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.” 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 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 the 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.

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@p3care.com.

An Overview of MIPS 2018 by P3 Healthcare Solutions

MIPS 2017 update is over. All the eligible participants who took part in MIPS 2017, whether individuals or groups now await results and the payment adjustments due in 2019. Whoever was unable to participate in 2017 can start attempting measures in MIPS 2018 while reporting data to CMS through a MIPS Registry.

Let us look at the most prominent changes made in MIPS 2018. The Quality Payment Program’s track of MIPS in 2018 adds new clauses to the value-based reimbursement system in the form of measures and weight classifications. It will help us in learning about the program’s salient features as well as becoming aware of the new additions.

MIPS 2018 performance benchmark is raised from 3 to 15

From a total score of 100, now the eligible clinicians must have a score above 15 to avoid negative payment adjustments in 2020. To achieve this target, the eligible professionals will be reporting at least 6 quality measures and a clinical cluster or fulfilling the requirements of improvement activity category.

The Quality category carries 50% weight

The Quality category’s value is down by 10% making it 50% for MIPS 2018.

To achieve a safe final score, the participants should attest to and report a total 6 quality measures to the CMS. In those 6 measures, one must be an Outcome Measure or a High-Priority Measure, in case you can’t find a suitable Outcome Measure. However, if you choose to submit data via CMS web interface (eligible for groups of 25 or more clinicians), you will have to report 14 measures.

Outcome Measures are those measures that relate to the health of the patients after a possible treatment or intervention. For example, the number of patients who passed away after the surgery.

The other types of measures include reporting against procedures, arrangements, effectiveness and patient involvement/experiences.

Be prepared to score in the Cost category

The big change in MIPS 2018 is the addition of a new category, cost! Now clinicians will be judged against the cost category as well. It holds 10% weight in the MIPS final score. Performing well in this category means a better composite performance score (CPS). It will impact the total score and may be the only measure standing between you and the bonus payments. The two most important measures evaluated under this category are –

  • Medicare Spending Per Beneficiary (MSPB)
  • Total Per Capita cost per recognized beneficiary

Cost category works through medical billing claims analysis as there are no data submissions required for it. To have a higher score in cost category, clinicians:

  • Must see the patients in the hospitals
  • Must have a background in at least 35 cases for MSPB
  • Must have at least 20 cases for Total Per Capita
  • Must provide a multiplicity of Medicare Part B services to a beneficiary

The idea behind this performance category is to see how much cost on an average incurs in the treatment of the patients.

The Rise of the Virtual Groups

In 2018, we see the inclusion of virtual groups as a new method of participation in MIPS. There are a total of four ways to take part in MIPS 2018. They can take part in as:

  • Individuals
  • Groups
  • APM entity in a MIPS APM
  • Virtual groups

A virtual group combines two or more TINs (Tax Identification Numbers) associated with one or more individual practitioners or one or more groups comprising of 10 or fewer eligible professionals.

Quality reporting period extends from 90 days to a whole year

Remember to complete and report those 6 measures including an outcome measure or a high-priority measure for the entire year. If you haven’t started reporting until now, there is no time left. You must start reporting MIPS data instantly. We invite you to choose P3Care for better reporting and adherence to the rules and regulations laid down by CMS. The quality category holds 50% weight in the total score, thus, a crucial factor in the achievement of bonus payments.

Data completeness

This element is emphasized in 2018. In the current performance year, all the quality methods should report 60% data completeness instead of 50%.

Using Certified EHR Technology of 2015

To make the data more authentic and up-to-date, CMS will prefer reports initiating from the 2015 Edition of the Certified EHR Technology (CEHRT). A 10% bonus for Advancing Care Information (ACI) category will be a reward for those eligible clinicians using the most recent EHR system.

You have to report for quality performance category for the entire year and the rest of the three performance categories; you only need to report for 90 days.

Conclusion

Be mindful of the deadlines in 2018. To conclude it, we have MIPS 2018 with quality category holding 50% importance, Advancing Care Information with its 25% invaluable share, Improvement Activities (IA) carrying 15% weight and finally the cost category holding 10% value in the final score.

P3Care Medical Billing Services for Emergency Physicians

P3Care medical billing services are precise both regarding serving physician-specialists and accurate management of accounts receivables.  CMS recognizes P3 Healthcare Solutions as a MIPS Qualified Registry. You can view it here – https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/2017-Qualified-Registries.pdf.

Outsourcing the medical billing services is a tough decision to make. There are several factors which influence the indecisiveness. Putting your finances in the hands of a company which is physically unreachable is not an easy thing to do.

Filing a claim with the insurance company needs to be speedily expedited for timely reimbursement of the incentive payment. When you receive the amount in your bank, it completes the revenue cycle for that claim. P3Care assists with revenue cycle management in a highly professional way providing you with timely transactional insights. Moreover, the first-time claim acceptance rate matters a lot, and P3Care does perform reasonably well when it comes to first-time acceptance of claims.

What is an ASC? P3Care Stands by Your Side in Critical Times

ASC stands for Ambulatory Surgery Center. P3Care’s philosophy and the visionary statement speaks of the deep relationship it has with the healthcare professionals dealing with emergencies. Emergencies can be traumatic and stressful.

P3Care Medical Billing Service Facilitates Reimbursements for Providers

Welcome to P3 Healthcare Solutions. Medical billing services are getting sophisticated and tech-oriented with new rules and guidelines. The electronic health records are fast replacing the old way of manually maintaining medical records. It is becoming difficult for medical practitioners to be able to get a grip on procedural necessities leading to obstacles in the collection.

Previously, PHI documents were hand-written and exchanged through the traditional mail, but since the advent of the internet, things have become effective. However, complexities are a big part of the new age computerization with hard-to-understand software functionalities and apps. They are designed to make the medical billing process easier which often prove to be a roadblock for the providers.

Core Objective of P3Care Medical Billing Service Company

P3Care Healthcare Solutions offers many services, and medical billing is one of them. The goal, however, is to support the healthcare industry by leveraging advanced technical and computerized solutions for both the physicians and specialty-specific clinical experts all across the US.

P3Care always works hard on delivering for the providers to help add to their revenue. The high claims acceptance percentage in one go is relieving for both the providers and the payers which further endorses their confidence. Getting the job done before it gets complicated is accomplished through experience, dedication, skills and staying on our toes.

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.

How to Avert Medical Billing Claim Denials?

Medical billing denial is the rejection of a claim by an insurance company made by any individual or by their provider, to pay for the rendered health care services. If you are a financial administrator in a hospital or any other healthcare facility, you would have an idea about the complications involved in medical billing claims. The denial of such claims proves to be a continuous headache as they affect the credibility, cash flow, and overall efficiency of a healthcare provider.

Studies suggest that the annual medical billing claims denials for hospitals stand at 2 percent, whereas, for medical practices, the percentage increases up to 10 percent. This makes the medical practices less profitable by comparison.

Some of the healthcare organizations even undergo a denial rate of 15 to 20 percent, which is considered extremely high. This means that providers facing this kind of denial rate have one out of five medical billing claims denied.

Overview and Tips for Provider Credentialing Process

Provider credentialing is critical for authenticating expertise, experience, willingness, and interest in providing medical care. If you are not able to follow the provider credentialing process, it can result in delay or worse, denial of the provider payment.

Provider Credentialing Process

It is not one of the formalities that you have to complete or a form that you need to fill. It is an ongoing process that involves a lot of complexities. Therefore, you need to closely follow all the requirements. There are many steps that you need to follow in order to qualify for credentialing. Also, it is essential for your business that you practice without any hindrances.

Besides the simplistic definition, it also involves submitting a lot of documents and forms to various third parties for verifying your practice. You do not need to follow the entire process each year. However, you must provide annual updates.

MIPS Quality Measures 2017 Applicable to LTPAC Medicine

The following article looks at CMS MIPS quality measures for LPTAC medicine. However, before we go towards the MIPS quality details, we need to look at the underlying purpose and objectives.

Purpose

CMS (Centers for Medicare and Medicaid Services) is always working on improving the policy to provide better healthcare facilities. Therefore, the new measures are aimed to help improve the overall care delivery and also reward clinicians who are better engaging patients, families, and the caregivers.

Here is how CMS looks at MIPS.

“To these ends, and to ensure the Quality Payment Program works for all stakeholders, we further recognize that we must provide ongoing education, support, and technical assistance so that clinicians can understand requirements, use available tools to enhance their practices, and improve quality and progress toward participation in APMs, if that is the best choice for their practice.”

Medical Billing – Over 50% Americans Can’t Afford to Go to the Doctor

The sorry state of affairs in the American medicare industry reflects the inability of many Americans to afford quality healthcare. Many can’t afford medical billing despite having insurance. The Obamacare premiums are making it difficult for them to continue with the payments.

Can’t Afford To Go To the Doctor – HealthPocket

A recent survey by HealthPocket revealed the difficulties that many Americans face. The Affordable Care Act is reducing people’s ability to afford health insurance. They have so many other expenses that they can’t afford take out money for health insurance.

The survey results show that a lot of Americans can only afford $100.

Here are the results.

  • Around 52.5% say that they can only afford $100 or more.
  • Only 15.95% can afford $200 each month.
  • The number of Americans drops 11.6% who can pay $300 each month.
  • The percentage further reduces to 5.5% for $400 health insurance deductible assistance.
  • Only 4.8% say they can set aside $500 each month.
  • Only one out of ten Americans, or 9.8% say that they can give away $500 a month for health insurance.

Fake Meaningful Use May Cost EHR $1Billion in Lawsuits

An estate of a cancer patient, Stjepan Tot, filed a class action lawsuit against eClinicalWorks. The estate maintains the patient could not refer to earlier cancer symptoms due to faulty meaningful use software.

eClinicalWorks is hit with a class action lawsuit since the patients can no longer trust the accuracy of their medical records. The lawsuit point towards the flaws in the software clearly, defying the meaningful use core objectives.

Lawsuit Adds to eClinicalWorks Financial Struggles

eClinicalWorks had to deal with a huge settlement claim of $155 million only six months ago. The False Claim Act alleged that eClinicalWorks incentivized its customers to promote its products.

Details of the $1 Billion Lawsuit Against EHR Vendor

Kristina Tot, who represents Stjepan Tot estate, filed the lawsuit in New York’s Southern District. She claimed $999 million in monetary damages for gross negligence. Furthermore, the lawsuit also states that Stjepan Tot died because of cancer.

He could not search his electronic medical records to ascertain when was the first diagnosed with cancer. As there was no accuracy in the display of the medical records.

Request Your 2016 PQRS Feedback Report

If you haven’t so already, now is the time to request your PQRS feedback report for 2016, and see if you can apply for an informal review performed by P3Care.

Did you know a Medicare penalty is put in place for those who do not apply for an informal review, which will take effect in 2018! The absolute deadline to request your feedback report is December 1st, 2017. The feedback report will illustrate your 2016 PQRS reporting results and indicate if you are subjected to a positive, neutral, or negative payment adjustment for 2018. Based on the 2016 quality reporting results, you will also receive information on how individual and group providers have performed on quality and cost measures through the Annual Quality and Resource and Use Reports (QRURs). The objective of the PQRS feedback report is to ensure you have the necessary information for a positive outcome on future Quality Payment Programs (MIPS). The feedback report also consists of comprehensive information regarding the overall quality of healthcare provided to Medicare patients and cost performance. You are also given the opportunity to have your results reviewed if you believe there has been a miscalculation in the value modifier adjustment; you must make this request by December 1st, 2017.

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 of 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.

MIPS 2017 – The P3Care Way

MIPS Consulting Services

At P3Care, we understand the importance of participating in MIPS and achieving positive outcome goals. We go the extra mile, to ensure we are there to assist you every step of the way, no matter how big or small your practice is! From determining eligibility, to explaining MIPS core requirements, to providing progress reports, we are committed to eliminate stress associated with performance data and allow you to focus on providing high quality care to patients. P3Care’s analysts and consultants are trained and have comprehensive experience with Medicare Quality Care Programs. Our professional team of consultants will closely work with you to determine which quality measures are best suited for your practice. In addition, we will apply all applicable codes to claims, provide you with monthly analysis and feedback reports, submit your performance data to Medicare by appropriate deadlines, and provide you with the best solutions to gain a positive or neutral payment adjustment.  There is still time to avoid a negative payment adjustment for the transition year 2017. Contact P3 today to find out how!

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 first year of MIPS. The amount MACRA will provide for positive payment adjustments is quiet 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 Participation: Pick Your Pace

Depending on the size of your practice, and outcome goal you’re looking to achieve, you can choose how many days you want to participate in the program.  The MIPS transition year stated January 1st, 2017 and runs until December 31st, 2017. The most efficient and effective way to take full advantage of MIPS is to take part in a full year. However, submitting data for a consecutive 90 days can still earn you a maximum payment adjustment. You must remember to submit data no later than March 31st, 2018.

  • Full- Submit data for a full year. May earn maximum/positive payment adjustment.
  • Partial –Submit data for 90 consecutive days. May earn positive, neutral, or max adjustment.
  • Test- By submitting the minimum amount of data (for example. One quality measure for 2017), you may avoid a negative payment adjustment.
  • Do Not Participate- By choosing not to submit any data at all for 2017 you will earn a -4% payment adjustment. (go into effect January 1st, 2019).

*Note: Now that we are less than 90 days away from December 31st, 2017, you MUST submit at least one quality measure or improvement activity data using the Test option, in order to avoid the outcome of a -4% payment adjustment.

Deadline to Participate in MIPS 2017

DON’T DELAY! DEADLINE TO PARTICIPATE IN MIPS 2017 IS OCTOBER 2ND!

Have you thought of participating in the MIPS (Merit-based Incentive Payment System) program this year, but believed it was too late? Don’t worry, there’s still enough time! The MIPS transition year started January 1st 2017 and goes through to December 31st 2017. You’ll need to begin your 90 consecutive days of data collection no later than October 2nd, 2017 in order to be eligible for a neutral or positive payment adjustment. Contact P3 to ensure all applicable data codes are applied to your claims starting no later than October 2nd.

To earn the maximum payment adjustment, it is best to submit data for a full year. If you choose not to submit any 2017 data, you will receive a negative payment adjustment which will go into effect January 1st, 2019. Don’t be discouraged though, if you only submit for 90 days there is still the opportunity to earn the maximum adjustment. Don’t delay, October 2nd is just around the corner, contact your P3 consultant today!

HOW TO PARTICIPATE: