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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To consider MACRA into your practice, upgrade your outdated EHR system to the 2015 certified EHR technology edition.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 services in general. One remedy is to stay updated with the latest Medicare MIPS reporting requirements and to provide quality billing services to clinicians.

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

Take Advantage Of MIPS 2018 Reporting Standards & Score High!

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

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

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

Virtual Group Participation is now LEGAL

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

The requirement for a Virtual Participating Group

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

Low-Patient Threshold Update

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

Bonuses for Care Services of Complex Patients

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

MIPS Favors Small Healthcare Practices

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

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

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

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

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

The threshold for Penalty-Less Spot has increased

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

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

MACRA, MIPS, MACRA and MIPS, Quality Payment Program, QPP, Merit-based Incentive Payment System, Alternative Payment Models, P3Care, MIPS consulting services, Medicare billing, MIPS performance categories, MIPS score, Improvement Activities, clinical practice, Medicare providers, physicians, MIPS quality measure, healthcare services, MIPS 2017, MIPS 2019, MIPS 2021, revenue cycle management

MACRA & MIPS: A Closer Look

MACRA

Talking about MACRA & MIPS, it is important to learn that in 2016, MACRA (Medicare Access and CHIP Reauthorization Act of 2015) was officially introduced, ruling out the existing and outdated Sustainable Growth Rate method.

Previously, providers received payments based on the number of Medicare patients they provided care to rather than for the quality of care they provided. So, not only was this method was ineffective for the patients but drastic effects were observed when it came to receiving financial support for Medicare expenses. Treating a high volume of patients (quality or no quality) basically meant higher payments for providers.

MACRA established a Quality Payment Program (QPP), a method that will motivate providers to deliver well thought out quality care to patients. And it will reward them with payment adjustments. Moreover, eligible providers are able to choose one of two pathways in the QPP, MIPS (Merit-based Incentive Payment System) or APMs (Alternative Payment Models).

An estimated 500,000 providers will be eligible to participate in the first year of MIPS. Likewise, the amount MACRA will provide for positive payment adjustments is quite overwhelming, up to 3 billion dollars in the next six years! Now, let’s take a closer look at MIPS, and how P3Care can provide you with MIPS consulting services to ensure you understand how to take full advantage of this new and improved payment process.

MIPS

In order to take part in MIPS, you must meet the requirements associated with Medicare billing (Part B). Selecting this route of the QPP focuses on receiving payment adjustments based on the specific data you have submitted.

For the 2017 transition year, there are three different categories. To help better understand how CMS scores physicians under MIPS, we have specific weights per category. This will allow you to divide your attention accordingly. You will also need to determine if you are participating in MIPS individuals or as a group.

Here’s a closer look at the MIPS performance categories for 2017.

Quality

60% of the data submitted will pertain to this category; signifying the main purpose of eliminating the previous method, and implementing MIPS. Moreover, in this category, providers which practice solely report up to 6 quality measures (out of 271), which are the most associated with their specialty.

Clinicians will get scores based on the number of days they have submitted data for (read more below), along with the accuracy and completion of all the required specifications for each measure. Moreover, closely assessing each measure helps determine if clinicians achieved the high-quality healthcare goals. The total number of points earned on 6 quality measures + any bonus points will determine your final score of the Quality category.

Advancing Care Information

Taking up 25% of the total MIPS score, this category replaces the previous Meaningful Use program. You’ll need to select one of two reporting measure sets, depending on your EHR edition.

Each option includes different measures; therefore it’s essential you only report on which option relates to you. There are three subcategories that will determine you’re total score for this category, they include Base Score, Performance Score, and Bonus Score.

Failing to complete all of the requirements in the Base Score category will result in a 0 in the overall Advancing Care Information category.

Improvement Activities

The remainder of the score (for 2017) will come from the Improvement Activities category, weighing at 15%. And this category allows CMS to determine if clinicians are improving clinical practice to its highest potential.

A few key aspects include providing quality care by involving the patients in decisions:

  • Continuous coordination between provider and patient
  • Providing self-management techniques
  • Patient/family education
  • Providing follow-ups
  • Using safe technology and being reasonably accessible

You’ll have the opportunity to choose from a variety of activities, that best suit your practice, to report data on. Each activity is categorized as either has High or Medium; high-weighted activities are worth more points. Individual Medicare providers will need to submit data on up to 4 activities for a minimum of 90 days, in order to earn full potential points.

Cost

In last but not least, Cost is the fourth category, upon which CMS measures physicians’ MIPS score.

Physicians don’t have to report separate data for the cost category. However, CMS calculates this MIPS quality measure by analyzing the submitted administrative data.

For the year MIPS 2017, the cost category had a value of 0% in the final scorecard. On the other hand, in MIPS 2018, it was the first time that cost category weighed 10%. This score accounts for the lower cost expenditure while physicians provide high-quality healthcare services to patients.

Right now, we are passing through MIPS 2019, which is the 3rd year of this value-based program.  And the cost-quality measure is a significant part of this year as well. It accounts for 15% of the final MIPS score.

MIPS is running quite successfully with more and more clinicians taking part in it every year. Its impact on the healthcare industry is progressive and physicians upon realizing its importance for revenue cycle management are subject to adopt modern and cost-effective healthcare ways.

News

MIPS reporting services, Medicare and Medicaid Services, MIPS 2020 Reporting, MIPS 2020, MIPS score, MIPS payment adjustments, MIPS 2020 data submission, MIPS eligible clinicians, MIPS 2020 Data

The Deadline for MIPS 2020 Performance Year Targeted Review Extended

The impact of covid-19 is still not over. We are feeling its after-effects, to say the least. And MIPS reporting services are no exception in this regard.

Due to the lag in 2020, CMS (Centers for Medicare and Medicaid Services) extended the deadline for its targeted review.

The deadline extends to November 29, 2021, until 8 p.m. ET. Now, clinicians, groups, virtual groups, and Alternative Payment Model (APM) entities can request reweighting any category. However, it all happens under the Extreme and Uncontrollable Circumstances (EUC) policy.

Why Is EUC Deadline Extension for MIPS 2020 Reporting Serious?

Well! Now, all MIPS 2020 eligible clinicians have the authority to review their final MIPS score, individually or as a group. Moreover, they can also go through their MIPS payment adjustments

It is also important to review every single detail in order to avoid penalties of any sort. Because it is observed that some clinicians have also received a penalty for reporting Medicare Part B claims in 2020.

What This Program Is All About?

Under the EUC policy, CMS is also granted to reweight any category to 0% in case of the no MIPS 2020 data submission. However, this condition applies only to MIPS-eligible clinicians that qualify for group, virtual group, or APM entity participation.

Having said that, if any medical practice compiles Medicare Part B claims for 2020 as an individual and group! It could lead to negative payment adjustments for clinicians who were not eligible to report as individuals but the group.

So, Review Your MIPS 2020 Data Scrupulously!

MIPS 2020 eligible clinicians must take this opportunity to review all their data as an individual and group to keep a check on the impact on the non-eligible clinicians of their facility.

What you or your MIPS reporting services can do on your behalf is to see if your group data meets the performance threshold. If yes, it is fine. Otherwise, ask for a review for a score below then 45 MIPS points.

So, hurry up! Time is running out.

MIPS 2021 reporting, MIPS Qualified Registries, MIPS Reporting 2021, MIPS 2020 feedback, Medicare and Medicaid Services, MIPS payment adjustments, MIPS score, MIPS consultants

QPP MIPS 2020 Feedback Is Available for Review

You heard it right. The Centers for Medicare and Medicaid Services has officially released the feedback for the MIPS Reporting 2021 period. Now clinicians have the chance to review their final score and the MIPS payment adjustments, which they still receive in 2022.

Why This Review Matters?

This review is an opportunity where you are more than welcome to look into details and check if there is any issue or error in the processing of your submitted data.

MIPS data reflects your performance for the whole year, and clinicians pay attention to this process throughout. They spend time understanding the reporting requirements that MIPS CMS mentions. However, it is a hectic process and requires careful diligence. A MIPS Qualified Registry becomes important in this regard.

Why it’s High Time to Consult a Reporting Registry?

MIPS consultants will give you the ease to cater to the administrative load without any stress. CMS has tough requirements and tougher reporting details that cannot be missed. The resources seem to provide the professional documentation that ultimately adds up to your score.

Now, when there are a few months left for MIPS 2021 reporting, MIPS Qualified Registries are also gearing up to manage their clients. Physicians! They are the most suitable or convenient option among the data submission methods because they offer reliability and transparency in all matters.

Another plus point that such associations can offer is the accuracy of measure selection that safeguards the interests of clinicians.

So, it is better to review 2020 feedback and look for all the errors that somehow reflected on your score wrongfully.

You Can Call For a Review until October 01, 2021

Now, when you can go through the MIPS data and review your performance and payment adjustments, you can know about the payment adjustments that you will be receiving in 2022.

And, if there happen to be any errors, clinicians can apply for targeted review to CMS for reassessment and readjustment. However, you have a deadline until October 01, 2021, 8:00 PM (ET).

The good news is if you were already in touch with the MIPS consultants, you would have no problem in recognizing areas where CMS misinterpreted your data. You would already access how much MIPS score and what percentage of incentives you should get.