Quality Payment Program 2018

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Together We Report the Quality Payment Program (QPP) 2018 to Avoid Penalties in 2020

Medicare and Medicaid meaningful use gather value for the healthcare system regardless of the infinite scale of the implementation task. As long as all the stakeholders stay resilient, the system moves on towards betterment. P3 Healthcare Solutions stays on track to give you an edge over the others.

Medicare Access and CHIP Reauthorization Act

The Medicare Access and CHIP Reauthorization Act (MACRA) is the law establishing the Quality Payment Program (QPP) for eligible professionals. MIPS 2017 was the first year of this program, and the scores for 2017 are out. CMS’ specific portal for QPP mentions them with more than 2 percent payment adjustments for the top participants.

We are currently going through the second year of the Quality Payment Program. QPP 2018 is here to accomplish three basic goals.

Enhanced Care

Intelligent Spending

Healthier Society

Merit-Based Incentive Payment System (MIPS) 2018

The purpose of MIPS is to focus on the importance of value-based care over volume-based treatments. It also recaptures the idea of improved patient outcomes.
As far as the patients are concerned, if you, as an eligible professional, treat them well keeping the cost of care under limits, you accomplish the spirit of the program. However, CMS requires reports and data submissions to know the status of care delivery at your practice.
MIPS in healthcare play a crucial role in shaping up the future of the US healthcare system.

MIPS in healthcare plays a crucial role in shaping up the future of the US healthcare system

Quality (Formerly Physician Quality Reporting System)
Promoting Interoperability (Formerly Advancing Care Information/Meaningful Use of EHRs)
Cost (Formerly Value-Based Modifier)
Improvement Activities (New component introduced in 2017)

Types of Clinicians

Primary Care Physicians and Physician Specialists (billing Medicare)
Physician Assistants (PAs)
Nurse Practitioners
Clinical Nurse Specialists
Certified Registered Nurse Anesthetists

Low-Volume Threshold Requirement

For MIPS 2018, the eligibility benchmark has exceeded.

You are eligible for MIPS 2018 if you are –

Providing care to more than 200 patients in a year
Billing $90,000 or more to Medicare for Medicare Part B patients

These are comprehensive changes and exclude many clinicians from participating in the 2018 program.

You are exempt

If you newly enroll in Medicare and 2018 is your first year of providing care to Medicare patients
If you don’t fall into the above criteria (type and low-volume threshold)
If you decide to participate in an Advanced APM

Do You Want To Ace In Reporting Quality Measures?

Four Performance Categories

Carries 50% weight in the MIPS Final Score
Report 6 quality measures in which one is an outcome measure or a high-priority measure
Submit data on 50% or more Medicare patients (The measures must meet the data completeness attribute for more points otherwise; each of them will receive only one point)
Report quality for the whole year (12 months)

A new category that holds 10% of the MIPS Final Score (CPS)
There is no reporting method required for this category because CMS will evaluate your billing claims for 2018 (January 1 to December 31, 2018) to calculate the score
You can download QRUR (Quality Resource Use report) of the previous year to find out areas of improvement in Cost.

It carries 15% weight in the MIPS Final Score
The list of measures has grown – From 92 in 2017 to 112 in 2018
Eligible clinicians must achieve a score of 40 in this category
Report for at least 90 consecutive days to avoid negative payment adjustments

Worth 25% of the MIPS Final Score
You may use the 2014 or 2015 version of certified EHRs for MIPS meaningful use (MU) in 2018
Must report on all the base measures to earn a decent score and then move on to bonus measures
Report for at least 90 consecutive days

If your total MIPS score is 15, it means nothing deducts from your annual Medicare payments. If it is anything less than 15, get ready to face -5% payment adjustments. However, if you score above or equal to 70, be happy and expect +5% payment adjustments in the year 2020. These rewards add to your finances as exceptional performance bonuses.

If your total composite performance score is 15, you will receive neutral payment adjustment on your Medicare Reimbursements (no downward or upward adjustment) in 2020
If your total MIPS Final Score is less than 15, you will receive a negative 5% payment adjustment on your Medicare reimbursement in 2020
If you score above or equal to 70, you will get a positive 5x budget-neutral incentive in the year 2020
Scoring above 70 CPS for MIPS may also make a practice eligible for MIPS bonus payments, which every year are paid out of a $500 million dollar pool to the top 25% performing clinicians

You can choose a QCDR, a MIPS Registry, EHR system, and CMS web interface (for groups of 25 ECs or more) to report on these performance categories. However, you must choose a single method of reporting for each category.

Improve your MIPS score by focusing more on the activities for the Quality performance category. It can give you up to 10% bonus points.
For Cost category, making significant changes in care delivery to cut down costs can earn you up to 1% extra points.
ECs and groups gain up to 5 points for treating the patients who are in serious condition
ECs and groups must submit data on one of the performance categories to be eligible for bonuses
Scoring is relying on Hierarchical Conditions Category (HCC)
If ECs or groups are part of small practices, they are awarded 5 bonus points

Advanced Alternative Payment Models (APMs) for 2018

Advanced APMs is the second track of the Quality Payment Program, which you can opt-out of by meeting the eligibility criteria.

An APM is a payment system that rewards incentives on account of superior-quality and money-saving care.

What Physicians Need to Know about AAPMs?

This is the second track of the Quality Payment Program (QPP), which you can opt for, by meeting the eligibility criteria.

An APM is a payment system that rewards incentives because of superior-quality and money-saving care.

How Do You Benefit From An Advanced APM?

Once you attest and participate in an Advanced APM in 2018, you are eligible for incentive payments of up to 5% in 2020.

Eligibility Requirements for Participation

You must:

Receive 25% of your Medicare Part B payments through an Advanced APM
You must be treating 20% of your Medicare patients through an Advanced APM

The model’s portal will guide you through the process of reporting quality category data to CMS effectively. If you decide to leave this track in the ongoing performance period of 2018, you must ensure you have received enough payments or treated enough patients through an Advanced APM to be eligible for 5% positive payment adjustments in 2020.

If you don’t meet the minimum requirements of the Advanced APM, you have to join the MIPS 2018 track to prevent -5% deductions from your annual Medicare income in 2020

Additional Information

Reputational Impacts

CMS publishes sets of clinician-identifiable performance measures through the Physician Compare website and the third-party physician-rating websites. With a more digitally aware consumer population, this data is going to inform more patients and encourage fair competition among the practitioners to deliver superior service.

Virtual Groups vs. Individual Participation

Eligible professionals can participate in the Quality Payment Program 2018 in the form of virtual groups
Reporting as individuals or as groups (under one TIN) is similar to 2017

P3Care – Optimizing Your Performance

With a long-running experience on Medicare Part B Quality Reporting, seasoned P3 analysts and consultants provide more than just a helping hand. We take control of your demonstration from day one and make sure staff time, and physician time is saved through-out the program’s demonstration.

2018 MIPS Qualified Registry

Why Us?

We are a MIPS Qualified Registry for 2018 and a complete health IT solutions provider.
CMS recognizes P3 Healthcare Solutions as a MIPS Qualified Registry for the year 2018. We report on all Quality Measures, Promoting Interoperability, and/or Improvement Activities on behalf of MIPS participants in the form of individuals, groups, and virtual groups.
P3Care had the honor of being a MIPS Registry in 2017, and CMS recognizes us to report data on behalf of the eligible physicians in 2018 as well.

How P3Care Does Its Part?

With a long-running experience on Medicare Part B Quality Reporting, seasoned P3 analysts and consultants provide more than just a helping hand. We take control of your demonstration from day one and make sure we save physician and staff time during the entire demonstration

Performance Category
Quality
Promoting Interoperability (ACI)
Improvement Activities
Cost

Weightage in 2017
60%
25%
15%
0%

Weightage in 2018
50%
25%
15%
10%

We primarily provide HIPAA medical billing services and MIPS consultancy, among other services. As your HIT consultant, we optimize providers’ performance for improved RCM.

info@p3care.com

(844) 557-3227

3200 E Guasti Rd Suite 100, Ontario, CA 91761, United States

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