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Providers’ Guide to Best Practices for Revenue Cycle Management

Healthcare industry doesn’t only have hospitals and large medical practices. There are some medical practices that function in only one specific medical area and consult medical billing companies for reimbursements.

P3 healthcare solutions being a medical billing company has years of experience in medical billing services. We have come across many independent or stand-alone medical practices and well-established hospitals.

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How Independent Healthcare Providers Are Coping Up With Changes?

One thing we understood in all these years is that the norms of the modern healthcare industry are changing. The focus has shifted to a value-based healthcare system instead of volume-based care services.

It also leads to structural changes in the progressive healthcare industry. According to the American Medical Association (AMA), physicians having independent clinics cover less than half of the total US doctors’ population. However, this trend of owning personal medical practice was high back in the 1990s.

Reason for Reduced Rate of Independent Healthcare Practices

The declining practice of independent healthcare providers owes to many reasons.

Some observers of the healthcare industry state that independent healthcare providers are forced to join larger healthcare systems as the earned revenue is not sufficient for survival.

Why medical billing companies Can’t Support independent healthcare providers?

Independent healthcare providers don’t meet up with their cost expenditure due to inflation and price surge. The increased administrative burden of MIPS QPP increased the price of surgical hospital admissions, emergency room visits, and drugs, which has caused major problems for independent healthcare providers.

Thus, in recent years, due to low reimbursements, around 22% of the independent clinicians reduced their office support.

Impact of Low Reimbursement Rate

Low reimbursement rate from insurance companies has also damaged this industry. Even hospitals and large medical practices are not safe from the changes in the healthcare industry.

The healthcare providers when unable to cover expenses within earned money, get in-touch with huge healthcare networks. Thus, the amalgamation of large and small healthcare practices has led to low competition in the healthcare industry.

In addition, often patients don’t pay deductibles or the extra amount other than their insurance benefits to independent medical practitioners. This way, independent healthcare providers never really compete with bigger healthcare organizations.

Reservations of Solo-Medical Practitioners

One concern that solo-healthcare services show is about the unreasonable reimbursement standards of insurance companies. Big healthcare organizations can better negotiate their demands with the increased volume of patients, which is a profit source for insurance companies.

All these issues make it impossible for small independent healthcare providers to stay in the industry. MIPS QPP has also fueled the declining trend of independent health services. Patients want access to top-quality healthcare, which a separate-working medical provider may not be able to provide. Consequently, the doctor doesn’t find a large share of incentives and bonuses.

To keep an independent medical practice, most solo-physicians function as a group outside the hospital circle. It has also helped medical billing companies to get high reimbursement for them as well as offered shared administrative responsibilities and resources over the network.

This might be the only surviving option left for independent healthcare service providers.

As large medical practices are dominating the healthcare industry, it is evident that revenue cycle management has not remained easy for solo-practitioners. However, with little adaption to change and a professional medical billing company, independent healthcare service providers can work their way up the success ladder.

THE ROLE OF CLINICAL QUALITY MEASURES FOR PHYSICIANS

Since the healthcare industry has taken serious measures to revamp healthcare services, the emphasis on incentive payment programs has increased. MIPS, MACRA, and more offer facilities to physicians that regular payment method can never provide.

Such incentive payment programs come with various quality measures against which clinical data is needed to report. The number of clinical quality measures is so large that it is difficult to manage them for each healthcare provider. Moreover, the requirements for each program be it Meaningful Use (MU), MIPS or others and the implementation of reporting criteria can be quite confusing.

The Center for Medicare and Medicaid Services (CMS) states Clinical Quality Measures (CQMs) for incentive payment programs. The result is not just to pay physicians but the value-based healthcare improvement efforts. These clinical quality measures also put their part in various government or private development projects.

Need of CQMs

Eligible physicians and hospitals submit data to CMS as in MIPS. In return, CMS estimates their performance and reward accordingly while checking that patients are getting the deserved attention from physicians. In addition, it works in favor of the healthcare industry to improve performance categories, falling short in terms of efficiency and quality.

What factors determine success in Clinical Quality Measures Submission?

As per the CMS website, it checks the following parameters to score CQMs.

  1. Use of available resources
  2. Compatibility to healthcare standards
  3. Healthcare outcomes
  4. Patient’s safety and welfare
  5. Coordination among physicians
  6. Patient’s engagement level
  7. Population & overall health standard
  8. Healthcare clinical processes

To maintain the accuracy and transparency in the healthcare system, ONC, Office of the National Coordinator for Health Information Technology (US Government Health and Human Services), monitors the use of EHR and other technologies.

The Development Process of Clinical Quality Measures (CQMs)

National Quality Forum

Many healthcare industry leaders and stakeholders take part in developing CQMs. However, measures standardized by the National Quality Forum (NQF) are considered as the top priority. Most of the incentive payment programs use their measures because their development process involves extensive research.

Another reason for adopting NQF quality measures is their work and objectives that match with that of CMS. Moreover, their initiative boosts the use of electronic healthcare records (EHRs).

Development Process via CMS

CMS also has its own measure development project known as The Measures Management system. This system is always in its evolution stage and sets values for business processes. The deduced measures also support MIPS and other incentive payment programs and provide an opportunity for their growth.

Real – Life Implementation of Quality Measures

Clinical quality measure reporting accounts for many uses, but its major reliance is on EHR technology usage or Meaningful Use. However, many healthcare providers deem Meaningful Use to be stressful and demanding. Moreover, not every quality measure is for everyone. Thus, there should be some flexibility in the reporting criteria.

CMS has gone to great lengths to overcome reporting issues and streamlined measures under seven categories.  When physicians are reimbursed and incentivize, it becomes obligatory for them to maintain their performance instead of giving quality as a onetime shot.

Clinical quality measures are also a great aspect of Physicians’ Quality Reporting System. Physicians are met with penalties when they don’t report according to the standards.

Thus, MIPS, MACRA, and other payment incentive programs can’t perform their actual functions without efficient marking of clinical quality measures. The key to success is the selection of accurate measures according to the practice and the value-based approach of practicing physicians towards patients.

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3 TYPES OF PAYMENT MODELS, PHYSICIANS PROBABLY DON’T KNOW!

Value-based healthcare services have not only changed the patients’ healthcare standard but also the physicians’ payment model. Value-based reimbursement models encourage clinicians to adopt methods that make healthcare easy and efficient. Programs like MIPS, MACRA, and more depict value-based care system and allow physicians to achieve rewards and bonuses. The purpose is value-based reimbursement models are to;

  • Straighten up physicians’ revenue cycle management
  • Make patients empower the healthcare system where they choose their desired service

We have heard many of the benefits and the need for value-based healthcare models, but the proper information about the available models is not very common. Let’s review that.

What are the Available Value-Based Care Models?

There are a few types of value-based payment models with a variety of risks attached and the benefits.

1. Accountable Care Organizations (ACO)

It is a system of hospitals, clinicians, and other healthcare providers to provide organized and high-quality services to Medicare beneficiaries. It was started to help patients receive up-to-the-mark services at the most appropriate time. It means that in case of emergencies or other scenarios, patients don’t have to wait to get to the relevant doctor.

This organization ensures that patient only bears expenses for those services that are absolutely necessary to treat an illness. Redundant medical services are reduced by eliminating medical errors that occur while diagnosis or treatment.

Healthcare providers volunteer in this program to get shared savings if the ACO fulfills the standardized healthcare criteria with reduced expenditure.

Risk Factor Involved in ACO

It is not like ACO volunteers always end up adding a bonus to their revenue cycle, but the financial risk is also involved. When able to meet the requirement, physicians have a jackpot, but on the other side, they also have to bear shared losses if any.

For shared loss, healthcare providers have to pay Medicare as compensation for not delivering value-based care to patients.

This value-based reimbursement model is not just about value-based medical procedures but also support volume-based services. However, the evaluation is based on quality, safety, and experience.

2. Bundled Payment for Rendered Services

This payment model pays physicians not for each service but as a whole series of services. Clinicians receive collective reimbursement for treating a medical condition, including all the charges for physicians and the types of rendered procedures.

For Instance,

If a patient undergoes a surgical procedure, CMS (The Centers for Medicare and Medicaid Services) sets a collective payment for surgeons, an anesthesiologist. It then pays a total amount rather than paying separately to each clinician.

Risks Attached with Bundled Payment Model

A certain level of risk is also involved with this type of payment model same as the ACO. Physicians get to full their pockets when they collectively reduce the incurred cost. Otherwise, they get will have to bear the loss.

Thus, this practice requires standardized procedures so that, all stakeholders get the rightful reimbursements.

3. Patient-Centered Medical Homes (PCMH)

It represents the healthcare payment model in which a primary care physician coordinates the patients’ healthcare. This payment model manages and handles all the needs of the patient in a centralized setting.

It’s certification highlights that the physicians are capable of providing healthcare in a patient-centered setting with team-based methods. Moreover, it also ensures consistent care quality for patients.

Patients are allowed to develop a one-to-one relationship with their physicians, and it governs on the medical and environmental factors.

This payment system has shown great potential in reducing the un-necessary cost expenditure. According to a Maryland – based PCMH, via the efficient practice of this reimbursement model, they were able to save up to $98 million and enhance their quality standards by 10%.

Alternative payment methods other than the fee-per-service are not very popular practices. However, physicians are unable to meet their financial requirements. Thus, they are devising ways to incorporate new technologies into their system to speed up the workflow.

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HOW MIPS CAN BE AN ACCEPTABLE PROGRAM FOR CLINICIANS?

The argument that CMS needs to improve MIPS is a thing in the past. Now, the focus is on “how to devise ways that actually implement the change and stands true to its promise of a better healthcare system.

Let’s admit there is no standard way for any quality payment program to hit bull’s eye in its starting years. When a program is initiated and tested in a real-time environment, it gives insight on the actual performance and capability of the program; the same is the case with MIPS. Since, its first year in 2017, physicians are raising questions against its payment model.

Many leading healthcare organizations have proposed ideas that might help CMS to overcome related issues.

Reduce Un-Necessary Administrative Work

It is observed that there is a lot of administrative work associated with MIPS reporting. There is a lot of data that needs to be collected and managed to submit to CMS. One reason is the primary care and the value-based medical services that quality measures cover. This program can serve to be more physician-friendly if clinicians are not burdened with extensive administrative work.

MIPS solutions consist of elements from three major programs:

  • Physician Quality Reporting System (PQRS)
  • Value-Based Payment Modifier (VM)
  • Meaningful Use (MU)

CMS is working in this context and simplifying this quality payment program with the easy amalgamation of all elements.

However, clinicians are not satisfied and still face administrative burden while quality reporting. Most of the physicians have reservations regarding the relevance of MIPS quality measures to the program. Quality measures have been a special concern for surgeons because they have been evaluated on patient’s immunizations. This approach is particularly un-necessary for surgeons and reflects poorly on the intention.

Past president of The American Medical Association (AMA) David O. Barde, has provided with a list of suggestions in this regard.

  • Reduce the number of measures for which a physician can report.
  • Re-expand the definition of a facility in MIPS reporting to include all healthcare service providers; no matter wherever they are, such as post-acute care center.
  • Set a 90-day performance period for all MIPS measures.
    This way, physicians will be able to invest their energies in the right direction that is, on their patients.

Rethink and Modify Promoting Interoperability (PI) Category for MIPS

Promoting Interoperability (formerly known as Advancing Care Information (ACI)) performance category tests physicians’ patient the most. Via this category, CMS has tried to encourage physicians to incorporate certified usage of EHR technology.

According to some physicians, this category focuses entirely on EHR technology, instead of actual advancement in the healthcare system. However, they need to shift their focus on actual usage of technology and to translate digital health information on patient level. Only this way, the PI category will stand true to its name.
The reporting requirements for this quality measure should also be modified to make this category more useful for physicians.

Implement MIPS to its True Potential

MIPS has the potential to bring advancement in the healthcare industry. However, with the final rule of QPP for MIPS 2019, around 58% of the physicians are already excluded to even participate in this program. It will result in fewer payment adjustments for physicians who improved their healthcare quality.

According to the CMS, with higher reporting criteria, non-eligible physicians will have more time to improve their quality to the maximum level. Nevertheless, the question remains that the purpose of this program is to pay clinicians for their investment in medical practice, not to judge their improvement rate until it reaches a certain level.

In addition, small medical practices have fewer resources, therefore; their performance should be analyzed separately from large healthcare organizations. This will stir the air in the healthcare industry and encourage physicians to move towards valuable healthcare.

Many healthcare organizations want to target incentives and bonuses but due to the inflexibility of the program, they can’t strike on the right target. By acknowledging the resources and the improvement made by the medical practice, MIPS should recognize the efforts one made to comply with the burdensome MIPS reporting.

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MACRA MIPS – GET READY FOR THESE CHANGES IN 2019!

For those covered by Medicare, the paperwork requirements wait for your attention, as a physician, and you can’t take a step back from those duties.

Why has this become crucial for medical practices? Because the Medicare Access and CHIP Reauthorization Act of 2015 and MIPS incentives depend on fulfilling these requirements in the new value-based care system!

And, once you have followed these requirements in letter and spirit, 5% incentives add to your 2020 Medicare payments. Those of you, who don’t think much of this payment adjustment, think again! Because the adjustments increase your finances by huge numbers!

Not all of us are in it for monetary benefits. Nevertheless, the reputational advantage as a clinician will take your practice to the next level. People are going to recognize you as a clinician with superior healthcare knowledge and consider you as an authority in the industry.

To consider MACRA into your practice, upgrade your outdated EHR system to the 2015 certified EHR technology edition. And, consider doing so in case you are an old-fashioned paper-based practice. In addition to that, ensure the technology vendor is trust-worthy and has a history of meeting government proposals. A tip to remember here is that proper training of the staff goes hand in hand with the newly installed EHR system.

Prepare yourself for the few changes regarding exemptions under extreme conditions, an increase in the cost category’s weight, an increase in low-volume thresholds, and a boost to the cost performance category in 2019.

Change 1 – Exemptions under Harsh and Uncontainable Situations

CMS owns the fact that extreme conditions can affect gathering, storing and submitting patient information. Hence, in 2019, it gives more space to such clinicians under intense circumstances. According to Clinician Today, in the performance year 2017, the clinicians were not scrutinized for any lack of information if they had to face extreme conditions such as California wildfires.

The automatic exemptions expect to continue going forward in 2019. God forbid, if there are any acts of God or natural disasters, as a MIPS reporting physician, CMS will not put you on a penalty list. First, we pray that neither a flood nor a wildfire breaks around your practice. Second, choose P3 Healthcare Solutions MIPS consulting service for Quality measures and reporting other categories properly 1-844-557-3227.

info@p3care.com is the address you’ll be emailing your queries to.

Change 2 – Expect an Increase in the Weight of the Cost Category

As the Medicare reimbursement model transforms into the value-based care model, MIPS in healthcare will have the cost category hold more weight than in 2018. It was at 10% of the total weight in the previous year and it is going to stay that way or go higher in 2019.

Clinician Today mentions that the cost category is going to accommodate 30 percent of the total MIPS score (CPS) by the year 2022. By preparing early and maximizing on this category, your practice can achieve a decent MIPS final score. Consequently, everything falls in line with quality-based care.

To maintain the balance between categories, expect a formidable decrease in the weight of the Quality category at an equal level.

Change 3 – Expansion in Low-Volume Thresholds (LVT)

A Low-Volume Threshold (LVT) depends on the number of allowed Medicare Part B charges and the number of patients cared by an eligible clinician. There is a consistent increase in the LVT in subsequent years until 2018. And, 2019 is not going to be any different.

Currently, the LVT has more than or equal to 200 Medicare patients or your practice/group has billed more than or equal to $90,000 in Medicare Part B allowed charges. It was an uptick to MIPS 2017 requirements of 100 Medicare Part B patients or $30,000 Medicare Part B allowed charges.

You may not be eligible in the past year, but there is a high probability of your eligibility to MIPS submissions in 2019. Therefore, be well aware and as soon as you reach the Low-Volume Threshold, P3Care being a MIPS qualified registry, reports on your behalf so that you receive high incentives.

Change 4 – MIPS Cost Category to Experience a Boost

We can see the cost category weight rise to 15% in 2019. MIPS 2019 reporting is not going to be a child’s play because the focus on trimming healthcare expenses is now more than before. CMS suggests adjusting this raise by offsetting the Quality category from 50 to 45%.

Hence, be on the lookout for any changes in government regulations around Medicare reimbursements! Quality reporting aims to improve healthcare delivery and better compensation to the physicians.

We try to give you the insight into the world of medicine as it crosses paths with medical billing. P3 Healthcare Solutions deals with the revenue cycle management process efficiently when it comes to MIPS consulting and medical billing service in general. One remedy to stay updated with the latest Medicare MIPS reporting requirements is to follow the company page on LinkedIn – https://www.linkedin.com/company/p3-healthcare-solutions

RIGHT MIPS SUBMISSION METHODS LEAD TO SUCCESSFUL MIPS REPORTING!

MIPS – a quality payment program for physicians is one of a kind and progressive step that benefits both, physicians and even the patients. The prior tangled and twisted reimbursement method failed to contribute to the healthcare industry via any advancement. Thus, MIPS came as light at the end of the tunnel for physicians to direct their financial matters in the right direction.

Reporting accurate data, according to the medical practice and with the appropriate submission method is inevitable to score high in MIPS scorecard. The period for submitting MIPS qualified measures is already short so there is no time to waste.

This article discusses all the queries regarding MIPS submission methods so that physicians successfully report clinical data to CMS.

First, Do Your Research Well!

The first step in MIPS reporting is to recognize what submission method will suit your practice, the best. The right decision will have a huge impact on your submission. Otherwise, you’ll end up scratching your head for unnecessary delays caused by poor research, as many factors are important for a professional MIPS submission.
In addition, MIPS data submission seems easy. However, it is not as simple as one may estimate. Let us briefly explain the MIPS reporting process.

How to Report MIPS?

Physicians work day and night treating patients to deliver quality-based medical services. MIPS eligible clinicians report their performance data on a yearly basis to CMS. There are four performance categories for MIPS:
• Quality holds 50% of the total MIPS score
• Promoting Interoperability (PI) holds 25% of the total MIPS score
• Improvement Activities (IA) holds 15% of the MIPS score
• Cost holds 10% of the total MIPS score

As per the CMS submission requirements, physicians report against three categories. However, the CMS authorities themselves measure the cost category. They calculate performance for this category by administrative claims data.

Now, Choose Between MIPS Submission Methods!

Clinicians can choose from a number of submission methods as per their requirement,
• CMS Web Interface
• Administrative Claims
• Electronic Healthcare Records (EHRs)
• Qualified Clinical Data Registries (QCDR)
• Qualified Registry
• CAHPS for MIPS Reporting Survey Vendor
• Attestation

Consider the Following Points When Choose a Submission Method!

  • While considering what submission methods will result in your favor cost-effectively, you also need to ponder upon their limitations.
  • Clinicians are only allowed to report data via a single submission method for a single performance category.

Look out for all possible scenarios that can occur with the submission method. As each MIPS submission method has its benefits and limits as per the medical practice. Therefore, carefully check all the logistics and your organizational structure before submitting data. It may leverage your performance score for positive or negative payment adjustment.

Not only deciding the right submission method is time-consuming, but it also requires thoughtful planning, resourceful implementation, and the ability to incorporate progressive steps of your organization.

All this Process is Hectic but you can Stay Stress-Free with P3Care!

Physicians may be worried about how they’ll manage to choose the right MIPS submission method along with their responsibilities. Don’t worry and let us share your MIPS reporting burden. P3Care has been MIPS qualified registry for two years. Our specialized methods, resources, and experience in this field speak for itself. Moreover, we as an H I.T consultants help to choose you the right quality measures and the submission method.

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TAKE ADVANTAGE OF MIPS 2018 REPORTING STANDARDS & SCORE HIGH!

2018 has been a revolutionary year for MIPS in healthcare. MIPS has faced much criticism as physicians were not comfortable with its payment model. The minimum threshold for a penalty-less spot was unacceptable for many clinicians, as it didn’t seem to bring any improvement in the healthcare industry in any manner. Physicians only worried about saving themselves from negative adjustments and that’s just it.

CMS replaced prior MIPS reporting rules with the new ones to address such reservations and to benefit physicians and the healthcare industry’s growth.

Apart from the changes in the percentages of the performance categories, the changes that CMS proposed for MIPS quality measure reporting; let’s look at them and analyze how we can target incentives and bonuses instead of just worrying about penalties.

Virtual Group Participation is now LEGAL

  • This year, a terrific advancement is seen in MIPS reporting guidelines as CMS is offering virtual group participation.
  • Virtual groups should consist of solo practitioners and an eligible group of 10 or fewer clinicians. They should work together VIRTUALLY for the MIPS performance year.
  • Generally, the participants in a virtual group report against all four performance quality measures and meet all reporting standards same as any non-virtual MIPS group would.

The requirement for a Virtual Participating Group

  • Groups and solo medical practitioners who want to participate, as a virtual group needs to go through an election process.
  • The election process must end before the performance year and can’t change in-between. For Example, the election date for MIPS 2018 was from October 11- December 31st, 2017.

Low-Patient Threshold Update

Low-Patient threshold has been increased to exclude individual clinicians or groups with less than or equal to $90,000 in Part B allowed charges or less than or equal to 200 Part B beneficiaries. It is done in the determination period or during or prior to the performance year.

Bonuses for Care Services of Complex Patients

CMS grants 5 points as a bonus to the final MIPS scorecard by adding average Hierarchical Conditions Category (HCC) risk factor. The information is based on the complexity of the medical condition of the patient.

MIPS Favors Small Healthcare Practices

When small medical practices either individually or as a group submits data on at least one performance category, they get an additional 5 points in their final MIPS score. Thus, MIPS 2018 understands struggles that small medical practices go through and is trying to uplift such practices by favoring them.

Submit Hardship Exception Application for Extreme Cases & Save Yourself from Penalty

If the eligible clinician doesn’t use CEHRT- Certified EHR Technology, due to uncontrollable circumstances, for instance; natural disaster, he can submit Hardship Exception Application for reweighting Advancing Care Information (ACA) performance category. It increases the percentage of other remaining categories in the final MIPS score.

An update in this regard is that 31st December 2018 is the last date for hardship application submission.

According to CMS estimation, around 572,000 clinicians will participate for MIPS 2018 reporting. They also propose that clinicians will receive approximately $173million as positive payment adjustments via MIPS consulting services. So, why not report clinical data to CMS, the way it wants and get more payment incentive than expected.

The threshold for Penalty-Less Spot has increased

In its first year, keeping yourself safe was just a matter of three points. Now, the bar has been raised to at least 15 points. This way, clinicians have improved their care standards drastically and the overall pace of the healthcare industry improved.

Keeping track of all the changes is surely hectic for the clinicians; therefore, consulting a MIPS qualified registry becomes a necessity. P3Care has a distinguished name as a professional MIPS consulting service.

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AVOIDANCE OF PENALTIES IN MIPS 2018! GET READY TO REPORT SMARTLY!

The American Medical Association (AMA) has clearly stated that the only way to avoid penalties regarding MIPS 2018 is to report on one of the three significant MIPS quality measures. In this way, physicians can prevent those negative payment adjustments waiting to happen in 2020. Connect with P3Care instantly on LinkedIn – https://www.linkedin.com/company/p3-healthcare-solutions/

The three quality measures are

  • Promoting interoperability
  • Quality
  • Improvement activities

How Reporting Criteria Changed Over Time?

Eligible clinicians can avoid the penalty by following a reporting strategy as per AMA’s advice. In 2017, it was compulsory for physicians to score at least three MIPS points to avoid a financial penalty at the start of 2019. It means that they only needed to report one quality measure to overcome the penalty risk.

Nevertheless, now the rules are stricter and the focus on value-based services is now more than ever. With this advancement and the modified requirement criteria in the healthcare industry, the new threshold for MIPS 2018 reporting is fifteen points. The clinicians having a score of 15 are able to avoid penalties in 2020. As an EP, if you fail to report the minimum amount of quality measures governed under the Quality Payment Program’s specifications, it results in a definite 5% decrease in reimbursements.

Therefore, scoring equal to 15 is essential for those eligible in this program.

Follow the tips below to avoid a financial penalty in 2020, improve your MIPS performance, and increase your Composite Performance Score (CPS).

Report on Improvement Activities (IAs) to Score Higher

The BEST WAY to meet the required threshold is to report Improvement Activities (IAs) immediately.

The Centers for Medicare & Medicaid Services (CMS) defined 113 measures under this performance category in MIPS 2018. Each performance measure has further subcategories in the form of medium and high-weighted activities. Obviously, the high-weighted activities carry more points and can get you closer to the maximum score.

How Do You Calculate Performance Categories?

The activities for the performance categories function around care coordination, population healthcare, beneficiary engagement, and health equity factors. To score in any category, eligible clinicians are required to collect and submit data for 90 consecutive days in 2018.

How to Submit MIPS to the CMS?

Healthcare providers can submit clinical data for MIPS 2018 via:

  • Quality payment program 2018 (QPP) data submission system
  • Electronic health record (EHR) system
  • MIPS qualified registry
  • The qualified clinical data registry (QCDR)

Improvement Activities – A Lucrative Offer for Small Practices

Reporting Improvement Activities (IAs) under MIPS 2018 can elevate the revenue cycle for small medical practices. MIPS reward small healthcare practices with double points as compared to well- established healthcare facilities.

Another advantage to smaller practices is a bonus of five extra points when they score a total of 15 points. It ranks them above the others on the MIPS scorecard with 20 points. Therefore, if you report for one high-weighted improvement activity, you are bound to earn more points.

For the same MIPS score, ECs working for large medical practices must submit data for two or more improvement activities to get up to the threshold limit of 15 points.

MIPS Quality Measures Shield You from Negative Payment Adjustments

Negative payment adjustments can be a big setback for your profit journey. Therefore, use quality measures wisely and in a timely manner.  To stay on top of your game, you must fully understand the performance measures to make to turn it into a lucrative opportunity.

There are 275 quality measures and clinicians can select from among them the most suitable measures to meet the MIPS 2018 threshold score.  Each Quality measure has further sub-categories as per the following factors:

  • Efficiency
  • Outcome
  • Patient engagement

Moreover, CMS has developed a specialized set of quality measures to help physicians identify appropriate quality measures. Clinicians can report data for 12 months on six quality measures. However, it is necessary that one of the quality measures should be an outcome measure or a high priority performance measure.

Clinicians participating in the form of virtual groups can use CMS Web interface or Consumer Assessment for Healthcare Providers and Systems (CAHPS) for MIPS survey.

Report for At Least Two Performance Categories

To stay away from negative payment adjustments, report for at least two performance categories. For instance –

  • Improvement Activities and Quality
  • Or, Promoting Interoperability and Quality

How to Score High and Handsome?

Ordinarily, we see small medical practitioners reporting one medium-weighted improvement activity and one quality measure. This reporting tactic earns you 10 points and with an extra 5 bonus points, you may achieve a total of 15 points.

The Territory of “Promoting Interoperability (PI)”

Another way to earn 50 out of 100 points is by reporting on the Promoting Interoperability performance category. It investigates the patient and physician engagement level and makes the patient information available to other clinicians via EHR technology. EPs are required to submit data for 90 days or more on the base score of four or five measures in this category. The base score measures take their value from the certified EHR edition.

Large medical facilities can achieve high scores by reporting on PI and quality categories. However, they must report on PI performance category to score 50 and two quality measures to get to 70 points and target the bonuses out of a $500 million pool.

EHR Technology – One Step Ahead

Each EHR edition has a different set of performance measures. For instance, the 2014 EHR edition allows reporting on the Promoting Interoperability Transition Objectives and measure set.

Important Tips to Score Higher

  • The data submitted on quality measures for at least 20 patients fulfill the data completeness requirement.
  • Two medium-weighted improvement activities and four quality measures can get you a score of 16 points in 2018.

It is only possible when the physicians earn 12 out of 70 points in the “Quality” performance category and score 20 out of 40 points in the Improvement Activities.

Vote for Better Healthcare

As 2018 is about to end, the evergreen slogan for the welfare of Americans is to vote for a better healthcare system. That truly goes in favor of the Americans.

If you still haven’t done anything to avoid the penalty in 2020, it is time to connect with a reliable MIPS registry for submissions. America needs you to come out as a winner and reputable practitioner.

Most of the performance categories require data for 90 days. Therefore, reach out to P3Care and report QPP measures efficiently and be free from the worries of non-reporting.

INTRODUCTION TO THE PHYSICIAN COMPARE INITIATIVE

Launched as a part of the Affordable Care Act (ACA) or the Obamacare Act of 2010, the physician compare initiative started out as a simple online searchable database of healthcare professionals eligible under Medicare.  Since its launch in 2011, the Physician Compare website has been regularly updated by the CMS’ Medicare department to enhance the information that helps patients make informed healthcare decisions.

Changes to Physician Compare Website

Presently, the Physician Compare website shows necessary physician and group association information like physician name, practice name, location, phone numbers, specialties, gender, medical certifications, affiliations, and languages spoken. However, so far the website is just that, it gives the necessary information. The website does say whether or not a physician participated in the outdated Physician Quality Reporting System (PQRS) program and the most recent information on the site is from 2016. Doctors supporting the Million Hearts initiative by the Department of Health and Human Services (HHS) are also identified.

However, is this about to change?

CMS has declared that it will soon make available the MIPS score of all eligible providers on its website. Provider scores in each of the performance category, i.e., Quality, Cost, Promoting Interoperability, and Improvement Activities will be posted on the site based on 2017 performance scores. The data will be available in downloadable file format free for use by online directories and health information websites like Yelp, ZocDoc, Healthgrades, and Vitals, etc.

Reputation Impact of Physician Compare

What this means is that all those clinicians that have been reporting a minimal amount of data to avoid a MIPS penalty need to rethink their strategy. MIPS score is not only about receiving an incentive payment anymore. The doctor’s reputation is at stake here, not just dollars. Furthermore, individual physician star ratings will follow them if they change their organization. The MIPS score may directly impact their future career opportunities, clinician recruitment, potential mergers or acquisitions, insurance contracts and more.

Eligibility Criteria for Appearance on the Website

A physician or a provider group needs to have ratified Medicare PECOS information available. Furthermore, the clinicians should have submitted at least one value-based claim within the last 12 months. Groups must have at least two clinicians reallocating their benefits to the group as a whole.

What Sources of Data Will CMS Use?

CMS has been using multiple sources to update its website; these sources will be expanded in the future. The information displayed on the site may be derived from self-submitted data via claims, qualified clinical data registry, qualified registries, consumer assessment of healthcare providers and systems (CAHPS) and the provider enrollment, chain, and ownership system (PECOS). CMS also coordinates with national certifying boards to confirm board certifications. CMS determines which quality measures are statistically reliable enough to be displayed on the website.

Star Ratings for Easy Comparison

Beginning this year, performance on quality measures will be depicted by a one-to-five star rating system. Each star represents a 20 percent performance score on MIPS (i.e. 1 Star = 20%, 2 Stars = 40%, 3 Stars = 60%, 4 Stars = 80%, 5 Stars = 100%). These ratings are relative, that is, they depend on the performance of other eligible practitioners and groups under the program.

30-Day Preview for Checking Information & Correction

CMS has announced that it will provide a 30-day preview to the clinicians for review and correction before the measures and ratings are finally made public on the Physician Compare website. The physicians will be made aware through the MLN Connects weekly newsletter and various other platforms. If you discover any errors or omissions in the information, you can contact CMS for correction. You may need to submit proofs supporting your claim for your correction. Also, there is no formal appeals process thus ensuring correction within the 30 days preview period is highly critical. If you discover any errors during the preview period, you can report it to CMS via the contact information provided on the website.

How Can P3 Healthcare Solutions help?

Be patient, for instance, if you have switched a group practice or a hospital, or you upgraded your certifications, you need to update the information through PECOS. Corrections made in PECOS could take up to 4 months to be reflected in the website. Furthermore, healthcare providers will only learn about their MIPS score for the performance year 2018 by late 2019. That means when they learn about bad performance, the year after the bad performance will also almost be over. Thus they can start focusing on improvement only in the next year. It means that not only the incentive payments will continue to get hurt, the reputation impact will also continue until at least the end of 2020.

P3 Healthcare Solutions is a MIPS Registry for the second consecutive year in 2018. Our advanced analytical tools help you track your performance throughout the year and can give an estimated MIPS score to ensure that you are satisfied with your score before you submit your reports to CMS.

It is very vital to get an expert opinion about how to balance the costs associated with getting a high MIPS score and the potential negative impacts of a low MIPS score.  For any more questions related to this, or for instructions on how to get started call one of our MIPS medical billing service experts today at 1-844-557-3227 (1-844-55-P3CARE) or email at info@www.p3care.com.

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.” A 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 are 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 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@www.p3care.com.