How to Stabilize Finances of Healthcare Practices?

This is the 21st century. The healthcare rules are changed. Physicians don’t have the time to file claims with insurance companies due to administrative burden. Therefore, medical billing services stand next to healthcare practices to help them increase revenue. Certainly, it’s not time when physicians’ only had to worry about the well-being of patients. Now, the factors like patients’ satisfaction, implementation of engagement strategies, and innovation in the healthcare industry via MIPS have more points in making a physician’s reputation.

Thus, it is not wrong to say that it’s time to work smart! Therefore, technology comes to save the day for physicians and medical billing companies.

Medical Billing Services! If you’re looking to increase the collection rate for your clients, watch out for the following technology innovations.

These suggestions optimize medical billing and coding process, save time, and help increase ROI.

  1. Go Online

Leave paper behind. In this digital era, do you believe, sending invoices to patients via paper is a reliable or safe way? Well, No.

Most of the medical billing services still send bills via papers, and we must know this method is obsolete. Collection rate can be significantly increased if physicians allow a digital method of sending invoices.

  1. Ask for Payments While the Patient’s Visit

It is observed that the chance of collecting payment decreases by 20% when patients walk out of the physicians’ office.

In-house or in-office payment rate increases when medical billing companies or front-desk staff accepts credit/debit cards on the spot. But, first make sure you have a HIPAA-compliant setup and you obey Payment Card Industry Data Security Standards (PCI DSS) guidelines.

  1. Verify Patient’s Insurance Eligibility Beforehand

Verifying patient’s insurance eligibility before the treatment is an under-rated practice. However, when done, it makes bank accounts full. Some software can help in this task, and some of them are so advanced that they even notify physicians for the paid payments by the patients such as deductibles and copayments. In this way, medical billing services can proceed with medical claims without any difficulty afterward and even inform patients about their financial responsibilities.

It needs a big investment, but it is worth every penny.

Healthcare innovations are on the rise. So, it’s better to move forward instead of sticking to the old conventional methods. It is not only beneficial for introducing interoperability but also to level up the billing and coding standards.

Don’t you think?

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In What Ways Medical Practices Can Take Risks to Increase Revenue

Everybody agrees that healthcare professionals, no matter in what capacity they serve, require every bit of applause. Working in hospitals is indeed a hectic job, and clinicians work tirelessly from day to night.

When it became difficult for physicians to meet up with ever-changing scenarios, medical billing companies came to their rescue.

Now, insurance companies have strict rules and regulations, and physicians get reimbursements only when they meet the standards. Also, with the already complex U.S healthcare system and value-based incentive programs as MIPS, physicians tend to put greater efforts for their survival. It also put pressure over the medical billing services, as they could not afford to perform below average.

Besides, the focus on value-driven healthcare services has increased. Patients’ engagement level and integrated healthcare infrastructure have also gained more importance than before. Thus, medical practices ought to implement strategies that benefit them in the long run.

According to a survey report of Healthcare Financial Management Association (HFMA), more than 7 medical facilities in a group of 10, aim to take risk via

  • New commercial payers
  • Medicare advantages
  • Medicare contracts

One thing is interesting to note that many healthcare leaders support the idea of a revolutionary healthcare system that benefits both, patients and physicians.

Provider-Sponsored Healthcare Plans (PSHP) is gaining much attention even from medical billing companies as patients get insurance plan owned by a hospital or physician. 25% of the medical practices are already going to be part of the PSHP system, and 19% of hospitals want to launch their own healthcare insurance plan in the upcoming years.

Alongside this, Medicare and private payers are also increasing their range of insurance benefits.

What Benefits will Physicians Get?

If medical practices take chances to go for new payment models, both payers and physicians will be equally benefitted. Physicians will be able to implement accurate value-based practices while being closely in touch with the payers. The communication gap will be reduced, and the medical billing companies will reduce the rate of denied medical claims.

The Use of Healthcare Technology

By taking bold steps to increase reimbursements and efficiently run revenue cycle management, physicians will be able to use the latest healthcare technology successfully.

Hospitals will manage to spend efficiently upon the technological infrastructure to increase engagement between physicians, patients, and payers. Surprisingly, many physicians are ready to spend money on new technology avenues.

What are the hurdles that might come?

Even in 2019, there is not much demand for drastic risks in the healthcare industry. Although, many physicians like the idea to try something new. Still, they are comfortable with the Fee-for-Service (FFS) payment model.

What Should Physicians Do?

You can always take risks whenever you want.  On the contrary, you can also benefit yourself from the existing payment model and generate revenue by focusing on the betterment of the following parameters.

  • Engagement rate
  • Standardized clinical procedures
  • Cost-effectiveness

If you’re struggling in managing accounts receivable (AR), taking risks may seem like an appropriate option, but the transition process is also tiring. You can’t expect to achieve everything within a little time. The best approach is to keep improving healthcare strategies gradually and consult a professional medical billing company that creates medical claims with up-to-date knowledge. Like, P3 Healthcare Solutions- A professional medical billing company in Ontario, CA that has years of experience in the billing field and helps in generating revenue for its clients.

What are your thoughts? Let us know if you’re willing to take risks regarding revenue generation?

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SWITCHING TOWARDS CLOUD SERVICES ISN’T EASY FOR PHARMACEUTICAL INDUSTRY

The modern healthcare industry is the amalgamation of technology and medical services. With this growing trend of health IT, data security and privacy have become the main concern for physicians. Be it, medical billing, MIPS, MACRA, electronic healthcare records (EHRs), digital collection and storage has taken the paramount place.

To take advantage of technology and to support MIPS in healthcare, pharmaceutical companies are interested in going cloud-based. However, they want surety to have a secure transition, which is not as simple as it seems.

The professional mapping of the data flows, frameworks and technology implementation require amazing efforts. While doing all this, a proactive approach, anticipating the potential threats is compulsory.

What steps should be taken to have a safe cloud-based technology?

  • Take Measures for Security Breaches

Same as physicians have to protect patients’ data, and other sensitive information from hackers in the MIPS program, the pharma industry has to pay attention to security threats.

It is estimated that during the shifting process of the hand-written data to the cloud-based database, many incidents of data breaches will be experienced. Security experts that are well-aware of the data sensitivity and actively take measures against breaches are one of the major hurdles in implementing this migration.

A connected and heterogeneous cloud-based storage system is a complex process. Therefore, not just secure database is to be designed but also with an efficient backup system.

Security failures can only be prevented when there will be the right personnel with the right expertise for this job.  Therefore, before moving towards cloud-based technology, the pharma industry needs to have a proper execution plan.

  • Be Prepared To Manage Risks

Translating the manual database to a cloud-based database may disturb the entire pharma company. Therefore, calculation of the internal and external risks is equally important for the effective functioning of cloud-based technology in the pharmaceutical industry.

A reasonable solution is to convert data step-by-step until the whole staff gets comfortable with it. Test the cloud technology implementation and highlight errors that don’t meet the standard. Manage risks and measure return-over-investment.

  • Research about the Implementation Protocols

Pharma industry will not just face problems regarding the right technology.  In addition, it needs to research all the pros, cons, and the working process of technology implementation. Vulnerabilities come across as major setbacks in an efficient running system. If there will not be a proper channel or sequence of operations to enter, fetch, and share data from the system, what will be the point?

In order to support MIPS in healthcare, that is one of the leading value-based incentive programs, pharma companies need to have a front role in understanding all the implementation details.

Healthcare industry is already sensitive, and pharma being its part can’t be separated from its rules and obligations. There is a reason that the regulatory authorities highly govern this industry.

SaaS – Software as a Service model is getting popularity in the pharma industry. However, there is a need to develop the understanding that implementation of the cloud-based services without seeing the capability of the system will cost more than ever.

Thus, flexibility is required but with the hint of sensibility to predict different case scenarios and the associated cost to check if this is the best-suited solution.

Surely, the pharma industry should move forward with the changing times. Nevertheless, the change should be transitive and be able to generate constructive results while making sure of all the security aspects.

In your opinion, what steps should be taken to ensure reliable implementation of cloud technology in the pharma industry?

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3 TYPES OF PAYMENT MODELS, PHYSICIANS PROBABLY DON’T KNOW!

Value-based healthcare services have not only changed the patients’ healthcare standard but also the physicians’ payment model. Value-based reimbursement models encourage clinicians to adopt methods that make healthcare easy and efficient. Programs like MIPS, MACRA, and more depict value-based care system and allow physicians to achieve rewards and bonuses. The purpose is value-based reimbursement models are to;

  • Straighten up physicians’ revenue cycle management
  • Make patients empower the healthcare system where they choose their desired service

We have heard many of the benefits and the need for value-based healthcare models, but the proper information about the available models is not very common. Let’s review that.

What are the Available Value-Based Care Models?

There are a few types of value-based payment models with a variety of risks attached and the benefits.

1. Accountable Care Organizations (ACO)

It is a system of hospitals, clinicians, and other healthcare providers to provide organized and high-quality services to Medicare beneficiaries. It was started to help patients receive up-to-the-mark services at the most appropriate time. It means that in case of emergencies or other scenarios, patients don’t have to wait to get to the relevant doctor.

This organization ensures that patient only bears expenses for those services that are absolutely necessary to treat an illness. Redundant medical services are reduced by eliminating medical errors that occur while diagnosis or treatment.

Healthcare providers volunteer in this program to get shared savings if the ACO fulfills the standardized healthcare criteria with reduced expenditure.

Risk Factor Involved in ACO

It is not like ACO volunteers always end up adding a bonus to their revenue cycle, but the financial risk is also involved. When able to meet the requirement, physicians have a jackpot, but on the other side, they also have to bear shared losses if any.

For shared loss, healthcare providers have to pay Medicare as compensation for not delivering value-based care to patients.

This value-based reimbursement model is not just about value-based medical procedures but also support volume-based services. However, the evaluation is based on quality, safety, and experience.

2. Bundled Payment for Rendered Services

This payment model pays physicians not for each service but as a whole series of services. Clinicians receive collective reimbursement for treating a medical condition, including all the charges for physicians and the types of rendered procedures.

For Instance,

If a patient undergoes a surgical procedure, CMS (The Centers for Medicare and Medicaid Services) sets a collective payment for surgeons, an anesthesiologist. It then pays a total amount rather than paying separately to each clinician.

Risks Attached with Bundled Payment Model

A certain level of risk is also involved with this type of payment model same as the ACO. Physicians get to full their pockets when they collectively reduce the incurred cost. Otherwise, they get will have to bear the loss.

Thus, this practice requires standardized procedures so that, all stakeholders get the rightful reimbursements.

3. Patient-Centered Medical Homes (PCMH)

It represents the healthcare payment model in which a primary care physician coordinates the patients’ healthcare. This payment model manages and handles all the needs of the patient in a centralized setting.

It’s certification highlights that the physicians are capable of providing healthcare in a patient-centered setting with team-based methods. Moreover, it also ensures consistent care quality for patients.

Patients are allowed to develop a one-to-one relationship with their physicians, and it governs on the medical and environmental factors.

This payment system has shown great potential in reducing the un-necessary cost expenditure. According to a Maryland – based PCMH, via the efficient practice of this reimbursement model, they were able to save up to $98 million and enhance their quality standards by 10%.

Alternative payment methods other than the fee-per-service are not very popular practices. However, physicians are unable to meet their financial requirements. Thus, they are devising ways to incorporate new technologies into their system to speed up the workflow.

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HOW MIPS CAN BE AN ACCEPTABLE PROGRAM FOR CLINICIANS?

The argument that CMS needs to improve MIPS is a thing in the past. Now, the focus is on “how to devise ways that actually implement the change and stands true to its promise of a better healthcare system.

Let’s admit there is no standard way for any quality payment program to hit bull’s eye in its starting years. When a program is initiated and tested in a real-time environment, it gives insight on the actual performance and capability of the program; the same is the case with MIPS. Since, its first year in 2017, physicians are raising questions against its payment model.

Many leading healthcare organizations have proposed ideas that might help CMS to overcome related issues.

Reduce Un-Necessary Administrative Work

It is observed that there is a lot of administrative work associated with MIPS reporting. There is a lot of data that needs to be collected and managed to submit to CMS. One reason is the primary care and the value-based medical services that quality measures cover. This program can serve to be more physician-friendly if clinicians are not burdened with extensive administrative work.

MIPS solutions consist of elements from three major programs:

  • Physician Quality Reporting System (PQRS)
  • Value-Based Payment Modifier (VM)
  • Meaningful Use (MU)

CMS is working in this context and simplifying this quality payment program with the easy amalgamation of all elements.

However, clinicians are not satisfied and still face administrative burden while quality reporting. Most of the physicians have reservations regarding the relevance of MIPS quality measures to the program. Quality measures have been a special concern for surgeons because they have been evaluated on patient’s immunizations. This approach is particularly un-necessary for surgeons and reflects poorly on the intention.

Past president of The American Medical Association (AMA) David O. Barde, has provided with a list of suggestions in this regard.

  • Reduce the number of measures for which a physician can report.
  • Re-expand the definition of a facility in MIPS reporting to include all healthcare service providers; no matter wherever they are, such as post-acute care center.
  • Set a 90-day performance period for all MIPS measures.
    This way, physicians will be able to invest their energies in the right direction that is, on their patients.

Rethink and Modify Promoting Interoperability (PI) Category for MIPS

Promoting Interoperability (formerly known as Advancing Care Information (ACI)) performance category tests physicians’ patient the most. Via this category, CMS has tried to encourage physicians to incorporate certified usage of EHR technology.

According to some physicians, this category focuses entirely on EHR technology, instead of actual advancement in the healthcare system. However, they need to shift their focus on actual usage of technology and to translate digital health information on patient level. Only this way, the PI category will stand true to its name.
The reporting requirements for this quality measure should also be modified to make this category more useful for physicians.

Implement MIPS to its True Potential

MIPS has the potential to bring advancement in the healthcare industry. However, with the final rule of QPP for MIPS 2019, around 58% of the physicians are already excluded to even participate in this program. It will result in fewer payment adjustments for physicians who improved their healthcare quality.

According to the CMS, with higher reporting criteria, non-eligible physicians will have more time to improve their quality to the maximum level. Nevertheless, the question remains that the purpose of this program is to pay clinicians for their investment in medical practice, not to judge their improvement rate until it reaches a certain level.

In addition, small medical practices have fewer resources, therefore; their performance should be analyzed separately from large healthcare organizations. This will stir the air in the healthcare industry and encourage physicians to move towards valuable healthcare.

Many healthcare organizations want to target incentives and bonuses but due to the inflexibility of the program, they can’t strike on the right target. By acknowledging the resources and the improvement made by the medical practice, MIPS should recognize the efforts one made to comply with the burdensome MIPS reporting.

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RIGHT MIPS SUBMISSION METHODS LEAD TO SUCCESSFUL MIPS REPORTING!

MIPS – a quality payment program for physicians is one of a kind and progressive step that benefits both, physicians and even the patients. The prior tangled and twisted reimbursement method failed to contribute to the healthcare industry via any advancement. Thus, MIPS came as light at the end of the tunnel for physicians to direct their financial matters in the right direction.

Reporting accurate data, according to the medical practice and with the appropriate submission method is inevitable to score high in MIPS scorecard. The period for submitting MIPS qualified measures is already short so there is no time to waste.

This article discusses all the queries regarding MIPS submission methods so that physicians successfully report clinical data to CMS.

First, Do Your Research Well!

The first step in MIPS reporting is to recognize what submission method will suit your practice, the best. The right decision will have a huge impact on your submission. Otherwise, you’ll end up scratching your head for unnecessary delays caused by poor research, as many factors are important for a professional MIPS submission.
In addition, MIPS data submission seems easy. However, it is not as simple as one may estimate. Let us briefly explain the MIPS reporting process.

How to Report MIPS?

Physicians work day and night treating patients to deliver quality-based medical services. MIPS eligible clinicians report their performance data on a yearly basis to CMS. There are four performance categories for MIPS:
• Quality holds 50% of the total MIPS score
• Promoting Interoperability (PI) holds 25% of the total MIPS score
• Improvement Activities (IA) holds 15% of the MIPS score
• Cost holds 10% of the total MIPS score

As per the CMS submission requirements, physicians report against three categories. However, the CMS authorities themselves measure the cost category. They calculate performance for this category by administrative claims data.

Now, Choose Between MIPS Submission Methods!

Clinicians can choose from a number of submission methods as per their requirement,
• CMS Web Interface
• Administrative Claims
• Electronic Healthcare Records (EHRs)
• Qualified Clinical Data Registries (QCDR)
• Qualified Registry
• CAHPS for MIPS Reporting Survey Vendor
• Attestation

Consider the Following Points When Choose a Submission Method!

  • While considering what submission methods will result in your favor cost-effectively, you also need to ponder upon their limitations.
  • Clinicians are only allowed to report data via a single submission method for a single performance category.

Look out for all possible scenarios that can occur with the submission method. As each MIPS submission method has its benefits and limits as per the medical practice. Therefore, carefully check all the logistics and your organizational structure before submitting data. It may leverage your performance score for positive or negative payment adjustment.

Not only deciding the right submission method is time-consuming, but it also requires thoughtful planning, resourceful implementation, and the ability to incorporate progressive steps of your organization.

All this Process is Hectic but you can Stay Stress-Free with P3Care!

Physicians may be worried about how they’ll manage to choose the right MIPS submission method along with their responsibilities. Don’t worry and let us share your MIPS reporting burden. P3Care has been MIPS qualified registry for two years. Our specialized methods, resources, and experience in this field speak for itself. Moreover, we as an H I.T consultants help to choose you the right quality measures and the submission method.

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TAKE ADVANTAGE OF MIPS 2018 REPORTING STANDARDS & SCORE HIGH!

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

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

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

Virtual Group Participation is now LEGAL

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

The requirement for a Virtual Participating Group

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

Low-Patient Threshold Update

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

Bonuses for Care Services of Complex Patients

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

MIPS Favors Small Healthcare Practices

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

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

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

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

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

The threshold for Penalty-Less Spot has increased

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

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

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INTRODUCTION TO THE PHYSICIAN COMPARE INITIATIVE

Launched as a part of the Affordable Care Act (ACA) or the Obamacare Act of 2010, the physician compare initiative started out as a simple online searchable database of healthcare professionals eligible under Medicare.  Since its launch in 2011, the Physician Compare website has been regularly updated by the CMS’ Medicare department to enhance the information that helps patients make informed healthcare decisions.

Changes to Physician Compare Website

Presently, the Physician Compare website shows necessary physician and group association information like physician name, practice name, location, phone numbers, specialties, gender, medical certifications, affiliations, and languages spoken. However, so far the website is just that, it gives the necessary information. The website does say whether or not a physician participated in the outdated Physician Quality Reporting System (PQRS) program and the most recent information on the site is from 2016. Doctors supporting the Million Hearts initiative by the Department of Health and Human Services (HHS) are also identified.

However, is this about to change?

CMS has declared that it will soon make available the MIPS score of all eligible providers on its website. Provider scores in each of the performance category, i.e., Quality, Cost, Promoting Interoperability, and Improvement Activities will be posted on the site based on 2017 performance scores. The data will be available in downloadable file format free for use by online directories and health information websites like Yelp, ZocDoc, Healthgrades, and Vitals, etc.

Reputation Impact of Physician Compare

What this means is that all those clinicians that have been reporting a minimal amount of data to avoid a MIPS penalty need to rethink their strategy. MIPS score is not only about receiving an incentive payment anymore. The doctor’s reputation is at stake here, not just dollars. Furthermore, individual physician star ratings will follow them if they change their organization. The MIPS score may directly impact their future career opportunities, clinician recruitment, potential mergers or acquisitions, insurance contracts and more.

Eligibility Criteria for Appearance on the Website

A physician or a provider group needs to have ratified Medicare PECOS information available. Furthermore, the clinicians should have submitted at least one value-based claim within the last 12 months. Groups must have at least two clinicians reallocating their benefits to the group as a whole.

What Sources of Data Will CMS Use?

CMS has been using multiple sources to update its website; these sources will be expanded in the future. The information displayed on the site may be derived from self-submitted data via claims, qualified clinical data registry, qualified registries, consumer assessment of healthcare providers and systems (CAHPS) and the provider enrollment, chain, and ownership system (PECOS). CMS also coordinates with national certifying boards to confirm board certifications. CMS determines which quality measures are statistically reliable enough to be displayed on the website.

Star Ratings for Easy Comparison

Beginning this year, performance on quality measures will be depicted by a one-to-five star rating system. Each star represents a 20 percent performance score on MIPS (i.e. 1 Star = 20%, 2 Stars = 40%, 3 Stars = 60%, 4 Stars = 80%, 5 Stars = 100%). These ratings are relative, that is, they depend on the performance of other eligible practitioners and groups under the program.

30-Day Preview for Checking Information & Correction

CMS has announced that it will provide a 30-day preview to the clinicians for review and correction before the measures and ratings are finally made public on the Physician Compare website. The physicians will be made aware through the MLN Connects weekly newsletter and various other platforms. If you discover any errors or omissions in the information, you can contact CMS for correction. You may need to submit proofs supporting your claim for your correction. Also, there is no formal appeals process thus ensuring correction within the 30 days preview period is highly critical. If you discover any errors during the preview period, you can report it to CMS via the contact information provided on the website.

How Can P3 Healthcare Solutions help?

Be patient, for instance, if you have switched a group practice or a hospital, or you upgraded your certifications, you need to update the information through PECOS. Corrections made in PECOS could take up to 4 months to be reflected in the website. Furthermore, healthcare providers will only learn about their MIPS score for the performance year 2018 by late 2019. That means when they learn about bad performance, the year after the bad performance will also almost be over. Thus they can start focusing on improvement only in the next year. It means that not only the incentive payments will continue to get hurt, the reputation impact will also continue until at least the end of 2020.

P3 Healthcare Solutions is a MIPS Registry for the second consecutive year in 2018. Our advanced analytical tools help you track your performance throughout the year and can give an estimated MIPS score to ensure that you are satisfied with your score before you submit your reports to CMS.

It is very vital to get an expert opinion about how to balance the costs associated with getting a high MIPS score and the potential negative impacts of a low MIPS score.  For any more questions related to this, or for instructions on how to get started call one of our MIPS medical billing service experts today at 1-844-557-3227 (1-844-55-P3CARE) or email at info@www.p3care.com.

MIPS QUALIFIED REGISTRY & VENDORS

Criteria 

In order to be included in the MIPS qualified registry vendors, you must self-nominate your organization each year (even if you have previously qualified) and gain approval by CMS. As a clinician, individual or group, you’ll see yourself directly interacting with your selected vendor on a regular basis.

Therefore, it’s absolutely necessary there’s a mutual understanding in regards to expectations and outcome goals. Essentially, the objective of any qualified vendor is to ease all billing and QPP reporting tasks. Which leaves you with valuable time to focus on patients.

To give you a brief understanding of the procedure, here are a few of the necessary requirements to be completed by a vendor in order to be approved by CMS for the 2018 MIPS Qualified Registry Vendors.

  • Provide information about previous registry status (new or existing registry)
  • Each vendor should have at least 25 participants by January 1st, 2018.
  • Provide an attestation statement, verifying that all data in relation to measures, activities, and objectives are accurate and complete.
  • You must submit data using one of the CMS provided secure data submission methods.
  • Provide information on how we (the vendor) will process data validation and MIPS eligibility.
  • Include our supported MIPS quality measures and performance categories.
  • How the vendor will collect information and determine the provider’s performance rates.
  • Process for verifying providers TINs and NPIs.
  • Provide random audit process.

Disclaimer 

Accuracy is absolutely vital in all aspects of data collection, reporting, and submission. CMS has determined a penalty in regards to inaccurate data submissions. Therefore, this results in possible probation and disqualification for the following year.

Side Note-  Registry updates would show which vendor is on probation.

In addition, CMS has provided us with a checklist consisting of data submission tasks. You must complete all the tasks to be approved for a qualified registry. The categories a vendor must complete (with a brief description) include:

Indicate– Certified EHR technology, start and end dates for performance periods. Whether or not vendors are reporting on quality measures, objectives, and improvement activities.

Submit– Submit and report data for all supported MIPS categories, provide eligible clinicians with performance feedback at least 4 times a year, quality measure ID numbers.

Report (on the number of) – Performance and reporting instances, inadequate submission criteria.

MIPS Qualified Registry Vendors 2018

Verify (clinician information)–  Details about services provided to clinicians along with contact information and charges. This should be a signed consent by the provider to allow the vendor to provide CMS with MIPS data on their behalf. Also provide HIPAA compliance (patient-focused) agreement between both vendor and clinician, verify all data submitted is accurate and complete.

Comply- Submit data using one of the secure options provided by CMS, fulfill requests by CMS to review data at any time, take part in annual registry meeting and monthly support calls.

We at P3Care are proud to be 2017 CMS certified! P3Care’s objective has always been to reduce workload burdens off of providers and staff to enable them to look after patients in a better way.

If you’re on the hunt for a medical billing provider or MIPS support, we can ensure you will be satisfied with our committed service!

Our CMS registry approval will ensure you that we have successfully demonstrated our capabilities on reporting data for the MIPS transition year 2017 in the following categories: Quality, Advancing Care Information, and Improvement Activities.

Furthermore, the CMS registry will provide you with the necessary information needed when selecting an appropriate vendor for your practice. Therefore, you can find detailed information about each vendor under the following headings: Contact Information, Cost, Reporting Options (individual or group, Services Offered, Performance Categories, Quality Measures Supported, and eCQMs Supported.

P3 Healthcare Solutions and Medical Billing

To decide which professional medical billing company suits their practice best is one of the most important decisions a provider will make. The financial outcome of your practice heavily relies on the efficiency and accuracy of the medical billing vendor you select. Whether you practice individually or in a group,

CMS qualified registries are a collection of vendors that are certified to report on quality measures and data for the Quality Payment Program / MIPS. CMS registry vendors have all necessary tools, knowledge, and software up their sleeves. This is important to submit data on behalf of providers directly to CMS.

Furthermore,  qualified registries are self-nominated. And they have proved to meet requirements set out by CMS and the QPP. P3 Healthcare specializes in supporting MIPS eligible clinicians through Benchmark Quality Reporting. While also functioning as a proficient and client-centered Medical Billing firm.

Therefore, MIPS qualified registry is open to the public anytime. You can view P3 HealthCare Solutions in the MIPS qualified registry vendors by visiting the CMS Resource Library.

MACRA & MIPS: A CLOSER LOOK

MACRA

Talking about MACRA & MIPS, it is important to learn that in 2016, MACRA (Medicare Access and CHIP Reauthorization Act of 2015) was officially introduced, ruling out the existing and outdated Sustainable Growth Rate method. Previously, providers received payments based on the number of Medicare patients they provided care to; rather than being paid for the quality of care they provided. Not only was this method proven to be ineffective for the patients, but drastic effects were observed when it came to receiving financial support for Medicare expenses. Treating a high volume of patients (quality or no quality) basically meant higher payments for providers. MACRA established a Quality Payment Program (QPP), a method that will motivate providers to deliver well thought out quality care to patients by rewarding them with payment adjustments. Eligible providers are able to choose one of two pathways in the QPP, MIPS (Merit-based Incentive Payment System) or APMs (Alternative Payment Models).  An estimated 500,000 providers will be eligible to participate in the first year of MIPS. The amount MACRA will provide for positive payment adjustments is quite overwhelming, up to 3 billion dollars in the next six years! Let’s take a closer look at MIPS, and how P3Care can provide you with consulting services to ensure you understand how to take full advantage of this new and improved payment process.

MIPS

In order to take part in MIPS, you must meet the requirements associated with Medicare billing (Part B). Selecting this route of the QPP focuses on receiving payment adjustments based on the specific data you have submitted. For the 2017 transition year, there are three different categories. To help better understand how you’ll be scored under MIPS, specific weights are given to each category. This will allow you to divide your attention accordingly. You will also need to determine if you are participating in MIPS individual or as a group. Here’s a closer look at the MIPS performance categories for 2017.

·         Quality

60% of the data submitted will pertain to this category; signifying the main purpose of eliminating the previous method, and implementing MIPS. In this category, providers which practice solely are required to report up to 6 quality measures (out of 271), which are the most associated with their specialty. Clinicians will be scored based on the number of days they have submitted data for (read more below), along with accuracy and completion of all the required specifications for each measure. Closely assessing each measure helps determine if high-quality healthcare goals are achieved. The total number of points earned on 6 quality measures + any bonus points will determine your final score of the Quality category.

·         Advancing Care Information

Taking up 25% of the total MIPS score, this category replaces the previous Meaningful Use program. You’ll need to select one of two reporting measure sets, depending on your EHR edition. Each option is composed of different measures; therefore it’s essential you only report on which option relates to you. There are three subcategories that will determine you’re the total score for this category, they include Base Score, Performance Score, and Bonus Score. Failing to complete all of the requirements in the Base Score category will result in a 0 in the overall Advancing Care Information category.

·         Improvement Activities

The remainder of the score (for 2017) will come from the Improvement Activities category, weighing at 15%. This category allows CMS to determine if clinicians are improving clinical practice to its highest potential. A few key aspects include providing quality care by involving the patients in decisions,  continuous coordination between provider and patient, providing self-management techniques, patient/family education, providing follow-ups, using safe technology, and being reasonably accessible. You’ll have the opportunity to choose from a variety of activities, that best suit your practice, to report data on. Each activity is categorized as either has High or Medium; high weighted activities are worth more points. Individual Medicare providers will need to submit data on up to 4 activities for a minimum of 90 days, in order to earn full potential points.

Cost

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

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

For the year MIPS 2017, the cost category had a value of 0% in the final scorecard. MIPS 2018 was the first performance year in which, the cost was set for 10%. This score accounts for the lower cost expenditure while physicians provide high-quality healthcare services to patients.

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

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