MEDICARE MIPS REPORTING ESSENTIALS FOR PHYSICAL THERAPISTS

Physical therapists (PTs) are now a breathing part of the Quality Payment Program (QPP). It is a choice they have to make because they can’t back out. Medicare MIPS reporting through a MIPS Qualified Registry or an EHR system can get them through the maze of value-based care smoothly.

The only choice the eligible PTs have is to choose between the Merit-Based Incentive Payment System and an Advanced APM. The popularity of MIPS as an incentive program outweighs the characteristics of the other track. Hence, MIPS is the go-to track.

The PTs who do not meet the low-volume threshold (LVT) can participate voluntarily.

Why?

They must be prepared for what lies ahead and no better way to do it than participating in it.

Medicare MIPS Reporting for Quality and IAs

Good news for PTs is that they are not required to report in all the four performance categories. Instead, they are required to report for only two – Quality and Improvement Activities.

It directly affects the number of measures they need to report to CMS. With all the focus on MIPS Quality measures and IA measures, they can score high and handsome. It also keeps them very much in the game without the possibility of burnout.

A yearlong report against Quality determines the final score, failing to do so; there are consequences in the form of negative payment adjustments.

Medicare MIPS reporting best happens through certified electronic health record technology (CEHRT) or MIPS Qualified registries such as P3 Healthcare Solutions. Please follow us for effective MIPS solutions on LinkedIn – https://www.linkedin.com/company/p3-healthcare-solutions

Advanced APM Participation Track

Physical therapists who follow Advanced APM as their participation track cannot go for Medicare MIPS reporting as it is one track at a time.

Expect an additional reward of +5% to your Medicare earnings of 2019 if the reporting results are at par with the benchmarks set against measures. Additionally, the high scorers have a chance to collect bonus rewards from the $500 million pool.

While PTs become an active part of the value-based payment system, the removal of functional limitation reporting (FLR) is a healthy change adopted by CMS.

P3Care for PTs and PTAs

The submission of MIPS data is unlike any other data submission. It requires your NPI/TIN and account creation on the QPP portal. Health IT consultants at P3Care activate your accounts with ease and with the mutual collaboration; you get to report to CMS. Accuracy is the key here because you can’t undo or redo these submissions. They happen only once so make sure they are accurate.

What about Telehealth?

The final rule doesn’t allow PTs to be reimbursed against Telehealth. The virtual check-ins will remain associated with physicians and specialty-specific clinicians, though P3Care backs the initiative of Telehealth for PTs and PTAs.

Moreover, there are no reimbursements for “Inter-professional Internet Consultations” for them.

Direct Submission Method

PTs can use the registry method for direct submission. For it to happen successfully, the collection type is MIPS Clinical Quality measures (CQMs). Medicare MIPS reporting 2019 returns optimum results if you are both accurate and smart in terms of selecting high scoring measures.

Outcome measures and high-priority measures hold significance in achieving reward and bonus-worthy scores.

For small practices, the clinicians and clinician groups can collect and submit measures for Quality through Medicare Part B claims.

Groups with 25 or more clinicians may use the CMS web interface for Medicare MIPS reporting.

Deadline for the QPP 2019 Program

MIPS eligible clinicians have time until March 31 of the next year after ending of the performance year. In addition, if your mode of submission is through claims, you have until 60 days after the closing of the performance year.

Improvement Activities (IA)

For PTs and OTs, the category holds 15% weight in the total score. It estimates to 40 points and only the top performing clinicians will be able to reach that number. The improvement activities you should consider reporting to CMS are –

  • Care Coordination
  • Patient safety
  • Beneficiary engagement
  • Participation in APM
  • Achieving health equity
  • Emergency preparedness and response
  • Population management

However, take note of the number and format to report in by the following classifications.

  • Two high-weighted measures
  • One high-weighted measure and one medium-weighted measure
  • Four or more medium-weighted measures

After selection of activities to submit, you are ready for Medicare MIPS reporting through QCDR, Qualified Registry or an EHR system. For those interested in the MIPS attestation process on their own, they can submit activities by logging on to the QPP portal.

Do you think you can gather data and report on your own or is it better to hire third-party intermediaries?

Reply in comments below, as we’d love to hear your thoughts.

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