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QPP MIPS 2020, MIPS 2020, MIPS qualified Registries, MIPS Quality measure

How CMS Assists Physicians with MIPS 2020 Reporting Amidst Corona?

As QPP MIPS 2020 is approaching the end of the performance year, P3Care has decided to revisit the changes and flexibilities in response to COVID-19. It has been a tough year, especially for our heroes – the healthcare providers. In fact, the pandemic made the healthcare industry work more than its capacity.

Besides relaxation in compliance obligations, the purpose of these flexibilities is to assist physicians in a state of emergency.

COVID, even after the vaccine is out and about, is still pretty much there. The federal agencies alongside CMS work to immunize people in the fifty states. That’s more than enough a country could do but there is still work to be done.

On the whole, the Joe Biden administration seems to care for the environment a lot. We will continue to see improvements in the natural order of things from here on.

Let’s dive into the final rule 2020 and the changes across the MIPS 2020 performance categories.

Reporting Flexibilities in QPP MIPS 2020

COVID-19 pandemic has affected every sector of the healthcare industry. There is no surprise there. However, the effects are not similar in every medical practice. Some practices suffered financially, while some came under pressure due to a high surge of patients.

Meanwhile, CMS realized that physicians and MIPS Qualified Registries might not report QPP MIPS 2020 data effortlessly. Therefore, the authority allowed clinicians, groups, and virtual groups to request to reweight one or more performance categories under the Extreme and Uncontrollable Circumstances policy.

CMS MIPS 2020 Special Circumstances Deadline Extends

As you know, our healthcare facilities are still struggling with the extreme pandemic situation. Therefore, CMS also extended the deadline to apply for Extreme and Uncontrollable Circumstances until February 01, 2021, Monday.

Moreover, CMS introduced a new MIPS Quality measure under Improvement Activities (IA) for the QPP MIPS 2020 reporting. Under this measure, eligible clinicians can receive credit for their quality healthcare services (related to COVID-19) that improve the overall patients’ outcomes.

Overall Performance Flexibilities under QPP

For the 2021 performance year, QPP (Quality Payment Program) has released the Final Rule:

APM Entities can request for extreme and uncontrollable circumstances exception to reweight QPP MIPS 2020 performance categories

The current Complex Patient Bonus is revised to account for the complex patients’ treatments during the pandemic. Moreover, Clinicians, groups, virtual groups, and APM entities can earn up to 10 bonus points in their QPP MIPS 2020 score.

We think that these steps from the CMS encourage clinicians to participate in the QPP MIPS 2020 despite the corona. It is an effort to facilitate PHE (Patient Health Examination) while considering the difficulties of affected physicians.

Technology Saves the Day

If one good thing happened during the pandemic, it is the use of technology at every forum. Obviously, the Healthcare industry is no exception.

Technology has been a savior throughout the pandemic in the form of telehealth. When there was risk catering to elective face-to-face visits, physicians kept in touch with their patients via technology. It helped them to keep the revenue cycle running while restricting the virus exposure.

Not just doctors but MIPS Qualified Registries are also using the latest ways to compile reporting data efficiently to avoid health security threats.

COVID-19 Response Overview

QPP MIPS 2020, MIPS 2020, MIPS qualified Registries, MIPS Quality measure

Updates for ACO Reporting

Another update is for ACOs (Accountable Care Organizations) that CMS considers them affected by the extreme condition. Thus, the Shared Savings Program extreme and uncontrollable circumstances policy applies to them. Besides, they do not have to file for Consumer Assessment of Healthcare Providers and Systems (CAHPS). In return, ACOS can receive full credit for the high patient experience.

Conclusion

All in all, CMS also supported the expanded use of PHI (Protected Health Information). Thus, we would see more technology-based services such as telephone-based evaluation and management services for CMS Web Interface and the CAHPS. Such services will assist in managing the QPP MIPS survey.

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.

CMS updates, QPP MIPS, MIPS Data Submission, MIPS 2020, Eligible physicians, professional healthcare services, QPP MIPS 2020, medical practice

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 if physicians are eligible for MIPS data submission or not.

However, the reporting requirements change each year due to changed policies. So, if we want to succeed in this program, we have to comply with the changes.

MIPS 2020 Reporting Deadline is Due March 31, 2021

We have almost 2 months to submit data to CMS. Most of you must have checked their MIPS eligibility status up until now. However, to ensure quality, go through this article to review the complete process.

Also, remember that MIPS participation is not easy, and the eligibility check is just the start. A MIPS Qualified Registry can take care of the administrative load without you being bothered. So, consult them for a seamless process.

 MIPS 2020 Eligibility Check

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 uses 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 the 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.

Eligibility Check for 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

Eligibility Check for 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.

Eligibility Check for 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

The above-mentioned are all the requirements that a MIPS participant should know beforehand of the MIPS data submission. We are halfway through QPP MIPS 2020, and many professionals already had planned and implemented a strategy for optimized performance in the end.

How to Report MIPS Data?

Physicians have a lot on their plate already, and the pandemic has increased their burden. In such a situation, MIPS quality reporting seems like a challenging task.

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.

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QPP MIPS 2020, MIPS 2020, MIPS Qualified Registries, MIPS and Macra, CMS announces, Medicare Quality Reporting, coronavirus pandemic, healthcare industry

CMS announces QPP MIPS reporting Relaxations for 2020

The last few months have been tough for the healthcare industry. All stakeholders were trying desperately to assist each other and save resources for COVID-19 response.  Of course, meanwhile, CMS also took necessary measures to unburden some of the clinicians’ load.

Where physicians have already burned out with COVID -19 cases, the administrative burden of QPP MIPS 2020 was additional pressure. The dynamics have changed. The contact points that were easily accessible before are now operational via online mediums.

Thus, eligible clinicians and MIPS Qualified Registries can take benefit from it and serve effortlessly to the patients.

At first, CMS requested clinicians to impede elective medical procedures. In simple terms, it means to delay diagnostic procedures or treatments that don’t qualify for emergency conditions.

However, the process of offering flexibilities continues for the QPP MIPS. At first, CMS asked healthcare professionals to delay elective medical procedures and treatments, but with things starting to get back to normal, the Trump administration reopens all medical practices.

Telehealth was another option that was promoted to continue the services along with COVID response. QPP MIPS 2020 is also going to reward physicians who adopted telehealth and practiced it to accommodate patients from every corner. It not only accounts for improvement activities but for promoting interoperability.  It is a great opportunity for scoring high and target incentives.

The following are the relaxation areas that MIPS eligible clinicians can enjoy.

Relaxations for the QPP MIPS 2020

CMS states that the eligible clinicians who are significantly impacted by the public health emergency can apply for Extreme and Uncontrollable Circumstances to reweight any of the four or all MIPS performance categories.

However, they are required to submit a solid explanation for the impact on their medical practice.

A COVID-19 clinical Improvement Activity under MIPS is also introduced by the CMS.  Eligible clinicians can obtain outcomes via:

  • Participating in a COVID-19 clinical trial Improvement Activity and submit data into a data platform
  • Participating in the healthcare of COVID-19 infectees and submit patients’ data to Clinical Data Registry for research

As physicians are busy battling against coronavirus pandemic, CMS has decided to not use data reflecting from January 1st to June 30th, 2020 for the Medicare Quality Reporting and value-based purchased programs. These measures are taken to give advantage to eligible physicians to some extent as to minimize the administrative burden incurred during data collection and management. A lot of time and investment can be saved, henceforth.