Quality Payment Program 2019

The Quality Payment Program (QPP) under Medicare Access and CHIP Reauthorization Act (MACRA) enters into the third year in 2019. CMS 2019 Final Rule brings a few changes to the Merit-Based Incentive Payment System as it works to accommodate the eligible professionals (EPs) and hospitals. In the end, whether it is the government authorities or CMS itself, they are on a mission to empower the patients and their health in an ideal healthcare system.

P3, as a MIPS consulting service, commits to these changes and arranges them for participants of MIPS 2019.
Are you an eligible professional in MIPS 2019? A CPS above 30 is directly proportional to incentives and bonuses out of the $500 million pool.

Participants in MIPS 2019

1-02

Physicians

2-02

Physician Assistants

3-02

Nurse Practitioners (NPs)

4-02

Clinical Nurse Specialists

5-02

Certified Nurse Anesthetists

6-02

Physical Therapists

7-02

Occupational Therapists

8-02

Language Pathologists

10-02

Clinical Psychologists

11-02

Dieticians and Nutritionists

9-02

Audiologists

Low Volume Threshold – The Minimum Requirements

Here, we narrate the low volume threshold or the minimum requirements for participating in MIPS 2019.

There are three characteristics to qualify in this program, which is one more than in 2018.

Eligible clinicians must:

  • Earn $90,000 or more in Medicare Part B allowed charges per year
  • Care for more than 200 Medicare beneficiaries
  • Execute more than 200 covered professional services under the Physician Fee Schedule (PFS)

If you are below the above criteria, you do not qualify for the MIPS program in 2019.

Furthermore, if you are taking part in an Advanced APM and enrolled for the first time in Medicare in 2018, consider your status in the current year as ‘Not Eligible’.

MIPS by Choice

A new directive to “opt-in” the program is prevalent in 2019. If you meet or go beyond one or two of the clauses in the low-volume threshold criteria, you can activate this option. But if you do there is no turning back as you will be subject to the negative, neutral or positive payment adjustment in 2021 based on your Composite Performance Score (CPS).

History of the Program and P3 as a MIPS Consulting Service

P3’s MIPS consulting goes back to 2016 when the Physician Quality Reporting System (PQRS) was still in play. Primarily, as a medical billing service, we not only submitted claims but we went on to report on behalf of the providers under the Medicare and Medicaid EHR Incentive Programs.

Medicare EHR Incentive Program merged into MIPS meaningful use (MU) and later called Promoting Interoperability (PI) performance category.

We have been consulting for MIPS from 2017 when the program started. It is no less than an honor for us to be recognized as a MIPS Qualified Registry for two consecutive years in 2017 and 2018.

How to Check Your Eligibility Status?

The Quality Payment Program Participation Status Tool available at the QPP website puts you in a position to know your real-time eligibility status.

As a MIPS consulting service, we can check it on your behalf. All we need is your National Provider Identifier (NPI).

Let’s do this!

What is MIPS?

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 a fair competition among the practitioners to deliver superior service.

Performance Categories with their Weights

The four areas of MIPS 2019 reporting include Quality, Improvement Activities (IA), Promoting Interoperability (PI) and Cost.

All these four aggregate to form a MIPS Final Score.

In 2019,

  • Quality is 45%
  • Promoting Interoperability is 25%
  • Cost is 15%
  • Improvement Activities (IA) is 15%

Time Allowed for Reporting Performance Categories

Cost and Quality data collection goes for a year while IA and PA evaluate data through 90 continuous days.

  • Improvement Activities – 3 months
  • Promoting Interoperability – 3 months
  • Cost – 12 months
  • Quality – 12 months

If you use P3 consulting for submissions before March 31, 2020, you can expect a positive payment adjustment in 2021.

P3Care’s MIPS Consulting Service is 100% equipped to give results in favor of the EPs.

Be free from the worry of MIPS reporting. Sign up for a high CPS equal to or more than 75 with reputation and clinical authority. Dial us in 1-844-55-P3CARE.

Select the Right Package to Mark Your Value-Based Destiny

P3 offers three extraordinary packages to support these data submissions keeping the prerequisites of quality reporting intact.

  1. Essential MIPS – Guaranteed 7% penalty avoidance
  2. Budget Neutral MIPS – Guaranteed 7% penalty avoidance & Up to 3”x” incentives
  3. Benchmark MIPS – Guaranteed 7% penalty avoidance & 3”x” incentives plus eligibility for MIPS bonuses out of a $500 million pool

The above options can get you home without negative payment adjustments on your 2021 Medicare reimbursement. The adjustment rises to 7% in 2019 from 5% in 2018.

Go here to read the list of MIPS Quality measures. Give us a call or visit the QPP portal to learn more. 1-844-557-3227 is your go-to number.

MIPS Qualified Registries submit most of the Quality measures. However, the submissions happen according to the measures (high-priority, outcome) supported by submission types. Generally, EHR, eCQMs, Qualified Registry and Claims are the four types of submission methods. When you submit the same measure through more than one submission type, only the best score will go in your final figure.

How Do We Work?

We don’t take more than 30 minutes of your time to shortlist measures.

Shortlist measures with mutual agreement and report to CMS confidently

We require a few minutes to train the practice manager/staff on the coordination process. As we are in this business for years now, the intelligence is already there to finalize and begin activity implementation.

The Gist of It

According to the CMS 2019 Final Rule, more clinician types enter into the program and if they are unable to score a minimum of 30 points, they are subject to -7% payment adjustments. 7% of your Medicare reimbursement is a big amount and not easy to digest.

P3 Healthcare Solutions will continue to post updates on MIPS so that there is no room for confusion. It is an honor for us to report MIPS on behalf of individual clinicians as well as groups (virtual groups included) for the past 2 years. Schedule a meeting today to discuss your financial and reputation career with us.

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What do you think is the right mode of MIPS data submissions?