Posts

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).

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 the first year of MIPS. The amount MACRA will provide for positive payment adjustments is quite 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

In order to take part in MIPS, you must meet the requirements associated with Medicare billing (Part B). Selecting this route of the QPP focuses on receiving payment adjustments based on the specific data you have submitted. For the 2017 transition year, there are three different categories. To help better understand how you’ll be scored under MIPS, specific weights are given to each category. This will allow you to divide your attention accordingly. You will also need to determine if you are participating in MIPS individual or as a group. Here’s a closer look at the MIPS performance categories for 2017.

·         Quality

60% of the data submitted will pertain to this category; signifying the main purpose of eliminating the previous method, and implementing MIPS. In this category, providers which practice solely are required to report up to 6 quality measures (out of 271), which are the most associated with their specialty. Clinicians will be scored based on the number of days they have submitted data for (read more below), along with accuracy and completion of all the required specifications for each measure. Closely assessing each measure helps determine if high-quality healthcare goals are achieved. The total number of points earned on 6 quality measures + any bonus points will determine your final score of the Quality category.

·         Advancing Care Information

Taking up 25% of the total MIPS score, this category replaces the previous Meaningful Use program. You’ll need to select one of two reporting measure sets, depending on your EHR edition. Each option is composed of different measures; therefore it’s essential you only report on which option relates to you. There are three subcategories that will determine you’re the total score for this category, they include Base Score, Performance Score, and Bonus Score. Failing to complete all of the requirements in the Base Score category will result in a 0 in the overall Advancing Care Information category.

·         Improvement Activities

The remainder of the score (for 2017) will come from the Improvement Activities category, weighing at 15%. This category allows CMS to determine if clinicians are improving clinical practice to its highest potential. A few key aspects include providing quality care by involving the patients in decisions,  continuous coordination between provider and patient, providing self-management techniques, patient/family education, providing follow-ups, using safe technology, and being reasonably accessible. You’ll have the opportunity to choose from a variety of activities, that best suit your practice, to report data on. Each activity is categorized as either has High or Medium; high weighted activities are worth more points. Individual Medicare providers will need to submit data on up to 4 activities for a minimum of 90 days, in order to earn full potential points.

Cost

In the last but not least, Cost is the fourth category, upon which physicians’ MIPS score is based upon.

Physicians don’t have to report separate data for cost category. However, CMS calculates this MIPS quality measure by analyzing the submitted administrative data.

For the year MIPS 2017, the cost category had a value of 0% in the final scorecard. MIPS 2018 was the first performance year in which, the cost was set for 10%. This score accounts for the lower cost expenditure while physicians provide high-quality healthcare services to patients.

Right now, we are passing through MIPS 2019, which is the 3rd year of this value-based program.  The cost-quality measure is a significant part this year as well and accounts for 15% of the final MIPS score.

MIPS is running quite successfully with more and more clinicians taking part in it every year. Its impact on the healthcare industry is progressive and physicians upon realizing its importance for revenue cycle management are subject to adopt modern and cost-effective healthcare ways.

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:

For 2017, you can participate in one of three ways:

  • Submit data covering a full year
  • Submit data covering at least a consecutive 90-day period
  • Submit a minimum amount of data (<90 days)

The MIPS 2017 reporting categories consist of Quality, Advancing Care Information, and Improvement activities; all which require immense attention and may be time-consuming. Our experienced team of analysts and consultants at P3 are dedicated to reporting the high-quality care you have provided to Medicare patients. We take all the necessary steps to ensure providers are eligible for earning the maximum adjustment including, selecting all applicable quality measures and applying quality data codes to claims.

Time is running out! If you plan on submitting less than 90 days of data you must do so before December 31st 2017 to avoid a negative payment adjustment. Contact our experts at P3 at 909-245-8350 for further guidance. We can provide you with solutions that will increase the chances of a positive outcome.