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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

CMS (Center for Medicare & Medicaid Services) recently announced the performance score for eligible clinicians of QPP MIPS 2019 on its official website.

Eligible physicians can review their MIPS 2019 score via a secure portal allotted to them.

This performance score depicts the percentage by which clinicians will be receiving positive, negative, or neutral payment adjustments. However, payment adjustments will be furnished in the year 2021.

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 as due to the pandemic situation going on, CMS enforced a policy to not penalized 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 most important incentive payment models. It accounts for quality healthcare services, which CMS recognizes and rewards for.

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

Most of the time, physicians, who submit MIPS data through MIPS Qualified Registry have an idea of their final score. Because their expert resources already have a roadmap to report quality measures to get a certain percentage of the score.

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 for 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)
  • Being not 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 offered flexibilities to ease out the administrative load. The option for applying for “the Extreme and Uncontrollable Conditions” is available until December 31, 2020.

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 Rule

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 will be dissecting changes that are expected 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 management.

As a physician, your first responsibility is towards patients. We are sure that you certainly would not have time to manage the MIPS reporting requirements.  However, with the help of MIPS consulting services, the process of MIPS data submission becomes easier and less hectic.

Besides the 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 quality care rather than volume care. 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.

We are expecting a delay in MIPS Value Pathways (MVPs) for 2021.

Additional reporting flexibilities are also in consideration in response to the COVID-19.

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.

MIPS 2020 reporting, MIPS Qualified registry, QPP MIPS, MIPS 2020 program, MIPS 2019

Surgeons: Tips for Successful MIPS 2020 Reporting

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

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

MIPS 2020 reporting, however, is still very much happening and clinicians are required to submit data as individuals, groups, and virtual groups to receive positive payment adjustments.

One of the ways to receive incentives is to score above 45.

Contrary to the previous years, MIPS 2020 program requires clinicians to submit data for all the reportable categories and avoid negative payment adjustments. Physicians, generally, submit MIPS data via a MIPS Qualified Registry.

However, whatever method you use, it is not possible to score above 45 by submitting only the Quality measures.

  1. Check Your Participation Status

The first thing to do before reporting MIPS 2020 is to check whether you are eligible for the program or not. Special statuses qualification also awaits certain surgeons.

Once you are there, include your NPI to display the required participation status.

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

Physicians can also outsource MIPS 2020 reporting to a MIPS Qualified Registry. They will ask you for the required information and check your eligibility status from the CMS portal. Moreover, you will not have to worry about MIPS data submission by yourself.

  1. Select MIPS Quality Measures Carefully

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

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

A MIPS Qualified Registry makes the quality measures selection easy for you.

Physicians do not have to stress upon looking into the list of measures, but an experienced team conducts analysis on your expertise and picks out the most appropriate measures.

  1. Participate in COVID-19 Clinical Trials Improvement Activity

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

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

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

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

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

Scoring Cases for Clinicians with Special Statuses

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

  • Scoring example for clinicians who are eligible for PI exemptions

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

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

Recommendation of the American College of Surgeons

45 is the safest score for MIPS 2020 submissions to avoid a penalty in the payment year 2022 regardless of the method you use. Moreover, the American College of Surgeons recommends the above techniques to score higher. In addition to that, clinicians breeze through the compliance program.

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

Conclusion

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

So then, there’s nothing to fear. It’s just a program for clinicians to get incentives as a reward to improve their quality care delivery. If you need help, you can contact MIPS consultants to enhance your performance.

How CMS determines MIPS eligibility?

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 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 use TINs for practices’ eligibility.

Eligibility Determination Period of MIPS

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

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

What is Low-Volume Threshold (LVT)?

LVT includes three aspects of professional healthcare services as follows.

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

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

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

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

Who Can Participate in MIPS 2020?

CMS has an eligible clinician type. Clinicians falling into 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 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.

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

QPP MIPS, MIPS Quality measures, MIPS reporting services, healthcare industry

How Can Physicians Increase Patient Referrals?

Survival in the healthcare industry is getting tough day by day. The cost factor to provide value-based healthcare services is doing well in patients’ favor, but it’s also been a burden for physicians. While MIPS reporting services, MIPS Quality Measures are the parameters to show progress in terms of interoperability, cost, quality, and improvement activities.

Other than making efforts to earn incentives and bonuses and to remain protected from penalties, MIPS has been a great help. But, first physicians have to meet the criteria of checking 200 patients and bill more than $90,000 for Part B covered services.

Why Referrals are Important?

Referrals are an excellent way to keep up with the high number of patients. Word of mouth from fellow physicians and patients also helps to maintain goodwill in the industry.

It helps to grow the practice and improves the worth of your services rapidly.

How to Increase Referrals for your Practice?

Here are several suggestions upon which medical practitioners can thrive and get referrals without any problem.

  1. Connect with Fellow Physicians

Find those physicians in the industry with which you can build a give and take relationship.

For Instance, if you can refer a patient for any service to another physician, he should be able to do the same for you for your area of expertise.

  1. Increase Patient’s Engagement Level

Make processes easy and less hectic for patients. Such as a simple or automated way of patient scheduling system automatically improves patients’ engagement.

Another way is to send follow up messages to remind patients about their appointments.

These tactics can help to get referrals from patients.

  1. Have a Friendly Behavior at Work

When someone treats you with kindness, it leaves an impact on you. The same rule works for organic referrals. If a physician treats his patients with a smile, listens to them, and take time to make things easy for them, he is more likely to get referrals.

  1. Be Kind to the Staff Working for You

Nurses, physician assistants (PAs), and others spend a major deal of effort and time for the well-being of patients.

Spend time with them, and make small talk to release work stress. In this way, your behavior and kindness will reflect across the board. Not only it does improve your performance but also makes an ideal working environment.

Additionally, it helps to know your staff’s relationships with others in healthcare. Through them comes the goodness for a practice. In fact, physicians can definitely deduce better results from this strategy.

  1. Embrace Technological Innovations

Adopting technology gives points for Improvement Activities (IA) in QPP MIPS. This way you get the reputation of a progressive medical practice and achieve higher MIPS points for incentives.

Medical practitioners can use the following things:

  • Make their own app if possible
  • Create a user-friendly website for their services
  • Figure a way to make the appointment scheduling process easy and automated
  • Use technology to offer support to staff and patients alike
  1. Be Informative & Unique with your Website

The website is the first portal to reach patients. Patients search online about what services they want and what doctor they need.

If you have all the information on your website, it’s easy to get referrals from others against your user-friendliness.

  1. Make Referral Process Easy

Another way to increase patient referrals is by making the referral process easy and simple.

Follow-up services after or during the appointment, thus, play a crucial role. It helps you provide quality healthcare to patients, which you can use to submit MIPS quality measures.

Moreover, if the patient has any problem giving a referral, it is easier for them to seek help from you.

Medical practices can handover a referral form during the treatment, stating the demographics, reason for referral, and other important information. It is indeed an added step for front desk staff or medical billing services can help cater to this process. The response will be quicker. But, in the long run, it will value your referral sheet.

Given above are just a few ideas to improve physicians’ worth in the industry and getting referrals. More referrals mean more patients and ultimately reimbursements and incentives to straighten up revenue cycle management.

So, get started now.

Healthcare industry, medical billing company, medical billing services, healthcare system, healthcare service providers, QPP MIPS, revenue cycle management, medical practice

Providers’ Guide to Best Practices for Revenue Cycle Management

Healthcare industry doesn’t only have hospitals and large medical practices. There are some medical practices that function in only one specific medical area and consult medical billing companies for reimbursements.

P3 healthcare solutions being a medical billing company has years of experience in medical billing services. We have come across many independent or stand-alone medical practices and well-established hospitals.

How Independent Healthcare Providers Are Coping Up With Changes?

One thing we understood in all these years is that the norms of the modern healthcare industry are changing. The focus has shifted to a value-based healthcare system instead of volume-based care services.

It also leads to structural changes in the progressive healthcare industry. According to the American Medical Association (AMA), physicians having independent clinics cover less than half of the total US doctors’ population. However, this trend of owning personal medical practice was high back in the 1990s.

Reason for Reduced Rate of Independent Healthcare Practices

The declining practice of independent healthcare providers owes to many reasons.

Some observers of the healthcare industry state that independent healthcare providers are forced to join larger healthcare systems as the earned revenue is not sufficient for survival.

Why medical billing companies Can’t Support independent healthcare providers?

Independent healthcare providers don’t meet up with their cost expenditure due to inflation and price surge. The increased administrative burden of MIPS QPP increased the price of surgical hospital admissions, emergency room visits, and drugs, which has caused major problems for independent healthcare providers.

Thus, in recent years, due to low reimbursements, around 22% of the independent clinicians reduced their office support.

Impact of Low Reimbursement Rate

Low reimbursement rate from insurance companies has also damaged this industry. Even hospitals and large medical practices are not safe from the changes in the healthcare industry.

The healthcare providers when unable to cover expenses within earned money, get in-touch with huge healthcare networks. Thus, the amalgamation of large and small healthcare practices has led to low competition in the healthcare industry.

In addition, often patients don’t pay deductibles or the extra amount other than their insurance benefits to independent medical practitioners. This way, independent healthcare providers never really compete with bigger healthcare organizations.

Reservations of Solo-Medical Practitioners

One concern that the solo-healthcare services show is about the unreasonable reimbursement standards of insurance companies. Big healthcare organizations can better negotiate their demands with the increased volume of patients, which is a profit source for insurance companies.

All these issues make it impossible for small independent healthcare providers to stay in the industry. QPP MIPS has also fueled the declining trend of independent health services. Patients want access to top-quality healthcare, which a separate-working medical provider may not be able to provide. Consequently, the doctor doesn’t find a large share of incentives and bonuses.

To keep an independent medical practice, most solo-physicians function as a group outside the hospital circle. It has also helped medical billing companies to get high reimbursement for them as well as offered shared administrative responsibilities and resources over the network.

This might be the only surviving option left for independent healthcare service providers.

As large medical practices are dominating the healthcare industry, it is evident that revenue cycle management has not remained easy for solo-practitioners. However, with little adaption to change and a professional medical billing company, independent healthcare service providers can work their way up the success ladder.

News

Electronic Healthcare Records, healthcare industry, healthcare service providers, healthcare services, healthcare system, Medicare and Medicaid Services, MIPS eligible clinicians, MIPS quality score, QPP MIPS

Updates in Stark Law: What It Means for QPP MIPS?

CMS (Centers for Medicare and Medicaid Services) has revamped the Stark Law for healthcare service providers.

The upgraded law will have an impact on the volume and quality of healthcare services. Especially, QPP MIPS eligible clinicians can take notes and design strategies to improve patient satisfaction.

For those of you, who do not know about the Stark Law, here is its definition!

What is Stark Law?

This law prohibits physicians from self-referral, particularly in a situation, when a physician has a financial relationship with a patient and refers to another entity for the provision of designated health services (DHS).

The new laws will also influence the QPP MIPS quality score via a transparent referral process. Without a doubt, it is a great step towards an altogether progressive healthcare system.

Proposed Changes

  • CMS proposed changes that allow exceptions for/among certain physicians.
  • The final proposed rule also applies exceptions in some cases when a physician receives reimbursement for items or services from another clinician.
  • CMS also proposed flexibilities for the funds or donations extended to the cybersecurity technology and services.
  • Moreover, the existing exceptions for the EHR (Electronic Healthcare Records) data, products, and services are also modified.
  • The update in the Stark Law is expected to be effective from next year January 19, 2021.

The Stark Law, since its provision in 1989 was the same, and there were no updates since then. CMS says that these modifications are significant and will change the referral scenario in the healthcare industry.

Conclusion

The new changes strive to encourage clinicians to adopt quality-based healthcare practices as specified by the QPP MIPS without fearing Stark Law violations.

The exceptions are introduced to facilitate the reimbursement process and to improve coordination among different stakeholders in a legitimate manner.

MIPS Value Pathways, MIPS program, QPP MIPS, QPP 2020, MIPS 2020 CMS administrator, healthcare industry, healthcare sector

An Insight into QPP MIPS Payment Adjustments in 2020

CMS states that up to ninety-eight percent of the eligible clinicians are expected to receive positive payments in 2020 for the year MIPS 2018. The rate is five percent higher than the previous year.

In the upcoming year, the trend of incentives and reimbursements is going to increase as the quality reporting is supposed to improve via MIPS Value Pathways (MVPs). MVPs will be operational from next year.

MVPs – A Chance to Succeed for Everyone

MIPS Value Pathways, MIPS program, QPP MIPS, QPP 2020, MIPS 2020 CMS administrator, healthcare industry, healthcare sector

In order to translate practice’s expertise in the true sense, we must adopt MVPs. Small medical practices and medical facilities in rural areas irrespective of their operational size can earn rewards for their rendered services. Seeing the numerous benefits of the MIPS program, rural medical facilities are participating more and more each year.  Statistics show that there was a rise of four percent in QPP MIPS participation from 2017 to 2018.

The Report Card for MIPS 2018

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CMS has published the results for MIPS 2018 participation. 889,995 eligible clinicians have reportedly received positive payment adjustment, and 872,148 of them have received neutral payment adjustment.

Seema Verma, CMS administrator is quite happy with the results as it depicts the higher number of physicians opting for quality healthcare delivery systems. The quality outcomes also credit the vision of empowered and cost-effective healthcare industry.

Despite the administrative burden, more and more participants succeed in the QPP MIPS. It is due to the lower performance thresholds, which ultimately reflect on payment adjustment. Moreover, CMS doesn’t want to jump up the positive payment adjustment, as it has to be balanced with the negative payment adjustments.

MIPS Future Holds Higher-Performance Thresholds

CMS has planned to make higher thresholds for exceptional performance to reduce the reward distribution. They are working on a strategy to reward physicians who continuously invest in the quality of healthcare and interoperability, and help patients in many manners. This can be seen in the gradual increase in the performance bar for penalties and bonuses.

Seema Verma also hints on supporting clinicians via reducing the burden and providing opportunities for meaningful services. The No-cost Small, Underserved and Rural Support initiative tends to lend a hand with technical assistance for smooth and optimized performance in the healthcare sector.

This program also creates awareness about the quality care and payment model along with helping eligible clinicians with participation in MIPS.

With the research and taking into account what physicians bring to the table, the future reporting criteria is estimated to only include a framework that flows without stressing physicians unnecessarily.

CMS also wants participants’ feedback on the MVPs’ developments. They are looking forward to advancements that help them drive value to the healthcare industry in terms of payment models, lower administrative burden, and cost-effective patient outcomes.

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P3 Investigates: Trump Administration Plans to Reopen Nursing Homes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Guide to the Latest Medical Billing Codes for COVID-19 Test

The constant threat of coronavirus has led the panel of AMA – The American Medical Association to introduce CPT (Current Procedural Terminology) codes for medical billing services.

As the number of infected cases in the USA increased, the need for a separate code for COVID-19 testing emerged. The president of AMA, Patrice A. Harris, MD, MA, announced a unique code to report for laboratory testing of the coronavirus. This information was released on March 13, 2020, in order to translate the advantages of tracking, allocating, and optimizing resources.

What’s New for Medical Billing Services Regarding Corona Test Coding?

The coronavirus code belongs to a new category I of CPT codes.  The details are as follows.

  1. 87635 infectious agent detection by nucleic acid (DNA or RNA)
  2. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), for the examination technique

The codes are now available to use to report on behalf of physicians by the medical billing companies. This code also has short and medium descriptors, which can be accessed on the official AMA website – https://www.ama-assn.org/practice-management/cpt/cpt-releases-new-coronavirus-covid-19-code-description-testing

Coronavirus around the Globe

The situation of the novel coronavirus is serious. President Trump has declared a national emergency in the USA, and the only way to stay safe is by maintaining the social distance.

The Healthcare industry, in almost every country, is under pressure to combat the seriousness of coronavirus pandemic. The number one step for managing this catastrophe is by dealing with hundreds and even thousands of diagnostics procedures, and this code will help deal with the billing matters.

Rick A. Bright, Ph.D., director of Biomedical Advanced Research and Development Authority (BARDA) at HHS stressed the need of increasing the capacity of testing kits to identify and separate infected individuals as early as possible.

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There have been delays reported in terms of accessing the diagnostic procedures of COVID-19. The delays and shortage in facilities may affect the frontline fighters (physicians), and ultimately potential patients.

According to AMA, the newly released code is a progressive step towards optimal coronavirus diagnostic services. All along, the physician or medical billing company is required to use the Healthcare Common Procedure Coding System (HCPCS) codes to document public encounters with the health payment programs as Medicare.

The Centers for Medicare and Medicaid Services (CMS) also stated to create two new HCPCS codes to support the coronavirus diagnostic procedure.

The first code released in February (U0001) is for SARS-CoV-2 diagnostic tests performed specifically for CDC testing laboratories.

The second billing code (U0002) released this month will extend medical billing services for coronavirus lab tests, allowing to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV, (novel coronavirus or COVID-19).

QPP MIPS requests everyone to stay strong and be mindful of others around you. Spend this difficult time to connect with yourself and be creative while staying home.  You never know who carries the virus therefore, use hand sanitizers, clean your space, wear gloves, and face mask before going out and keep a safe distance from everyone.