WHAT IS ABOUT MIPS THAT IS MAKING PHYSICIANS UNHAPPY?

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

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

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

MIPS Quality Measures Are Huge Set Back for Physicians

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

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

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

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

For Instance,

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

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

CMS Website Should be Updated on a Regular Basis

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

CMS is trying to Rectify Errors in MIPS!

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

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

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

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

Follow our LinkedIn page for more information: https://www.linkedin.com/company/p3-healthcare-solutions

P3CARE OFFERS WHAT PHYSICIANS EXACTLY WANT!

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

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

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

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

The Efficient MIPS Consulting Service

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

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

What Makes P3Care Different from Others?

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

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

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

HIPAA – Compliant Medical Billing Services

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

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

P3Care – Your One Stop Place for Reporting Services

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

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

To talk to their H I.T consultant, visit their website https://www.p3care.com or call right away 1-844-557-3227

HOW P3CARE HANDLES MEDICARE MIPS REPORTING FOR CARDIOLOGISTS

P3Care.com sort things out with the payers and at the same time keep the communication lines open on behalf of the providers. This way the patients receive the best care and the insurance reimbursement workflow keeps on moving.

Everyone is happy.

In addition, P3Care has a strong grip over the Quality Payment Program under MACRA. The Merit-Based Incentive Payment System (MIPS) track reporting mechanism for both the specialty-specific clinicians and the primary-care physicians brings in both incentives and reputational benefits.

What is P3?

The three “Ps” stands for –

  • Providers
  • Patients
  • Payers

P3Care Simplifies MIPS Reporting for Specialists

Merit-Based Incentive Payment System (MIPS) is an integral part of the value-based system. In addition, CMS recognizes P3Care as a MIPS Qualified Registry vendor in back to back years of 2017 and 2018. That makes it a favorable enterprise for physicians who want to choose a registry as their MIPS submission method.

The recognition puts a bigger responsibility on our shoulders in terms of performance and meeting your expectations.

The US healthcare system revolves around a working relationship between providers, patients, payers, and medical billing services. If there are disparities at any level, at any step, there is a high probability of bottlenecks.

The government has set the course for MIPS in healthcare to go the distance and want all the clinicians to accept it. If they fail to comply with MIPS, they must be ready to face financial penalties along with putting their integrity on the line.

Heart specialists or cardiologists choose quality measures, outcome measures (or high-priority measures) from specialty-specific sets and start their journey for incentives through MIPS reporting. We take a few minutes of your time and finalize measures before submitting to CMS.

Peace of Mind for Cardiologists

What do the cardiologists say?

First, they are ready to participate in the Merit-Based Incentive Payment System (MIPS). They are actually more excited about it than the general physicians. However, more than half of the cardiologists working in the healthcare industry have reported fatigue and higher stress levels due to excessive documentation.

If IT regulations ease up, it may give them ample time to treat patients and rest as well. P3 Healthcare Solutions is here to help you report MIPS in a timely manner. Connect with us 909-245-8350 to discuss.

CMS Incentivizes Practitioners

The doctors’ job is to treat the patients, but instead, they work 10 to 20 hours a week on paperwork. That is the fact, unfortunately.

The ground reality is that CMS has allocated $20 million on the smooth transition to Merit-Based Incentive Payment System. All these initiatives are going to improve healthcare down to the grassroots level. It must do so and silence those voices screaming the phrase, ‘Americans not getting the treatments they deserve’.

To make it more difficult for cardiologists, the data coming out of the EHR system is vague and doesn’t help with the diagnosis. Often it is descriptive rather than suggesting crucial care points. P3Care brings a solution to this problem by synchronizing the medical billing service with the practice management system.

Specialty-Specific Demotivating Factor

There are no standards set for specialty-specific clinicians when it comes to MIPS quality measures. Hence, there is no way to compare the scores of specialists. The result is a low MIPS Final Score, and there may be no bonus payments at all. It is derogatory and depressing.

Quality measures outlined by the Qualified Clinical Data Registry (QCDR) reporting mechanism also have a similar story. Generally, many specialists vote in favor of QCDR.

Data Submission for Physicians and Specialists

After the month of March, CMS takes around 6 months to generate detailed results on MIPS reports.

Medicare MIPS reporting on Quality measures through a registry is highly suitable because it helps to identify and list down probable errors in the report. There is no other way to identify any ambiguities because CMS directly publishes the results. We can’t afford to make mistakes. However, at the end of those evaluations, CMS gives time to practitioners to ask for a review if they are not satisfied with the MIPS final score.

MIPS Cost Measures

Cost is an additional category in MIPS 2018. It accounts for 10% of the composite performance score (CPS). As a cardiologist, you don’t need to worry about it, though. CMS directly manage this category according to your billing to Medicare.

P3Care has a plan in place for the cost category so that CMS gives you the highest ratings on it. If you’re a specialist, please follow us on LinkedIn https://www.linkedin.com/company/p3-healthcare-solutions/.  We are technologically tenable and keep a close eye on news, views, happenings, and information regarding the US healthcare industry.

When you add the inpatient and outpatient costs, the average of which is compared to the national standard set in the specialist category.  That is an overview of how the cost category is calculated. The lower the cost, the better the ratings!

AVOIDANCE OF PENALTIES IN MIPS 2018! GET READY TO REPORT SMARTLY!

The American Medical Association (AMA) has clearly stated that the only way to avoid penalties regarding MIPS 2018 is to report on one of the three significant MIPS quality measures. In this way, physicians can prevent those negative payment adjustments waiting to happen in 2020. Connect with P3Care instantly on LinkedIn – https://www.linkedin.com/company/p3-healthcare-solutions/

The three quality measures are

  • Promoting interoperability
  • Quality
  • Improvement activities

How Reporting Criteria Changed Over Time?

Eligible clinicians can avoid the penalty by following a reporting strategy as per AMA’s advice. In 2017, it was compulsory for physicians to score at least three MIPS points to avoid a financial penalty at the start of 2019. It means that they only needed to report one quality measure to overcome the penalty risk.

Nevertheless, now the rules are stricter and the focus on value-based services is now more than ever. With this advancement and the modified requirement criteria in the healthcare industry, the new threshold for MIPS 2018 reporting is fifteen points. The clinicians having a score of 15 are able to avoid penalties in 2020. As an EP, if you fail to report the minimum amount of quality measures governed under the Quality Payment Program’s specifications, it results in a definite 5% decrease in reimbursements.

Therefore, scoring equal to 15 is essential for those eligible in this program.

Follow the tips below to avoid a financial penalty in 2020, improve your MIPS performance, and increase your Composite Performance Score (CPS).

Report on Improvement Activities (IAs) to Score Higher

The BEST WAY to meet the required threshold is to report Improvement Activities (IAs) immediately.

The Centers for Medicare & Medicaid Services (CMS) defined 113 measures under this performance category in MIPS 2018. Each performance measure has further subcategories in the form of medium and high-weighted activities. Obviously, the high-weighted activities carry more points and can get you closer to the maximum score.

How Do You Calculate Performance Categories?

The activities for the performance categories function around care coordination, population healthcare, beneficiary engagement, and health equity factors. To score in any category, eligible clinicians are required to collect and submit data for 90 consecutive days in 2018.

How to Submit MIPS to the CMS?

Healthcare providers can submit clinical data for MIPS 2018 via:

  • Quality payment program 2018 (QPP) data submission system
  • Electronic health record (EHR) system
  • MIPS qualified registry
  • The qualified clinical data registry (QCDR)

Improvement Activities – A Lucrative Offer for Small Practices

Reporting Improvement Activities (IAs) under MIPS 2018 can elevate the revenue cycle for small medical practices. MIPS reward small healthcare practices with double points as compared to well- established healthcare facilities.

Another advantage to smaller practices is a bonus of five extra points when they score a total of 15 points. It ranks them above the others on the MIPS scorecard with 20 points. Therefore, if you report for one high-weighted improvement activity, you are bound to earn more points.

For the same MIPS score, ECs working for large medical practices must submit data for two or more improvement activities to get up to the threshold limit of 15 points.

MIPS Quality Measures Shield You from Negative Payment Adjustments

Negative payment adjustments can be a big setback for your profit journey. Therefore, use quality measures wisely and in a timely manner.  To stay on top of your game, you must fully understand the performance measures to make to turn it into a lucrative opportunity.

There are 275 quality measures and clinicians can select from among them the most suitable measures to meet the MIPS 2018 threshold score.  Each Quality measure has further sub-categories as per the following factors:

  • Efficiency
  • Outcome
  • Patient engagement

Moreover, CMS has developed a specialized set of quality measures to help physicians identify appropriate quality measures. Clinicians can report data for 12 months on six quality measures. However, it is necessary that one of the quality measures should be an outcome measure or a high priority performance measure.

Clinicians participating in the form of virtual groups can use CMS Web interface or Consumer Assessment for Healthcare Providers and Systems (CAHPS) for MIPS survey.

Report for At Least Two Performance Categories

To stay away from negative payment adjustments, report for at least two performance categories. For instance –

  • Improvement Activities and Quality
  • Or, Promoting Interoperability and Quality

How to Score High and Handsome?

Ordinarily, we see small medical practitioners reporting one medium-weighted improvement activity and one quality measure. This reporting tactic earns you 10 points and with an extra 5 bonus points, you may achieve a total of 15 points.

The Territory of “Promoting Interoperability (PI)”

Another way to earn 50 out of 100 points is by reporting on the Promoting Interoperability performance category. It investigates the patient and physician engagement level and makes the patient information available to other clinicians via EHR technology. EPs are required to submit data for 90 days or more on the base score of four or five measures in this category. The base score measures take their value from the certified EHR edition.

Large medical facilities can achieve high scores by reporting on PI and quality categories. However, they must report on PI performance category to score 50 and two quality measures to get to 70 points and target the bonuses out of a $500 million pool.

EHR Technology – One Step Ahead

Each EHR edition has a different set of performance measures. For instance, the 2014 EHR edition allows reporting on the Promoting Interoperability Transition Objectives and measure set.

Important Tips to Score Higher

  • The data submitted on quality measures for at least 20 patients fulfill the data completeness requirement.
  • Two medium-weighted improvement activities and four quality measures can get you a score of 16 points in 2018.

It is only possible when the physicians earn 12 out of 70 points in the “Quality” performance category and score 20 out of 40 points in the Improvement Activities.

Vote for Better Healthcare

As 2018 is about to end, the evergreen slogan for the welfare of Americans is to vote for a better healthcare system. That truly goes in favor of the Americans.

If you still haven’t done anything to avoid the penalty in 2020, it is time to connect with a reliable MIPS registry for submissions. America needs you to come out as a winner and reputable practitioner.

Most of the performance categories require data for 90 days. Therefore, reach out to P3Care and report QPP measures efficiently and be free from the worries of non-reporting.

LAYING DOWN THE NUMERAL FACTS OF MACRA-MIPS

MIPS a value-based reimbursement model activates under MACRA by the Centers for Medicare & Medicaid Services (CMS) to promote quality and cut-down the cost of healthcare. It is an opportunity for medical professionals to choose quality over quantity, effectively deliver, and in return, earn some incentives. The positive payment adjustments await only those with scores higher than 15 out of a total of 100 points.

To stay updated on the QPP, follow us on our LinkedIn page – https://www.linkedin.com/company/p3-healthcare-solutions/

For scores above 70, bonuses are likely to happen from the $500 million pool of money reserved only for the top performers. If you look closely, the program benefits all, the doctors, the insurance companies and most of all, the patients who are at the receiving end.

The Composite Performance Score (CPS) determines the overall performance of each practitioner when they report measures for four performance categories under the Quality Payment Program 2018.

Minimum Requirements of MIPS 2017

We saw the practical implementation of MIPS in 2017! The year 2017 was also the transition period to settle things down slowly and gradually. In 2018, the eligible practitioners are quite aware and implement the procedures to qualify for incentives, bonuses or simply to avoid penalties at the start of 2020.

There is a change in the set of rules for 2018. Each of the categories influencing the MIPS final score undergoes an increase in the number of measures. QPP 2018 is a chance for you to show brilliance in terms of quality of care and earn incentives along with a solid reputation in the healthcare industry.

Quality covers 60%, Improvement Activities (IAs) 25%, and ACI or meaningful use carries 15% of the total score. A MIPS Final Score of 3 or above would save them from negative adjustments in 2019.  It included reporting on 1 Quality measure, 1 Improvement Activity or all the Advancing Care Information (ACI) measures.

It was only recently that CMS published the scores of 2017 on their QPP portal.

Basic Requirements in 2018

In MIPS 2018, the Quality covers 50%, Improvement Activities (IAs) 15%, Promoting Interoperability (ACI or meaningful use) 25%, and Cost, the new category, makes up to 10% of the final score.

In 2018, the rules are changed and the stakes are higher now. The EPs need 15 points to make it to the safe zone and avoid a higher penalty (up to 5% of the Medicare Part B payments) in 2020. To achieve this score, you must successfully attempt 2-3 Quality measures, 4 Improved Activities or perform all the ACI base measures.

MIPS Qualified Registry like P3Care only takes a few of your minutes to shortlist those measures.

Mathematical Side of MIPS

Quality holds significance as a performance parameter for MIPS 2018. It adds to the total score by assessing how well the practitioners perform measures in terms of their practice or their field of expertise. The practitioners review the list of measures and select only those best suited to their practice.

For specialists, there are specialty-specific measure sets. In 2017, there were 30 specialty measure sets. Some sets have fewer measures and some have more, but you have to complete only those related to your specialty. For sets containing more than 6 measures, you must cater to those 6 and complete an outcome measure or a high-priority measure, additionally.

Topped Out Objectives

There are 6 topped out Quality measures identified by CMS in 2018. The measures identified as ‘topped out’ means that the eligible physicians are no longer able to score more than 7 in them. Performance for these measures is usually high and completing them does not mean improvement in the quality of service.

Multiple Measure Options for Eligible Clinicians in 2018

Quality – CMS website displays 271 measures from which you can select six of your choice with one outcome measure or a high-priority measure.

Improvement Activities (IA) – Report up to 4 measures to achieve a score of 40 points in this category.

Promoting Interoperability (PI) – The category was Advancing Care Information (ACI) or meaningful use the year before. ECs must report all 4 base measures to achieve a maximum score. Select from among the seven measures.

Cost – Medicare Spending per Beneficiary (MSPB) is at stake here and it has zero measures for you to report. CMS will deduce the score itself by analyzing the claims data of the practitioner.

Hard Work Pays Off

Successful execution of all these performance categories can earn you 15 points and save you from the penalty in 2020. However, when you complete more than 6 or 7 measures along with a few outcome measures or high-priority measures, you make yourself eligible to bonuses from the $500 million pool. The bonus payments keep on increasing with each passing MIPS evaluation period.

The 70 points will earn you a place in the elite class of doctors and practitioners who give maximum attention to their patients. They care for them to the best of their ability, and in return reap the profits. In doing so, they take the US healthcare system one-step closer to glory.

Everybody is a Winner                      

QPP 2018 has something for everyone. The clinicians reap the rewards in terms of positive payment adjustments, the patients go home feeling well, and the government feels the pride in its policy structure.

The resulting situation brings down healthcare expenses and improves efficiency. Everybody gets to be a winner.

We are an approved MIPS registry to report data on your behalf. Dial 1-844-557-3227 (1-844-55-P3CARE) or email at info@p3care.com to talk to a trained HIT consultant.

4 STATISTICAL REPORTS TO ACCESS REVENUE CYCLE MANAGEMENT

Medical billing services in the USA improve the revenue cycle management process by using the latest billing techniques. According to Kaufman Hall study of CFOs from more than 350 hospitals in 2018, the priority of the physicians is to reduce the cost of care delivery.

A MIPS qualified registry collects data in this context along with the information about the quality of services. QPP 2018 has everything in favor of the physicians monetarily and patients in terms of their best treatment. Follow P3Care on LinkedIn – https://www.linkedin.com/company/p3-healthcare-solutions/ to stay updated with the US healthcare industry.

Key performance indicators (KPIs) give us an idea of how much money healthcare services invest in high-quality medical facilities for the patients.
In addition, we know about the profits they earn in return. Today, medical billers don’t use papers to manage patient’s information, but billing software and the electronic health records (EHRs) provide the necessary assistance.

Billing software along with handling information generates reports as per the required functionality. How a medical billing practice contributes to the progress of healthcare professionals and effectively maintains the revenue cycle management process depends on the software as well. It becomes easy for a MIPS qualified registry to collect the relevant data without redundancy.

Given below are some types of reports that will inform you about the progress of the revenue cycle management process.

1. High-Level KPI Report

This report helps in learning about the Current Procedural Terminology (CPT) in medical coding. It confirms that the medical coders use the most common and profitable codes in a medical claim.

This report estimates the following parameters:
• Total encounters
• Total collected payments
• Accounts receivables
• Number of procedures

The difficulties in these KPIs help in knowing the areas that need improvement. For example;

If in a month, cost consumption increases, profit for that month should also increase in the same ratio. You experience a reduction in the accounts receivables (ARs).

Generally, medical billing software conducts everyday tasks of medical billing and coding in an efficient manner. The software has an inbuilt template for CPT, and if there isn’t, you must create one to promote future accurate claim creation.

2. Per-Encounter Reimbursement Report

Another KPI is to compare the reimbursement rates with that of your competitors. The formula to calculate the rate is simple – It is per-encounter reimbursement which is the total payment divided by the total number of encounters in a specific time.
When we know the average reimbursement rate per patient, it improves the consistency of the revenue cycle management process.

3. Report To Keep a Track of Accounts Receivables (ARs)

Revenue cycle management becomes more efficient when we keep a track of accounts receivables for the physicians. Ordinarily, medical billing and coding agencies neglect accounts receivables which exceed 120 days.

However, professional medical billers know the periods for particular claims – 30 days, 60 days and so on to keep an eye on the amount due by the insurance companies. If payments cross the 120-days mark, medical billers find out the exact reason for the delay and join heads to figure out a solution.

When the AR is less than 10%, it represents an ideal situation. If it is more than 25%, drastic changes in the revenue cycle management or a medical billing audit may be the ultimate remedy.

4. Report for Checking the Ratio of Net Collection

By the net collection rate, we know the exact performance of the revenue cycle management system. It highlights whether we are collect payments as per the number of resources we utilize or otherwise. Medical billing practices aim for 95% of revenue collection to progress in the healthcare industry. If the ratio is lesser, there is a room for improvement in the RCM.

Charge value is an important parameter and it is the contractual adjustment of the total billed amount. By knowing this value, billers can calculate the total collected amount and give an estimate of the profit.

Conclusion

We can’t measure the performance of practice unless the billing system works on specific lines of improvement. Ineffective billing directly reflects in your revenue at the end of the day.

Revenue, in general, experiences turbulence with little or no increase in it. The statistical reports mentioned in this article breathe life into the process of revenue generation from the start to finish.

P3Care holds a respectable status in the medical billing and coding field. Call us for a free RCM consultation 1-844-557-3227.

MIPS TRACK PARTICIPATION EXCEEDED 1ST YEAR GROWTH – CMS

The news just came in last night via the official CMS blog, where Seema Verma, the Administrator of the Centers for Medicare and Medicaid Services (CMS), announced that the participation rate for the Merit-based Incentive Payment System (MIPS) exceeded its 1st-year goal by 1 percent. The early goal was set at 90 percent for MIPS – one of the two tracks under the CMS’s Quality Payment Program (QPP). Furthermore, the announcement stated that the submission rates for ACOs (Accountable Care Organizations) were recorded at a whopping 98%, while those of clinicians in rural practices were found to be 94%. These figures show the results are truly outstanding. Verma says,

“What makes these numbers most exciting is the concerted efforts by clinicians, professional associations, and many others to ensure high-quality care and improved outcomes for patients.”

Patients Over Paperwork Initiative

Furthermore, these high participation rates show significant progress in the organization’s prime objective “Patients over Paperwork.” A patient over paperwork is an initiative by CMS, launched in November last year. The main idea behind the initiative was to streamline regulations by increasing efficiency, thus improving patients’ care and experience.

Steps are taken through this initiative, according to Verma, resulted in:

  • Continued free technical assistance to clinicians in the program.
  • The number of clinicians required to participate in the program reduced, thus making it possible for them to give more time to their patients, instead of worrying about lengthy filing requirements.
  • Addition of new bonus points for small practitioners, or practitioners who treat complex cases or are using 2015 edition of CEHRT exclusively thus promoting interoperability of health information.
  • A higher number of opportunities for healthcare providers to earn positive payment adjustments.

All of these measures helped CMS in achieving the success in its QPP program.

A Look Forward

Finally, Verma expressed CMS’s continued focus on reducing burden in various areas of MIPS, as has been mandated by the Bipartisan Budget Act of 2018. She further articulated her organization’s eagerness to continue its work on improving clinician and patient experience through their “Meaningful Measure Initiative”, instead of focusing on processes.

Now that the 3rd performance year MIPS 2019 has started, CMS expects even more participation than the previous years. Their efforts to minimize administrative burden and address concerns that clinicians highlighted are appreciated throughout.

An Overview of MIPS 2019

For 2019, positive or negative payment adjustment is raised to 7%. Talking in numbers, if medical practice scores well and bills approximately $1,500,000 in Medicare, it can earn up to $1,605,000. The huge money is surely an attraction.

Moreover, this year, the performance threshold is 30 points instead of 15 points. Achieving double the points than last year is quite easy if you use appropriate resources and latest tools.

CMS is stepping up each year for incentive payment program MIPS to make things work out for healthcare organizations. The competition is surely getting tougher, but the expected outcomes/incentives are worth putting efforts for the progressive healthcare industry.

While there is still time for MIPS 2019 data submission period, ensure an impactful performance for MIPS performance categories and report data via a MIPS qualified registry as P3 Healthcare Solutions.

For instructions on how to get started call a medical billing service expert today at 1-844-557-3227 (1-844-55-P3CARE) or email at info@www.p3care.com.

MIPS 2018 UPDATES FOR CLINICIANS AND HEALTHCARE PROVIDERS

The MIPS 2018 will help the healthcare providers realign themselves to ensure compliance, enabling them to keep taking advantage of the incentive payments.

CMS gave an update on 2nd November 2017, sharing MIPS 2018 updates applicable to the QPP (Quality Payment Program).

A Background to the MIPS 2018 Updates

We all know that there is a shift in the US healthcare industry towards quality healthcare. These new updates reflect the refinement of the policies for QPP while taking into consideration the US healthcare industry’s transformation concerning infrastructure, technology, clinical practices, and physician support practices.

MIPS 2018 Updates & QPP Strategic Payment Program Objectives

CMS aims to accomplish 7 strategic QPP objectives with the introduction of MIPS 2018 Updates.

  1. To assist in the overall improvement of beneficiary outcomes. It also means engaging patients by deploying relevant MIPS and Advanced APM policies.
  2. The improvement in the clinician experience through the introduction of a transparent and flexible program. This approach will help provide clinicians with easy to use program tools.
  3. Increase adoption and availability of the robust Advanced APMs.
  4. Maximize participation and understanding of the program by deploying customized communication which focuses on support, education, and outreach. The underlying theme is to ensure the program fulfills the needs of diverse types of practices, patients, physicians, and small healthcare providers.
  5. To promote the increased sharing of data and information relating to the program’s performance. Thus, the underlying concept is ensuring timely yet accurate availability of actionable feedback to clinicians and other relevant stakeholders.
  6. Help deliver IT systems with improved capabilities relating to reporting, data submission, and an overall improvement in its front and backend, delivering greater efficiency and value.
  7. Lastly, one of the core strategic QQP objectives is to improve program implementation and foster ongoing development that keeps the requirements of the US healthcare industry into context. Furthermore, it also helps small and rural healthcare providers successfully take part in the program.

What are the MIPS 2018 Updates?

Let’s look at the highlights of MIPS 2018 updates.

  • Performance Period
  • The performance period is changed from 90 days to the 12-month calendar year.
  • The cost will be applicable based on the 12-month calendar year.
  • A minimum of 90 days period will be under review for Advancing Care Information.
  • A minimum of 90 days period will be under consideration for evaluating Improvement Activities.

Performance Threshold or Payment Adjustment

  • Minimum Performance Threshold will consider 15 instead of 3 points.

Road to accomplishing 15 points for performance threshold

Here is how you can attempt to accomplish the 15 points. You can fulfill any one of these criteria to reach the goal of 15 points.

  • To submit 6 Quality Measures which meet data completeness criteria.
  • To meet the base score for Advancing Care Information. To accomplish it, you will have to submit 5 base measures and also submit a medium-weighted Improvement Activity.
  • To meet the base score for Advancing Care Information. Also, submit 1 Quality Measure which meets data completeness requirements.
  • Lastly, you can also reach the 15-points performance threshold goal by reporting all Improvement Activities.
  • For achieving exceptional performance, the providers must reach the threshold of 70 points.
  • The law requires the payment adjustment for the 2020 payment year to range between -5% to +5X% (where +5% means = 5% X scaling factor). Scaling factor is achieved to ensure accomplishment of budget neutrality.
  • Under the revised MIPS 2018 updates, the adjustment factor applies to items and services under Medicare Part B (It includes Part B drugs too).

Quality

  • The 2018 Quality Measures Specifications will become applicable.
  • Weight to the final score is 50% instead of 60%.
  • For Data Completeness, CMS wants providers and clinicians to meet a minimum threshold of 60% instead of 50%. Therefore, measures not meeting this data completeness criterion will only get 1 instead of 3 points. However, small healthcare practices will still get 3 points.
  • The scoring has a 3-point floor for measures against the benchmark. There are 3 points for measures which either do not have a benchmark or they do not meet the case minimum requirement. Measures which fail to meet data completeness requirements will only get 1 point and not 3 points, except small practices getting 3 points. There is no change introduced for the bonuses. One of the MIPS 2018 updates is that CMS proposes the introduction of a cap of 6 points for a particular set of 6 topped out measures.
  • The improvement scoring will be given by measuring the rate of improvement. The increase in improvement will mean more points, particularly for the providers that have a lower performance during the transition year. The improvement will be measured in the Quality Performance Category Level, with ten percentage points available for Quality Performance Category.
  • One of the MIPS 2018 updates is about the topped out measures scored with maximum 7-points and not the standard 10-points.

6 topped out measures for 2018

  • #21. To either select the Prophylactic Antibiotic-First or Second Generation Cephalosporin.
  • #23. Venous Thromboembolism Prophylaxis, when they are indicated in all the patients.
  • #52. The COPD (Chronic Obstructive Pulmonary Disease), Inhaled Bronchodilator Therapy.
  • #224. The overutilization of the Imaging Studies in Melanoma.
  • #262. Confirmation via image, of successful excision of Image Localized Breast Lesion.
  • #359. To optimize patient exposure by utilizing Standardized Nomenclature for CT (Computerized Tomography), imaging description.

Improvement Activities

  • The providers must be aware of the specifications of the 2018 Improvement Activities.
  • The weight to the final score will be 15%.
  • There isn’t any change in the number of activities which MIPS eligible clinicians need to report for reaching 40 points. CMS wants to propose more activities to select from and also wants changes to existing activities for Inventory. The clinicians practicing in rural areas and small practices would only be needed to report no more than 1 high-weighted or 2 medium weighted activities for reaching the highest score.
  • For the TIN to get credit for group participation, only one MIPS eligible clinician would have to perform the Improvement Activity.

Advancing Care Information

  • The providers and clinicians must be aware of the specifications for the 2018 Advancing Care Information Measures.
  • The weight to the final score is 25%.
  • To allow the MIPS eligible clinicians to use either the 2014 or 2015 Edition of CEHRT in 2018. And also to grant them a bonus if they only use 2015 Edition of CEHRT.
  • To add exclusions for the Health Exchange Measures and E-Prescribing.
  • To add more Improvement Activities which would show the use of CEHRT to the list eligible for a bonus of Advancing Scare Information.
  • One can earn 10% in performance score if they report about any of the criteria to clinical data registry or single public health agency.
  • An additional 5% is allocated for submitting to one additional clinical data registry or public health agency (not reported underperformance score).
  • To add decertification exception for those eligible clinicians who’s EHR has been decertified, retro effectively for 2017 performance periods.
  • The deadline for exception application submission for the year 2017 and for future years, is set at December 31st for measuring whole year’s performance.
  • Small practices which have 15 or fewer clinicians, the addition of a new category for hardship exceptions to re-weight the category of Advancing Care Information to 0. To reallocate the 25% of the category weight of Advancing Care Information to the category of Quality Performance.
  • CMS will reweight the category of Advancing Care Information to 0 and reallocate its 25% performance category weight to the category of Quality Performance for these reasons.
  • Automatic Re-weighting
  • Certified registered nurse anesthetists, clinical nurse specialist, physician assistants, and nurse practitioners.
  • The non-patient facing clinicians including pathologists and radiologists.
  • The hospital-based MIPS eligible clinicians.
  • The ASC (Ambulatory Surgical Center) – based MIPS eligible clinicians and the certified registered nurse anesthetists.
  • To reweight through an approved application.
  • There are significant hardship exceptions, and CMS will not be applying a five years limit for these exceptions.
  • A new hardship exception to the clinicians practicing in small practices has 15 or fewer clinicians.
  • There is a new decertification exception added for the eligible clinicians whose EHR has been decertified and becomes effective retroactively for the performance period of 2017.

Cost

  • There will be a weight of 10% added to the final score.
  • CMS will include the total per capita cost measures and MSPB (Medicare Spending per Beneficiary) for calculating the Cost performance category score for the MIPS performance period of 2018. These two measures will be carried over from the Value Modifier Program. These two programs are also currently used for providing feedback for MIPS transition year.
  • CMS will be calculating the cost measure performance. The clinicians do not need to take any action.
  • The new changes offer Virtual Groups with participation option for Year 2, providing clinicians with another way to participate in MIPS. The Virtual Groups can contain Solo Practitioners and Groups containing 10 or fewer eligible clinicians. They are eligible to participate in MIPS, coming together virtually with at least one such other Solo Practitioner or Group for participating in MIPS. In general, clinicians’ being part of a Virtual Group would have to report as a Virtual Group for four different performance categories. They will also need to meet the same performance category requirements and measures as that of the non-virtual MIPS groups.
  • Virtual Groups need to conduct their elections at the beginning of the performance period. It cannot be changed once the performance period starts.
  • Groups and Solo Practitioners wanting to participate in a Virtual Group have to go through the election process.
  • The period given for election is from October 11thto December 31st, 2017, for them to be considered for 2018 MIPS performance period.
  • To increase the low volume threshold by excluding individual clinicians or groups eligible for MIPS having < $90,000 in Part B allowed charges. It is also applicable to those individual clinicians or groups with < 200 Part B beneficiaries falling within the low volume threshold determination period occurring during a performance period or a prior period.
  • CMS is not changing the way it defines non-patient facing clinicians. Individuals <100 patient facing encounters, and for groups, it stands at > 75% NPI’s billing under the group’s TIN falling within a performance period and labeled as non-patient facing.
  • Under the Complex Patients Bonus, there is an adjustment applied to up to 5 bonus points by adding average HCC (Hierarchical Conditions Category) risk score to the final score. The score addition would be anywhere from 1 to 5 points given to the clinicians depending on the patient’s medical complexities.
  • The Small Practice Bonus will adjust the final score of an eligible clinician or group working in a small practice as defined in the regulation, applicable to 15 or fewer clinicians. It would add 5 points to the final score provided eligible clinician or group submits the data for at least one performance category within the applicable performance period.
  • There are payment adjustments by CMS for Extreme and Uncontrollable Circumstances, approximately given to 572,000 eligible clinicians. They would have to participate in MIPS for the 2018 MIPS performance period. Under the newly proposed rule, the payment adjustment for 2020 payment year may range from =5% to +5X%. (X is the adjustment factor which allows MIPS program for staying budget neutral.)
  • If the CEHRT for a MIPS clinician is unavailable due to uncontrollable circumstances like a natural disaster, public health emergency, or hurricane, etc. the clinician can submit a hardship exception application for getting reconsidered for reweighing of Advancing Care Information performance category. The application is due with a cut-off date of December 31st, 2017.
  • There is a final rule with comment period extending this reweighting policy for the performance categories of Improvement Activities, Cost, and Quality which starts with the 2018 MIPS Performance period. The deadline for this hardship exception application is December 31st, 2018.

As far as 2018’s submissions are concerned, the deadline was April 2, 2019. Moving on, if you were eligible back then, you are eligible in 2019 as well.

MIPS consulting services job is to satisfy your end of the deal with the authorities for compliance and data completeness. That is what we do for our clients!

Moreover, those of you who weren’t eligible then may be eligible now. Give us a call or simply fill up the form on the homepage to notify us. P3 Healthcare Solutions connects clinicians to high scores which means rewards and a better reputation.

QPP 2019 is prevailing and it is important to submit measures against Quality, Meaningful Use (MU) or Promoting Interoperability (PI), Improvement Activities, and Cost performance categories. With the promise of less reporting burden by CMS, we can expect the program to become clinician-friendly as time goes by. Please follow us on LinkedIn here – https://www.linkedin.com/company/p3-healthcare-solutions

What is next?

What changes to expect in MACRA-MIPS 2019?

For questions out of this knowledge base, or on instructions on how to get started call a MIPS specialist today at 1-844-557-3227 (1-844-55-P3CARE) or email at info@www.p3care.com .