homes, and as we reopen the country, we want to be sure that we are doing everything in our power to protect our most vulnerable citizens.

She continued by saying that their constant focus is on the protection and quality of life of the nursing home residents. While we reach the stage when we finally reopen, she said, we want to make sure that the communities have a set strategy moving forward.

Further, CMS recommends additional criteria for the safety of the nursing home residents since COVID-19 poses a direct threat to them as the country passes through the reopening phase. It is to complement the Trump Administration’s broader idea of the Reopening of America Again.

A nursing home, as part of the recommendation, must not advance through phases of reopening until all residents and staff have received their baseline test results.

CMS wants state survey agencies to keep an eye on nursing homes if they suffered from a serious COVID-19 outbreak before reopening.

As its final recommendation, CMS states that homes should remain in the highest state of restriction even if they see relaxation in the community around them, to ensure the preservation of lives.

Moving on, nursing homes will start taking in visitors in phase three, which will only occur when health reports show considerably less COVID-19 cases. Visitors must go through screening and wear a face-covering during the visit.

The guidance was released a couple of days back on May 18, 2020, but we thought by revisiting the recommendations, we can make a difference. P3, as QPP MIPS 2020 reporting registry, has considered it an honor to go the distance for the health of US citizens; this, specifically, goes out to seniors to whom we are grateful.

State leaders in collaboration with local health departments and state survey agencies would implement the guidance to limit COVID-19 exposure in nursing homes. Relaxation of the intense measures in a nursing home should only occur after a careful review of the following factors:

  • Number of COVID-19 cases in the local community
  • Number of COVID-19 cases in nursing homes
  • Available staff members
  • Baseline tests of all residents; weekly tests of all staff members; social distancing; face coverings
  • Presence of enough personal protective equipment (PPE)
  • Nearby hospital’s capacity

State and local leaders have a responsibility to see to these factors now and then and adjust their strategies accordingly, depending on the intensity of coronavirus spread in their vicinity. CMS is committed to taking measures that ensure the safety and revival of nursing homes.

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.