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Accountable Care Organization, ACO Reporting 2021, QPP MIPS, MIPS Qualified Registries, MIPS data submission method, MIPS quality measures

CMS Proposed Changes for ACO Reporting 2021

From the next performance year (2021), Accountable Care Organizations (ACOs) expect different reporting requirements under the Medicare Shared Savings Program.

CMS (Centers for Medicare and Medicaid Services) has recommended changes for ACO reporting criteria.  The requirements are somewhat the same as for QPP MIPS.

The purpose of the new proposed rules is to lower down the administrative burden of ACOs and to improve the quality of patients’ outcomes.

In light of the expected changes, ACOs can partner up with MIPS Qualified Registries to share their load and meet the reporting requirements efficiently.

CMS Is Eliminating Its Web Interface

The QPP MIPS data submission method, CMS will eliminate Web Interface starting from the next PY 2021.

This MIPS data submission method will no longer be available even for QPP MIPS (Quality Payment Program – Merit-based Incentive Payment System) and (Shared Savings Program) SSP reporting.

The Alternative Reporting Method

Instead of the regular reporting via CMS Web Interface, ACOs will now report data via a new APM Performance Pathway (APP).

All of these rules are proposed in order to include ACOs in the MIPS Value Pathways (MVPs).

Eligible clinicians submitting quality measures via the new APP do not have to submit them again for the QPP MIPS Quality category.

The administrative load for data collection and submission will reduce significantly for both SSP and QPP MIPS reporting processes. Moreover, we can expect improved quality care for Medicare patients as an outcome.

Compact MIPS Quality Measure Set

There is one good news for ACOs that will take effect from next year. They have to report only six measures in total (previously twenty-three measures).

The subcategories include:

  • 1 Diabetes: Hemoglobin A1c (HbA1c) Poor Control
  • #134 Preventive Care and Screening: Screening for Depression and Follow-up Plan
  • #236 Controlling High Blood Pressure
  • #321 CAHPS for MIPS Survey
  • Hospital-Wide, for 30 days; All-Cause Unplanned Readmission (HWR) (administrative claims)
  • Rate Risk Standardized; All-Cause Unplanned Admissions for Multiple Chronic Conditions for ACOs (administrative claims)

Score Assessment

ACOs can receive from 3 to 10 points against each measure.

However, points will be rewarded only when the data meets the data completeness rule and the performance threshold.

It is also to keep in mind that the performance threshold for eligible clinicians participating in the SSP has been raised. At least forty percent of the score or more than thirty percent is required for each performance category to earn the incentive and to avoid penalty.

It is indeed a great step towards the progressive and value-based healthcare system.

Quality of Care by ACOs

The idea behind ACOs is to improve the quality of healthcare with collective efforts.

A volunteer group of clinicians, healthcare providers, and hospitals come together to improve care standards for their Medicare patients. The coordinated efforts compensate for the shortcomings that they have to face individually while enhancing patient satisfaction.

Apart from the other changes, several data submission methods will be available for them.

They have the option to submit quality data to CMS for QPP MIPS or SSP as:

  • ACO by participating under the same TIN (Tax Identification Number), or
  • Individual clinicians

Data Submission Methods

ACOs can also choose to report via several methods as:

  • Directly
  • Via login and upload
  • A third-party intermediary such as MIPS Qualified Registry

Advantages of Submitting Data to CMS via MIPS Qualified Registry

It is always easy to hire a third-party intermediary to not lose the essence of the program in between the administrative burden. These intermediaries cater to the entire load, comprehend details of your specialty, segment data as per the CMS rules, and timely submit it to authorities.

Accurate Data Compilation

Most organizations still use different platforms to collect different types of data. A MIPS Qualified Registry caters to all such reporting challenges efficiently.

For Instance, they have the resources to collect data effectively and aggregate it as per the reporting requirements for accurate data submission.

Analyze Your Performance

The technology help solves half the problem for QPP MIPS data submission or SSP. Seeking a third-party intermediary helps you optimize, plan, and analyze your performance record.

For Instance, if you get in touch with P3Care, our specialist helps you gauge your performance via data analysis, so you improve your score by adjusting changes in the delivery of care services.

It allows ACOs to refocus on points that are limiting their high score.

Quality Data Reporting to CMS

The more accurately you submit data to CMS, the more chances you have to score high and target incentives and bonuses.

It all comes down to the expertise of the third-party intermediary that if they have resources to cater to the administrative load. Eligible clinicians or ACOs should choose a registry that has the experience to deal with all physician types, i.e. individuals, and groups respectively.

Another factor is the training of resources to cater to the administrative data. With a qualified team at your disposal, you have access to techniques that work reliably to help you avoid penalties.

Conclusion

CMS has offered several data submission options for the ACOs. Now, it is up to them to start planning their incentive payment model participation soon such as for QPP MIPS to maximize their performance.

Another update is also expected later this year. So, maybe there are further changes that we have to work upon.

However, the best approach is to consult a MIPS Qualified Registry as P3Care for the submission process.

We are using a QPP JSON file upload and API submission method for reporting the data to Medicare. Our process is efficient and complies with all quality reporting requirements.

For more information on ACO reporting, contact our MIPS consultants.

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.

News

Qpp Mips Penalty for late reporting

Small Medical Practices Can Save Themselves from QPP MIPS 2019 Penalty

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

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

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

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

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

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

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

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