Posts

MIPS reporting, medical billing services, Credentialing Services, medical billing companies

Credentialing Services Is More than Just Data Verification

The Healthcare industry cannot evolve without automated solutions. Nor can we restrict the implementation of technology in everyday operations. From patient treatments to data transmission in MIPS reporting to catering to everyday administrative load, technology is making rounds everywhere. Even medical billing services cannot subdue the importance of digital healthcare innovation.

Thus, technology is where helping to improve the care-coordinated system; it is also helpful in simplifying the verification system for clinicians.

Credentialing Services

Not many patients know about the credentialing process. Moreover, many physicians also do not pay attention to this process. Often patients only get to know about their physicians’ qualifications via the degree hanging on the wall.

The irony is that patients are most vulnerable when they go to a physician’s clinic. They are handing over their life to them. They must know that their physician is qualified enough to treat their condition. However, we also know that understanding confusing terms is not possible for many of us. Therefore, when experts credential physicians, it gives stakeholders peace of mind.

Credentialing Process Is a Must for Safe Healthcare Industry

Credentialing allows patients, medical billing companies, and payers to put their trust freely in physicians. There is nothing to worry about when experts verify their experience, qualifications, healthcare plans, and other respective credentials through a strict and systematic process.

The surge of telehealth and other advancing technologies have made us realize the worth of credentialing more than ever. Especially after the pandemic, the healthcare industry needs to be more careful with technology use and resource consumption.

Why Many Physicians Hesitate From the Credentialing Process?

The credentialing process is considered tedious among the physicians’ community. Doctors, nurses, and other healthcare professionals do not want to indulge in manual paperwork. However, technology has been kind for all fields, and with the electronic method, the verification process is made easy. Eventually, it reduces the burden on all stakeholders.

Credentialing Process Help with Patient Volume

Unfortunately, many Americans lose their lives each year due to medical errors. With a credentialed doctor, we can be sure of the caregiver’s expertise.

Moreover, credentialing services also help:

  • Improve the reputation of medical practices
  • Enhance patient outcomes
  • Reduce patient safety hazards

Large Medical Practices Must Ensure Credentialing Process

Credentialing in healthcare is a way to increase patient volume because, with a good reputation, you get more opportunities. Moreover, you do not compromise on the value-driven healthcare solution. It is a win-win situation for both physicians and patients.

Unfortunately, hospitals overlook the need for credentialing, which can cost a streamlined quality healthcare approach. They only look into physician’s details briefly at the time of hiring. The administration pays no attention to continuous or strict monitoring to avoid complications later on.

What is the Solution?

The good news is hospitals can outsource professional credentialing services as per the cost estimation. Without a doubt, it will assist in the expansion of the medical practice while meeting its benchmarks. We can also observe reduced care expenses, which is great for QPP MIPS reporting.

In short, credentialing from experts implicitly adds to the quality of care and aligns organizational goals with the industry standards. Thus, every medical practice must invest in the credentialing process to accommodate industry changes to expand as a medical practice.

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

MACRA MIPS – What it Means for Physicians?

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

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

Key Elements of QPP MIPS

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

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

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

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

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

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

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

MIPS Full Form in Healthcare

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

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

What Physicians Can Get from MIPS Reporting?

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

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

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

Should Physicians Report Data Despite Corona Pandemic?

There are lots of benefits if MIPS eligible clinicians choose to report data despite hardships.

For instance, MIPS incentives and bonus pool worth $500 million are worth a try, and reputation on Physician’s Portal can help to improve patients’ volume. However, it all depends on how individual clinicians, groups, and virtual groups, report data to CMS.

The first rule is to deeply analyze your strengths and select MIPS Quality Measures that are most suitable for the medical practice. The more specialty-specific measures you report, the more chances you have for maximum points. Consequently, a smooth revenue cycle management is what you all get at the end of the reporting period.

How to Report MIPS Data?

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

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

Conclusion

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

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

QPP MIPS, MIPS 2020 performance, MIPS Qualified Registry, healthcare services, submit MIPS data, healthcare system, MIPS reporting

Flexible Medicare MIPS Reporting Options Available Amidst Corona

In the last quarter of 2020, CMS (Centers for Medicare & Medicaid Services) announced the performance scores for clinicians of QPP MIPS 2019 on its official site.

Clinicians who participated may review their MIPS 2019 scores via a secure portal allotted to them. That along with your participation in MIPS 2020 reporting is going to add up to your revenue. God willing, you deserve every bit of it!

Ordinarily, the performance scores depict the percentage by which clinicians receive positive, negative, or neutral payment adjustments. However, for 2019, payment adjustments will be furnished in the year 2021. Once you have them, you are all set for incentives in 2022.

Review Window for MIPS 2019 Is Closed Now

October 5, 2020, was the last date to check and challenge the MIPS 2019 performance score. During this period, individuals, groups, virtual groups, and even APM (Alternative Payment Model) participants can apply to review their score, if they disagree with it.

There was no special requirement to review data. With the same credentials, you submitted data, you could check the performance score.

It is to be noted that it is the best approach to check feedback. Due to the pandemic, CMS enforced a policy to not penalize any physician, who could not submit data in the previous year.

(If you submitted data through MIPS Qualified Registry, they can review feedback on your behalf.)

Check Points for Performance Review

QPP MIPS is one of the incentive payment models with a goal. It accounts for quality healthcare services, that CMS recognizes and rewards for.

The performance review period allows seeing if your data is being reviewed properly or not.

Mostly, physicians who submit MIPS data through a MIPS Qualified Registry have an idea of their final score. Because registries like ours possess the right resources who follow a set roadmap to report quality measures, and in doing so, they can predict the scores.

Hence, QPP MIPS data submission through a qualified registry takes your stress away. You already become aware of your final score, and even strategize to maximize performance.

You can see the following situations while reviewing the MIPS performance score:

  • Errors or quality data loss in the MIPS submitted performance quality measures.
  • Eligibility and special status issues (Example: low-volume threshold performance).
  • Not being listed in the APM participation, thus, not being reviewed.
  • No performance categories reweighted although you qualify for automatic reweighting under the CMS extreme and uncontrollable circumstances clause.

Relaxations for QPP MIPS 2020 Data Submission

COVID-19 has overburdened the healthcare system beyond its handling capacity. Doctors do not have time to compile necessary data as per the CMS requirements.

In such tough times, CMS offers flexibility to ease out the administrative load. The option for applying for “the Extreme and Uncontrollable Conditions” was available until December 31, 2020. However, the deadline for MIPS 2020 submission still has some time left. If you are among the practices, that are eligible yet non-compliant, P3 may submit on your behalf. It protects you from a 9% penalty while brightening your chances towards 5% MIPS incentives.

Flexible Reporting Options

AMA (American Medical Association) requested CMS to offer flexible QPP MIPS reporting options and other incentive payment models.

Eligible physicians can choose not to be scored against “Cost” and “Quality” measures. In such a case, CMS only analyzes their performance based on “Improvement Activities (IA)” and “Promoting Interoperability (PI)” MIPS performance categories.

What More to Expect?

CMS is working alongside AMA to address issues related to QPP MIPS data submission during the COVID-19 pandemic.

We, stakeholders of the healthcare industry, can expect improvement in the Medicare payments and flexible regulatory guidelines. Let’s see how it goes for MIPS 2020 and the upcoming years.

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

P3Care Investigates: QPP MIPS 2021 Proposed Rules

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

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

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

How MIPS consultants take care of the administrative data to report to the authorities affects revenue cycles. How to report MIPS data is what add to your revenue year after year, especially for clinicians associated with Medicare.

Physicians Services Translate into Patient Care

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

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

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

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

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

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

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

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

MIPS Value Pathways (MVPs)

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

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

APM Performance Pathways

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

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

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

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

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

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

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

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

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

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

Cost Category: Weighs at 0%

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

QPP MIPS Program Updates

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

Physicians have the option to report QPP MIPS as:

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

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

APM Participation

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

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

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

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

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

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

Let’s get started!

Proposed Sunset of Web Interface Mechanism

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

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

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

Crucial Changes in APM Reporting

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

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

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

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

ACO (Accountable Care Organization) Reporting

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

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

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

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

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

Conclusion

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

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

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

healthcare providers, medical practitioners, HIPAA Privacy and Security, HIPAA Security Guidelines, Telehealth Communication, healthcare workers, telehealth services, HIPAA regulatory requirements, HIPAA Compliant, MIPS reporting, QPP MIPS, MIPS 2020, QPP 2020, HIPAA medical billing, telehealth medicine

COVID-19: HIPAA Security and Privacy Guidelines Relaxed for Providers

The Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services has announced relaxation in HIPAA rules for covered entities and business associates who participate in good faith in the COVID-19 testing site operation.

It doesn’t stop there, but HIPAA penalties won’t apply to covered healthcare providers for practicing telehealth medicine using third-party applications such as Skype or Facebook Messenger. OCR exercises its power to stall some of the HIPAA provisions, momentarily, in connection with the good faith provision of telehealth during the state of a national health emergency.

Provided we stand in the middle of an epidemic and our country is under attack, rightly so, such steps seem to be the only way out. Governor, Andrew Cuomo, of New York State, was a constant media personality during this crisis briefing us on developing stories every day. He was relentless in front of an unseen enemy.

The fact is, OCR holds the right to exercise enforcement discretion, and they did so on April 9 in an immediate press release. It goes to show their determination to eradicate the novel coronavirus from the US. Also, it speaks of their active role in the recovery process.

Director OCR, Roger Severino, narrates and I am paraphrasing it; It is time to empower medical practitioners to serve patients across the United States during this public health emergency period. We are concerned about the health of the vulnerable the most, including older Americans and persons with disabilities.

Why the Relaxation in HIPAA Rules?

First, the HIPAA rules were relaxed to provide immediate assistance to healthcare providers, including some large pharmaceuticals and their business associates that would like to participate in community-wide testing site operation. Second, it is officially called the Community Based-Testing Site (CBTS) operation. In short, it involves mobile, drive-through, and walk-up sites where they would conduct COVID-19 specimen collection or testing in abundance.

Before COVID, telehealth products had to follow the HIPAA Privacy and Security Guidelines. Now that this virus has spread all over the country, to stop it, the exception of extreme circumstances comes into play and brings flexibility to those guidelines.

In a time, when doctors are overburdened with the surge of patients, the administrative burden can only add to their worries. Therefore, CMS and OCR on their behalf have given breakthrough in strict conditions.

However, it doesn’t mean that HIPAA has been totally swept under the carpet. The importance of HIPAA cannot be undermined, and risking data is not compensable.  It’s just that the strictest rules are made flexible for guanine reasons.

What Products Are Safe for Telehealth Communication?

healthcare providers, medical practitioners, HIPAA Privacy and Security, HIPAA Security Guidelines, Telehealth Communication, healthcare workers, telehealth services, HIPAA regulatory requirements, HIPAA Compliant, MIPS reporting, QPP MIPS, MIPS 2020, QPP 2020, HIPAA medical billing, telehealth medicineProviders don’t have to worry about which products to use as long as they are not public-facing software applications. Products like Facebook Messenger, Skype, Apple FaceTime, Google Hangouts, or Zoom are good to go for care audio & video chats.

While you can use the above applications, some applications such as TikTok, Twitch, and Facebook Live come under the public-facing criterion. It means they are not permissible.

Therefore, before dispensing care, use applications in the allowed category.

As the nation is in dire need of healthcare workers, OCR exercises enforcement discretion for care to reach the farthest areas of the country in connection with the good faith provision of telehealth services. It means providers won’t face penalties in case of non-compliance with HIPAA regulatory requirements.

HIPAA Compliant Technology Vendors

Since malpractices in desperate times have their odd way to creep in, it is best to choose technology vendors who are HIPAA compliant. In addition, they should be willing to enter into a business associate agreement (BAA) with the provider. As a result, any audio or video communication that occurs through such vendors will not result in an intrusion or put PHI at risk.

The following list of vendors provide a haven for secure telehealth services; moreover, they are HIPAA compliant and willing to enter into a BAA with covered entities.

  • Skype for Business / Microsoft Teams
  • Updox
  • VSee
  • Zoom for Healthcare
  • me
  • Google G Suite Hangouts Meet
  • Cisco Webex Meetings/Webex Teams
  • Amazon Chime
  • GoToMeeting
  • Spruce Health Care Messenger

Now, that is the list of software for safe and complaint-friendly audio and video communication.

A word by OCR

OCR doesn’t endorse, recommend, or certify the above applications but simply suggests their use for guidance. It has not reviewed the BAAs that they have come up with. In reality, there may be other vendors out there who are HIPAA compliant and willing to enter into a BAA with a covered entity. The names above do not suggest any kind of affiliation with the above-mentioned products.

P3 as a business associate comes under the obligation of HIPAA too. We are, in fact, trying to help our healthcare heroes as best as we can by the use of HIPAA rules. One of our services, security risk analysis, uses HIPAA to conduct a risk assessment of practices. In addition to that, HIPAA medical billing, our principal service, follows the provisions of HIPAA accordingly. As providers make their way out of the pandemic, we are here to support them on every twist.

Please hit the follow button on Instagram for more insights: @p3healthcaresolutions

Medicare MIPS Reporting Essentials for Physical Therapists

Physical therapists (PTs) are now a breathing part of the Quality Payment Program (QPP). It is a choice they have to make because they can’t back out. Medicare MIPS reporting through a MIPS Qualified Registry or an EHR system can get them through the maze of value-based care smoothly.

Primarily, they have an option to choose between the Merit-Based Incentive Payment System and an Advanced APM. Though AAPMs have a strong influence over clinicians, the popularity of MIPS as an incentive program considerably outweighs it. Therefore, MIPS is the go-to program for most eligible PTs.

Now, PTs who do not meet the low-volume threshold (LVT) can participate voluntarily.

Why?

They must be prepared for what lies ahead and no better way to do it than participating in it.

Medicare MIPS Reporting for Quality and IAs

The good news for PTs is that they are NOT required to report in all the four performance categories. Instead, they are required to report in only two – Quality and Improvement Activities.

Fewer categories mean they have a decreased number of measures to report to CMS. With all the focus on MIPS Quality measures and IA measures, they are more than capable to score high and handsome. It also keeps them very much in the game without the possibility of burnout.

A yearlong report against Quality determines the final score, failing to do so; there are consequences in the form of negative payment adjustments.

Medicare MIPS reporting best happens through certified electronic health record technology (CEHRT) or MIPS Qualified registries such as P3 Healthcare Solutions.

Advanced APM Participation Track

Physical therapists who follow Advanced APM as their participation track cannot go after Medicare MIPS reporting. At one time they can only utilize one track.

They can expect an additional reward of +5% to your Medicare earnings of 2019 if the reporting results are at par with the benchmarks set against measures. Additionally, the high scorers have a chance to collect bonus rewards from the $500 million pool.

While PTs become an active part of the value-based payment system, the removal of functional limitation reporting (FLR) is a healthy change adopted by CMS.

P3Care Reports for PTs and PTAs

The submission of MIPS data is unlike any other data submission. It requires your NPI/TIN and account creation on the QPP portal. Health IT consultants at P3Care activate your accounts with ease and with mutual collaboration, we get to report to CMS on behalf of our clients. In short, accuracy is the key to it. They happen only once so make sure they are errorless.

What about Telehealth?

The final rule doesn’t allow PTs to be reimbursed against Telehealth. The virtual check-ins by physicians and specialty-specific clinicians call for timely reimbursements; moreover, P3Care backs the initiative of Telehealth for PTs and PTAs. Who knew the year 2020 would make Telehealth a necessity rather than an alternative.

Direct Submission Method

PTs can use the registry method for direct submission. For it to happen smoothly, MIPS Clinical Quality measures (CQMs) has to be the collection type. Medicare MIPS reporting 2019 returns optimum results if you are both accurate and smart in terms of selecting high scoring measures.

Generally, outcome measures and high-priority measures hold significance in achieving bonus-worthy scores. They, eventually, turn into financial rewards.

For small practices, individual clinicians and clinician groups can collect and submit measures for Quality through Medicare Part B claims.

Groups with 25 or more clinicians may use the CMS web interface for Medicare MIPS reporting.

Deadline for the QPP 2019 Program

MIPS eligible clinicians have time until March 31, 2020, to submit data for 2019. In addition, if your mode of submission is through claims, you have until 60 days after the closing of the performance year.

Improvement Activities (IA)

For PTs and OTs, the category holds 15% weight in the total score. It estimates 40 points and only the top-performing clinicians will be able to reach that number. The improvement activities you should consider reporting to CMS are –

  • Care Coordination
  • Patient safety
  • Beneficiary engagement
  • Participation in APM
  • Achieving health equity
  • Emergency preparedness and response
  • Population management

However, take note of the number and format to report in the following classifications.

  • Two high-weighted measures
  • One high-weighted measure and one medium-weighted measure
  • Four or more medium-weighted measures

After the selection of activities to submit, you are ready for Medicare MIPS reporting through QCDR, Qualified Registry, or an EHR system. For those interested in the MIPS attestation process on their own, they can submit activities by logging on to the QPP portal.

Do you think you can gather data and report on your own or is it better to hire third-party intermediaries?

Reply in the comments below, as we’d love to hear your thoughts.

CMS, QPP, MIPS, MIPS quality measures, quality payment program, healthcare organization, MIPS reporting, MIPS 2019

How MIPS Can be an Acceptable Program For Clinicians?

The argument that CMS needs to improve MIPS is a thing of the past. Now, the focus is on how to devise ways that actually implement the change and stand true to its promise of a better healthcare system.

Let’s admit there is no standard way for any quality payment program to hit bull’s eye in its starting years. When a program is initiated and tested in a real-time environment, it gives insight on the actual performance and capability of the program; the same is the case with MIPS. Since, its first year in 2017, physicians are raising questions against the payment model.

Many leading healthcare organizations have proposed ideas that might help CMS to overcome MIPS related issues.

Reduce Un-Necessary Administrative Work

It is observed that there is a lot of administrative work associated with MIPS reporting. There is a lot of data that needs to be collected and managed to submit to CMS. One reason is the primary care and the value-based medical services that quality measures cover. This program can serve to be more physician-friendly if clinicians are not burdened with extensive administrative work.

MIPS solutions consist of elements from three major programs:

  • Physician Quality Reporting System (PQRS)
  • Value-Based Payment Modifier (VM)
  • Meaningful Use (MU)

CMS is working in this context and simplifying this quality payment program with the easy amalgamation of all elements.

However, clinicians are not satisfied and still face administrative burdens while quality reporting. Most of the physicians have reservations regarding the relevance of MIPS quality measures to the program. Quality measures have been a special concern for surgeons because they have been evaluated on patient’s immunizations. This approach is particularly un-necessary for surgeons and reflects poorly on the intention.

The past president of The American Medical Association (AMA) David O. Barde, has provided a list of suggestions in this regard.

  • Reduce the number of measures for which a physician can report.
  • Re-expand the definition of a facility in MIPS reporting to include all healthcare service providers; no matter wherever they are, such as post-acute care centers.
  • Set a 90-day performance period for all MIPS measures.
    This way, physicians will be able to invest their energies in the right direction that is, on their patients.

Rethink and Modify Promoting Interoperability (PI) category for MIPS

Promoting Interoperability (formerly known as Advancing Care Information (ACI)) performance category tests physicians’ patience the most. Via this category, CMS has tried to encourage physicians to incorporate certified usage of EHR technology.

According to some physicians, this category focuses entirely on EHR technology, instead of actual advancement in the healthcare system. However, they need to shift their focus on the actual usage of technology and to translate digital health information on the patient level. Only this way, the PI category will stand true to its name.
The reporting requirements for this quality measure should also be modified to make this category more useful for physicians.

Here’s the good news, right from this year MIPS 2019, certain changes are observed for the PI category, which is expected to improve the overall performance of this category.

If physicians strive to score high in this category, they must take measures to perform well in the following sectors.

  • E-Prescribing: Computerized generation, transmission, and filling out of medical prescription
  • Secure health information exchange
  • Giving easy access to patients to their healthcare information
  • Public health and clinical data exchange: Exchanging data between different stakeholders/healthcare organizations.

Eligible clinicians don’t need to invest a fortune to excel in specific categories. But, a little improvement can add huge points to the MIPS total.

Make Use of the “Opt-In” Policy

MIPS has the potential to bring advancement in the healthcare industry. However, with the final rule of QPP for MIPS 2019 in motion, around 58% of the physicians are already excluded to even participate in it. But there is a new policy in town, making waves in the clinician fraternity, adopting which, those who are still outside the bounds of MACRA and MIPS will be able to participate.

According to CMS, the year holds comparatively doable reporting requirements as well in an effort to reduce physician burnout. By the introduction of the “Opt-In” policy, clinicians can now participate in the program and win rewards as if they were eligible for it.

Generally, the program shows some flexibility toward small medical practices with fewer resources by making their reporting requirements slightly easier than those of large practices. Hence, there is a good chance they get the most out of MIPS 2019. Moreover, it stirs the air in the US healthcare industry and encourages physicians to be promoters of value-based care.

As MIPS 2020 reporting has become a mandatory subject for physicians for the sake of quality care and low costs, patient portals are also an essential topic worth discussing, nowadays. We wrote an article to cover this topic for our audiences. If you want to read it, click over here: MIPS Quality Measures 2019 Vs. 2020 – Registry Investigates

MIPS 2018, Healthcare system, MIPS incentives, MIPS in healthcare solution, MIPS reporting, MIPS quality measures

What Is About MIPS That Is Making Physicians Unhappy?

This ongoing period is the MIPS 2018 reporting season! Physicians and MIPS consulting services have buckled up their shoes to assemble appropriate clinical data that best favors medical practice in terms of financial matters and physicians’ reputations.

MIPS QPP promises physicians to take their financial journey one-step more towards the progressive road leading to a better healthcare system. The eventual objective is to build a healthcare system that makes both patients and physicians happy; patients with value-based care service and physicians with accurate reimbursements, incentives, and bonuses.

From the past two years, physicians tend to have several reservations regarding MIPS. In their first year, they were not sure about reporting criteria and MIPS quality measures. However, for MIPS 2018 reporting period, physicians learned from their mistakes and performed to actually use this system to their benefit.

MIPS Quality Measures Are Huge Set Back for Physicians

Even though, CMS acted upon some reservations for 2018. Still, there are voices raised against MIPS 2018 to trap physicians within the penalty cycle that ultimately will lead to poor-quality services for patients.

  • According to the research of members of the American College of Physicians, around 37% of the 86 MIPS quality measures are not up-to-the-mark and can’t contribute to improved quality care standards.
  • Physicians also explained that the given measures are not meaningful. In addition, the investment made to improve the quality of these measures just increase the administrative cost.

Approximately, medical practices are spending $15.4 billion per year in the USA-healthcare industry that means about $40,000 per physician to report for MIPS.

There is a debate whether MIPS quality measures for the industry’s improvement are worth investment or not. Because, if they are not good enough, they are just a waste of money on the patient’s behalf.

For Instance,

According to Dr. Catherine MacLean (lead author of the analysis and chief value medical officer at the Hospital for Special Surgery), there is a quality measure that ensures all patients have a blood pressure of 140/90 or lower. However, this may be lower for some patients.

The Medicare Payment Advisory Commission has raised similar concerns. Therefore, Problematic areas of MIPS need to be overcome in order to improve healthcare quality standards and the payment model.

CMS Website Should be Updated on a Regular Basis

Moreover, physicians were facilitated with an online database to view their status. However, the CMS website doesn’t update on a regular basis. This may have led physicians to not meet reporting standards on time. All of the practices rely on the information provided by CMS. If data is not updated duly on the site, how will physicians ensure the accuracy of MIPS requirements? After all, the ultimate burden would have to be bear by physicians as a penalty or less MIPS score.

CMS is trying to Rectify Errors in MIPS!

According to the spokesperson of the CMS, they are very dedicated to looking into every issue that is a hurdle in raising the quality levels of the healthcare system.

MIPS Success Depends Upon How Much CMS Pays Attention Towards Reservations!

The MIPS 2018 performance period is over however, it is compulsory for CMS to render each problem that is making physicians unhappy, rather than, forcing them to report aimlessly without any attraction.

Another way to ensure success in MIPS reporting is via hiring a professional MIPS consulting service as P3 Healthcare Solutions that provides the best MIPS solutions.

MIPS&MACRA, MIPS in healthcare, MIPS reporting, MIPS 2019, MIPS quality measures, MIPS qualified registry

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 for 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 a 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 and to provide quality billing services to clinicians.

Healthcare system, MIPS 2018, MIPS Quality measures, MIPS in healthcare, MIPS reporting, MIPS data submissions

P3CARE Offers What Physicians Exactly Want!

The Healthcare industry is evolving at a fast pace. This revolution has led all stakeholders to adapt to unconventional ways of attending to patients. Moreover, the MIPS payment model has turned the quality of medical services upside down. It serves to comprehend the importance of valuable health services along with the financial needs of physicians.

P3Care isn’t a new name and been known as a legendary MIPS qualified registry in the competitive industry. Their focus is entirely on accurately reporting MIPS to support and uplift revenue cycle management (RCM) for medical practitioners. The reporting pattern is so precise that saves physicians from penalties and makes them eligible for incentives and bonuses.

Getting a star rating from a physician compare portal is not any problem for their professionals. The Centers for Medicare and Medicaid (CMS) and the National Committee for Quality Assurance (NCQA) monitor and ensure the quality of medical service and reward accordingly. P3Care is well aware of their standards and help physicians to get a prominent position in the healthcare industry.MIPS qualified registry

How P3Care’s MIPS Reporting Services Credit to a Physician’s Success?

The Efficient MIPS Consulting Service

MIPS has been operational for two years now. It has changed quite a lot in terms of higher standards and reporting requirements. The threshold for eligibility and penalty prevention is also increased as compared to last year.

The reporting experts at P3Care are experienced and trained enough to recognize the tricks and tactics that can benefit in higher MIPS scores. Preventing physicians from penalties is not their goal. Rather, they aim for incentives to increase revenue and get appreciation in the respective industry.

What Makes P3Care Different from Others?

When you have the goal of helping physicians and hospital systems to accomplish their objectives in the first place, your efforts should match respectively. P3Care no doubt possesses this quality.

It doesn’t matter if your practice is a small-scale or a well-established one, maintaining the balance of eligibility for higher points without putting too much pressure on practice to spend more, is an art. And, P3Care is a pro in this field.

  • The credentialing specialists at P3care ensure your legitimacy and enable you to get the rightful fame in the healthcare industry.
  • They spend quality time understanding the services you offer to patients and suggest improvement methods in your system.
  • From a budget point of view, they are very flexible and report clinical data as per your expertise.
  • Moreover, only by understanding your medical expertise, they plan and select the right MIPS quality measures to confirm that you get more MIPS points.

HIPAA – Compliant Medical Billing Services

P3Care is a renowned qualified registry for the last two years. However, it is also known as a leading medical billing service in the USA. Gone are the times when creating medical bills was that simple. Ensuring the patient’s and physician’s privacy is equally important. Therefore, HIPAA – compliant medical billing services serve the purpose.
Using the latest technologies such as; EHR technology to target Medicaid Meaningful Use (MU) and protecting the private information is their expertise. Patients feel secure and trust healthcare providers for the confidentiality of their data.

They have separate dedicated teams for creating medical claims and submitting to payers and reporting clinical data to CMS, according to the requirements.

P3Care – Your One Stop Place for Reporting Services

Many happy and satisfied clients testify P3Care performance. According to the founder of SunCoast, RHIO, Lou Galterio stated in a telephonic interview for Clutch. Co that his experience with P3Care has been immensely amazing! Their team is dedicated and leaves less room for error.

If your practice is unable to improve revenue cycle management and can’t find a break-through for a penalty-less spot, consult P3Care services and experience what it likes to be in a prominent position in the healthcare system.