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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 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.”

Key Strategic Objectives

Let us have a look at the strategic objectives set by CMS.

  • The engagement of patients and the improvement of beneficiary outcomes.
  • To further the clinical experiences that offer flexible yet transparent programs.
  • Ensure meeting of diverse needs of the physician practices typically those with small practices.
  • Further the capabilities of the IT systems that meet various data needs of the end user including reporting and submission.
  • Work on improving information and data sharing to ensure its timely availability.
  • Enable customized communication while keeping MIPS quality measures specifications into perspective.

Caveats for Individuals and Groups

The new MIPS quality measures take into consideration two LTPAC setting codes. These codes are the basis for the MIPS quality measures specifications. These MIPS quality measures are for application on individuals as well as groups.

Eligibility Criteria

Here are some considerations to undertake.

To qualify for the MIPS incentive payments you need to report on the following.

  • There are 6 measures with at least one of them as an outcome measure relating to poor diabetes control. The new quality measures mark high specialty and ambulatory practices.
  • Each measure’s applicability should be up to 90 days.
  • Around 50 percent of your patients have to qualify for one of those 6 measures.
  • The minimum number acceptable for the incentive payments stands at 20 patients.
  • The health practitioner can only report some measures after a specific diagnosis. Therefore, health clinicians have to be careful when selecting these measures.

Avenues for Submission

You can submit your measures to multiple avenues including EHR, claims, QCDR, and Registry. Registry seems to be the most suitable option for groups that aim to report when using the individual measures.

Why Consider Registry for Submission?

Here are the reasons why you must consider submission via Registry.

  • Since you can submit all 2017 QMs via Registry, you do not rely on any other methods.
  • Claims Reporting for 2017 QMs only supports a subset. Therefore, be careful to see the claims if the Claims Reporting offers support for it or you need to use Registry instead.
  • The group gets a measure of review or control when using Registry before you submit the data. Therefore, it gives a buffer, allowing you to remove any errors that you may find.

Avoiding Penalties is Critical

Make sure to always keep the benchmarks in perspective. By following them you can reduce your chances of getting a penalty. It will also help you satisfy base reporting requirements for MIPS.

Make sure that the data you submit for one patient satisfies that particular measure. If you are able to satisfy all six measures, the data would become a prime example for others to follow. In that case, you may be able to find your data published on CMS’s site for Physician Compare.

How 2017 MIPS Quality Measures Differ?

Previously, there was not much detail available. However, 2017 MIPS by CMS offers detailed benchmarking, relying upon the methodology which involves different performance points.

These individual performance points add to make a total score. Therefore, in 2017, you need to focus on performance as it is a critical year for it. Physicians should know the way they are graded to their performance, comparing it with the past year. It is vital to carefully select QMs which would help you score above average performance.

Here is how CMS elaborates this concept.

“By developing a program that is flexible instead of one-size-fits-all, we’re trying to meet clinicians where they are so that they can make the choice about how to participate in a way that is best for them, their practice, and their patients. Reducing burden, ensuring flexible program design, and improving how we measure cost and quality performance supports clinicians in doing what they do best – making their patients healthy.”

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.

The lawsuit also alleges that millions of patients relying on eClinicalWorks cannot sort out their medical history. Thus, the software provided by eClinicalWorks fails to meet the meaningful use core objectives. Therefore, eClinicalWorks software does not meet the necessary requirements.

eClinicalWorks Lawsuit Reminds of the Report by HHS-OIG

The US Department of Health and Human Services or HHS-OIG released a report this June. The report samples 100 electronic health record providers getting payments from CMS for meaningful use. This report points to the failure of meeting meaningful use requirements of these health care providers, using incentive payments to the tune of $729 million. HHS-OIG found many of these healthcare providers not qualifying for these meaningful use incentives.

Large Scale Implications of eClinicalWorks Lawsuit

This lawsuit would have widespread implications for eClinicalWorks customers. The lawsuit indicates over 850,000 health service providers relying on this software. These new findings clearly reflect the need for better checks on software development companies offering health care provides with the EHR software.

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.

Apply Today!

Don’t worry if you’re subjected to a negative payment adjustment for 2016; it’s never too late to get back on the right track with P3Care! The primary reason to replace the previous PQRS, and introduce the new and more effective MIPS was so providers can submit data by picking a pace that is best suited for their practice and focus on providing quality care at the same time. There is still enough time to take part in this year’s QPP and avoid a negative payment adjustment for 2019. P3Care is dedicated to improve your quality reporting and help you take full advantage of the remaining MIPS year. Our consultants will assist you every step of the way, and make sure you submit at least one quality measure for 2017 to help avoid further negative payment adjustments. The deadline is fast approaching, contact P3Care today for assistance in requesting your 2016 PQRS feedback report and to avoid a Medicare penalty.

909-245-8350 (P3 Client Service).

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.