CMS Offers Relief to Clinicians by Extending the MIPS 2019 Submissions Deadline

 

While the researchers everywhere in the world are trying to find a cure for COVID-19, the number of patients suffering from the virus continues to increase. Not only is the government using all the available machinery to make a vaccine, but it is also making the necessary arrangements for the sick at the same time.

Providers are also busy with the COVID-19 affectees, thus Reporting MIPS 2019 is not on their minds, primarily. At this time, what matters to them is to save lives.

But the question is, who will give relief to the MIPS eligible clinicians? 

The answer is the Trump administration!

The Trump administration, like in the past, comes to their rescue, and gives maximum relief to clinicians. It extends the MIPS 2019 reporting deadline – previously March 31, 2020 – to April 30, 2020.

MIPS 2019 and ACO Readjustments

As of now, the reporting requirements for QPP MIPS 2019 and MIPS 2020 realign for clinicians during the pandemic. 

CMS mentioned that it is being done to reduce data collection and reporting stress on providers currently busy with the COVID-19 outbreak.

The agency realizes that the performance on measures such as cost, readmissions, and patient experience will remain unjustified during the pandemic, hence, it is appropriate to show leniency. General Surgery Billing Services

Not only do MIPS 2019 eligible clinicians are justifiably addressed but Accountable Care Organizations (ACOs) in the Medicare Shared Saving Program (MSSP) also find relief.

CMS Evaluates Its Options for MIPS 2020

MIPS 2020 started on January 1 and is currently underway. CMS is not sure about relief around participation and data reporting in 2020. Since the pandemic is still at large and without a definitive cure, we have no way to determine the time it will end.  

When there are bells of relief ringing from every corner of the agency, hospitals won’t need to submit data for programs involving kidney disease and hospital-acquired situations.

Extension for Post-Acute Care Programs

 The same level of relief goes to post-acute care initiatives such as hospice and home health quality reporting initiatives including the long-term hospital quality initiative.

All this leniency in reporting data suggests that the government is determined to tackle the corona outbreak. In doing so, it takes those involved in confidence for a permanent solution to this disease. Once it is over and things go back to the way they were, we can always revisit the reporting guidelines.

The Centers for Medicare & Medicaid Services (CMS) has announced a significant extension to the deadline for clinicians to submit their data for the Merit-based Incentive Payment System (MIPS) for the 2019 performance year. This extension comes as a relief to many healthcare providers who have faced challenges in meeting the original submission deadline due to various circumstances, including the ongoing impacts of the COVID-19 pandemic. Neurology Billing Services

Key Details of the Extension

• New Deadline: The new deadline for MIPS 2019 data submissions is now set for March 31, 2020. This provides clinicians with additional time to ensure their submissions are accurate and complete.

• Who Benefits?: The extension applies to all eligible MIPS clinicians, including those who participate in the program on an individual basis or as part of a group.

Reasons for the Extension

1. COVID-19 Impact: Many clinicians have been heavily impacted by the pandemic, diverting their attention and resources away from data collection and submission processes.

2. Technological Challenges: Some providers have encountered difficulties with the technology required for MIPS submissions, including issues with electronic health records (EHR) systems.

3. Need for Accurate Reporting: The extension allows clinicians to focus on delivering patient care without the added stress of meeting the original deadline, ensuring that their submissions are more comprehensive and accurate.

Read More: Want Leverage MIPS 2020 Consulting Services in USA? Start Planning Toda

Implications for Clinicians

• Improved Reporting Quality: With more time to gather and analyze data, clinicians can enhance the quality of their submissions, which may lead to better performance scores and potential financial incentives.

• Financial Implications: MIPS is tied to reimbursement rates, so accurate and timely submissions can directly impact the financial health of healthcare practices.

• Support from CMS: CMS has indicated that they are committed to supporting clinicians and alleviating the administrative burdens associated with MIPS reporting.

What Clinicians Should Do Now

• Review Requirements: Clinicians should review the MIPS reporting requirements and ensure they understand what data needs to be collected and submitted.

• Plan for Submission: Use the additional time wisely by creating a clear plan for data collection, analysis, and submission to maximize their performance scores.

• Seek Assistance: Providers are encouraged to reach out for help if they face challenges. Many resources are available, including CMS guidance, webinars, and support from professional organizations.

Conclusion

The extension of the MIPS 2019 submissions deadline by CMS is a much-needed relief for clinicians who have faced unprecedented challenges over the past year. By allowing more time for data collection and submission, CMS is helping to ensure that providers can focus on delivering high-quality patient care while also meeting regulatory requirements. Clinicians should take advantage of this opportunity to enhance their reporting efforts and ultimately improve their performance in the MIPS program.

MIPs Reporting in healthcare was devised to prioritize quality care among the citizens of the United States. Thus, it will continue to do so through measures, programs, and regulatory relief. Outcomes and Quality are the two factors that drive such thought-provoking and action-driven initiatives in the first place.

FAQs

1. What is MIPS?

   • MIPS stands for the Merit-based Incentive Payment System, a program that adjusts Medicare payment based on the quality of care provided by clinicians.

2. Who is eligible for MIPS?

   • MIPS is applicable to eligible clinicians, including physicians, nurse practitioners, and other healthcare providers who bill Medicare.

3. How will the extension affect my reimbursement?

   • The extension allows for more accurate submissions, potentially improving your performance score and, consequently, your reimbursement rates.

4. What should I do if I missed the original deadline?

   • If you missed the original deadline, take advantage of the extension to prepare and submit your data by March 31, 2020.

5. Where can I find more information on MIPS?

   • More information can be found on the CMS website, where you can access resources, guidelines, and support for MIPS reporting.

Want Leverage MIPS 2020 Consulting Services in USA? Start Planning Today

Coronavirus has struck all, but the healthcare industry is under its wrath the most. With double the power, physicians, medical billing outsourcing companies, and MIPS Qualified Registries are working together to undermine the effect.

MIPS 2019 performance year is behind our back, and now it’s time for 2020. Although given circumstances are tough, the planning for MIPS 2020 will get fruitful results in terms of revenue.

Physicians! Bear in mind that with each performance year, requirements change.

• Payment adjustment will be 9% in 2020.

• 45 MIPS points are required to stay penalty-free.

• An exceptional performance bonus will be awarded at 85 points.

The reporting burden is great, but, we can’t afford to stay idle. You are busy dealing with COVID cases and risking your life. We suggest don’t risk your future revenue with the current situation.

Here is a guide to get you through the MIPS 2020 details. MIPS reporting services can take notes and get started.

Check Your Eligibility Status. Review if you’re required to Report Data?

CMS has updated the eligibility tool. Now, physicians or MIPS Qualified Registries can check on their behalf that if they can report data or they will have to opt-in.

Even ineligible clinicians can voluntarily participate in MIPS.

Enter your NPI – National Provider Identification number into the tool to get updates about:

• The eligibility status

• Qualifying Alternative Payment Model (APM, (QP) or a Partial QP participation status

• If the physician is required to opt-in

• The special status designation, For Instance, Small Practice, Ambulatory Surgery Center (ASC)-based, Hospital-based, etc.

If a physician has switched places, checking the latest eligibility status is necessary.

Which Reporting Option to Choose: Individual or Group Participation?

Physicians can report data either individually or in a group. If chosen to report via a group, two or more clinicians can report via the same Tax Identification Number (TIN). All the participants of the group will get the same points in the end. Neurology Billing Services

Group participation, of course, has some advantages. For Instance, Resources and time can be saved as it allows physicians a single MIPS submission on behalf of everybody.

• Group participants only have to report data for a similar set of patients.

• With more physicians on board, there are more chances to accurately submit data.

• However, there is a condition that at least 50% of participants should work upon the same activity for ninety days in order to report for Improvement Activities (IA).

Design Your Reporting Goals

Either you are submitting data via MIPS Qualified Registry or any other MIPS submission method, it's important to set goals beforehand. It gives time to analyze, and reflect the collected data for maximum revenue.

The Merit-based Incentive Payment System (MIPS) is a crucial component of the Quality Payment Program (QPP) established under the Medicare Access and CHIP Reauthorization Act (MACRA). It is designed to streamline the process of evaluating healthcare providers based on the quality of care they deliver. If you’re looking to improve your practice’s performance under MIPS 2020, leveraging consulting services can significantly enhance your strategy. In this article, we’ll explore how to effectively plan and implement MIPS 2020 consulting services.

Understanding MIPS 2020

What is MIPS?

MIPS combines several different Medicare quality programs into a single framework to assess providers based on four key performance categories:

• Quality
• Improvement Activities
• Promoting Interoperability
• Cost

Each category contributes to a provider’s overall MIPS score, affecting their Medicare reimbursement rates.

Importance of MIPS 2020

With increasing pressure on healthcare providers to deliver high-quality care while managing costs, MIPS 2020 serves as a framework for achieving these goals. Failing to meet the MIPS requirements can result in financial penalties, making it essential for providers to plan accordingly.

Why Consider MIPS Consulting Services?

Expertise and Guidance

MIPS consulting services offer specialized knowledge and support, helping practices navigate the complexities of the MIPS framework. Consultants can provide insights on:

• Understanding MIPS requirements
• Identifying performance improvement opportunities
• Developing effective reporting strategies

Customized Strategies

Every healthcare practice is unique, and MIPS consultants can tailor strategies to fit specific needs. They can assist in:

• Choosing the right quality measures
• Implementing improvement activities
• Optimizing performance in the promoting interoperability category

Maximizing Reimbursement

Consultants can help practices maximize their MIPS scores, ensuring they receive the best possible reimbursement rates from Medicare. This includes:

• Identifying areas for improvement
• Tracking performance metrics
• Implementing best practices for reporting

Steps to Start Planning for MIPS 2020 Consulting Services

1. Assess Current Performance

Before engaging with a consultant, assess your current MIPS performance. Review past reports and identify areas where your practice fell short. Understanding your baseline will help consultants create a targeted plan for improvement. General Surgery Billing Services

2. Set Clear Goals

Establish specific goals for your MIPS performance. Consider what you want to achieve, such as improving your Quality score or enhancing your Promoting Interoperability performance. Clear goals will guide your consulting efforts.

3. Research Consulting Services

Look for reputable MIPS consulting services that have a proven track record of helping practices succeed under the MIPS program. Consider factors such as:

• Experience with similar practices
• Client testimonials and case studies
• Services offered

4. Evaluate Service Offerings

Different consulting services offer various levels of support. Evaluate their offerings to find a service that aligns with your practice’s needs, whether it’s full-service consulting or targeted support in specific areas.

5. Create a Timeline

Develop a timeline for implementing consulting services. Include milestones for assessing current performance, engaging with consultants, and tracking progress throughout the year. A well-defined timeline ensures accountability and helps keep your team focused.

6. Collaborate with Your Team

Involve your practice’s staff in the planning process. Effective MIPS implementation requires teamwork and buy-in from all members. Schedule meetings to discuss goals, gather input, and foster a culture of continuous improvement.

7. Monitor Progress

Once you begin working with a consulting service, regularly monitor progress toward your MIPS goals. Set up periodic check-ins to assess performance, adjust strategies, and celebrate successes along the way.

A Little Overview of MIPS Quality Measures

Quality

This category has a total of 45 points.

• Report 6 Quality measures, with at least 1 measure Outcome measure or a High Priority measure

• Reported data should comply with data completeness constraint, otherwise, the physician will receive 0 points. Small medical practices can earn 3 points for this.

• To score high, report each measure for 70% of the eligible patients.

Promoting Interoperability (PI)

This category has a total of 25 points.

• Data should be reported for 90 consecutive days.

• The use of a 2015 certified Electronic Health Record (EHR) is required.

• For extreme and uncontrollable situations, CMS weighs this category to 0 and credits in the quality category.

Improvement Activities (IA)

This category has a total of 15 points.

• Total data for 90 days is required.

• Groups with 16 or more clinicians: Attest to 2 high-weighted IAs or 1 high-weighted and 2 medium-weighted IAs or 4 medium-weighted IA measures

• Individual clinicians and groups with 15 or fewer clinicians: Attest to 1 high-weighted IA or 2 medium-weighted IA measures

Cost

This category has a total of 15 points.

There is no need to submit data for this category. CMS will itself calculate the performance based on the Medicare claim data.

Instructions for Small Medical Practices

• Report 6 Quality measures on 1 eligible patient each with at least 1 measure should be an Outcome or High Priority measure
• Submit 1 High-weighted or 2 Medium-weighted Improvement Activities

QPP MIPS is a MIPS Qualified Registry ready to implement tried and tested strategies to increase physicians' score in MIPS performance. Whether you need assistance in submitting data to CMS or a full-proof plan to stay penalty-free, we got you covered in every need.

Read More: Is Prior Authorization Criterion Doing More Harm Medical Billing Services

Conclusion

Leveraging MIPS 2020 consulting services can significantly enhance your healthcare practice's ability to succeed under the Quality Payment Program. By assessing your current performance, setting clear goals, and collaborating with a reputable consulting firm, you can maximize your MIPS score and improve reimbursement rates. The time to start planning is now—ensure your practice is well-prepared for the challenges and opportunities presented by MIPS 2020.

FAQs

1. What is the Merit-based Incentive Payment System (MIPS)?
   MIPS is a program that evaluates healthcare providers based on quality, improvement activities, promoting interoperability, and cost, affecting their Medicare reimbursement rates.

2. Why is MIPS consulting important?
   Consulting services provide expertise, customized strategies, and guidance to help practices improve their MIPS performance and maximize reimbursement.

3. How do I assess my current MIPS performance?
   Review past performance reports, identify areas of weakness, and gather feedback from your team to understand your baseline performance.

4. What should I look for in a MIPS consulting service?
   Consider their experience, client testimonials, and the specific services they offer to find the best fit for your practice's needs.

5. How often should I monitor my MIPS progress?
   Regularly monitor progress through periodic check-ins, ensuring your practice stays on track to meet its MIPS goals.

Is Prior Authorization Criterion Doing More Harm Medical Billing Services

COVID-19 pandemic has changed healthcare industry’s dynamics. The impact might be temporary in some aspects while it can also lead to permanent changes in some situations.

Many changes were suggested to cater the overflowing COVID-19 positive cases. CMS even recommended delaying the nonessential medical procedures to curb down the virus exposure. This certainly was a brave decision as it protected the health of physicians, patients, and medical billing services workers but drag down their financial situation as well.

The prior authorization rule is also under fire for the same reason. Many insurance companies and Medicare payment models are waiving off the prior authorization restriction for diagnostic or surgical procedures for coronavirus.

However, there are many others, which require the pre-authorization segment filled in the claims. Even when the physicians obtain prior authorization, the claim might end up being denied.

Why Prior Authorization is Necessary?

Prior authorization is particularly required for expensive or new medical procedures. If insurance companies don’t pay up for the rendered services or don't prior authorize for the service, medical billing companies will be compelled to ask from the patients, which ultimately will lead to the complicated and frustrating revenue-generating process Mips Reporting.

Getting Authorizations Needs Investment

Getting authorizations is not that simple as one thinks. Physicians have to bear extra costs for that.

Healthcare costs are already getting out of hand as physicians have to maintain quality healthcare. In these drastic times, when reimbursements and payment models are failing to compensate physicians’ revenue problems, prior authorization is a clause that needs relaxation.

Why Prior Authorization is a Problem, Especially Now?

The prior authorization criteria from the insurance companies give more power to insurers rather than physicians and patients. Although, it is physicians, who are spending dimes for the authorization process; and with denial of the claim, the return payment becomes zero. General Surgery Billing Services

On average, medical billing companies spend at least twenty-seven minutes and almost eleven dollars on each authorization action. Every time, having to consult insurers, physicians get the idea that a third party is dictating the healthcare service. 

Moreover, with more medical procedures requiring prior authorization, the more burden physicians will have to bear.

It is not to be blamed upon insurance companies for such strict rules. It is the US healthcare industry whose complex structure is weighing down all stakeholders, be it, patients, medical practitioners, medical billing services, and insurers.

Coronavirus has adverse effects on the healthcare industry. But it certainly is reveling the problematic areas.

Prior authorization (PA) is a cost-containment strategy used by insurance companies to ensure that certain medical procedures, medications, or services are deemed necessary before they can be approved for coverage. While the intention behind prior authorization is to curb unnecessary healthcare costs, its implementation has sparked considerable debate. Many argue that it can lead to delays in care, increased administrative burdens, and even worse health outcomes for patients. In this article, we’ll delve into the impact of prior authorization on medical billing services and the broader healthcare landscape. Neurology Billing Services

Understanding Prior Authorization

Prior authorization requires healthcare providers to obtain approval from an insurance company before providing specific treatments. This process often involves submitting detailed information regarding the patient’s condition, the proposed treatment, and the rationale for its necessity.

The Burden on Healthcare Providers

1. Administrative Challenges
   Medical billing services face significant hurdles due to the complexity of prior authorization. The paperwork and documentation required can be time-consuming, leading to increased administrative costs. Staff must often spend hours on the phone with insurance companies, navigating complex guidelines to secure approvals.

2. Delays in Care
   One of the most pressing issues with prior authorization is the delay it creates in patient care. Patients may experience longer wait times for necessary treatments, which can exacerbate their medical conditions. For instance, if a patient requires a specific medication to manage a chronic illness, delays in authorization could lead to severe health complications.

Impact on Patient Health Outcomes

1. Increased Health Risks
   When patients experience delays due to prior authorization, their health may decline. This is particularly concerning in urgent care situations where timely intervention is crucial. Studies have shown that patients who face delays in necessary treatments often experience poorer health outcomes and higher rates of hospitalization.

2. Frustration and Confusion
   The prior authorization process can be a source of frustration for patients. They may be unaware of the requirements, leading to confusion and anxiety regarding their care. This lack of transparency can erode trust in healthcare providers and the insurance system.

Financial Implications

1. Increased Costs
   The administrative burden of prior authorization doesn’t just affect healthcare providers; it can also lead to increased costs for patients. When treatments are delayed, patients may require more intensive (and expensive) care later on. This cycle can inflate overall healthcare costs, negating the intended savings of prior authorization.

2. Insurance Rejections
   If a prior authorization request is denied, patients may find themselves liable for the full cost of care. This can lead to financial strain and may deter individuals from seeking necessary treatments altogether.

Alternatives to Prior Authorization

1. Value-Based Care
   Shifting toward value-based care models could alleviate some of the issues associated with prior authorization. By focusing on patient outcomes rather than procedural approvals, healthcare providers may be better equipped to deliver timely care without excessive administrative burdens.

2. Streamlined Processes
   Implementing more efficient prior authorization processes, such as automated systems, could reduce delays and administrative workloads. By harnessing technology, medical billing services can expedite approvals and enhance communication between providers and insurers.

The Counter Action

Some insurance companies are resolving this issue themselves by suspending referrals and prior authorization conditions and requesting notification within a day of any inpatient and outpatient medical service. There are, however, some exclusive cases such as, for transplant and genetic cases.

This service applies to all areas of physicians, even if they don’t belong to a network. It will not only reduce administrative burden over medical billing and coding services but also free up resources, which are consumed up during the delayed billing services.

Some states are working to empower patients and physicians, but the problem is that each state is working on its own, without any collective effort. Therefore, the confusion arises about the after-effects or long terms prerequisites of the COVID -19 counter-strategy.

The authorities say that it is in the best interest of the healthcare industry to continue the practice of prior authorization to avoid surprise medical bills. Popular opinion is that authorities might not know how surprise bills will be unfolded in the future.

The uncertainty and ambiguity disguised in temporary and permanent changes might find solace in technology incorporation.

Read More: QPP MIPS 2020 Reporting Guidelines for Chiropractors Reporting Services

Prior authorization generally consists of three steps:

•        ICD-10 codes incorporation
•        Automated data submission
•       Retrieval data process

With technology, these steps can be a lot smoother than before. The per authorization cost will be reduced, and of course, time consumption will also be minimum.

Even if the changes prolong, physicians and medical billing companies can enjoy a relaxed working environment. Prior authorization is surely an administrative burden but it encompasses lots of financial benefits. Healthcare professionals need to understand the requirement and adopt methods to make it a primary billing function.

There are opportunities to improve the system, and this time, we may be able to realize what’s best for all stakeholders.

QPP MIPS 2020 Reporting Guidelines for Chiropractors Reporting Services

 

QPP MIPS is a payment model that CMS (the Centers for Medicare & Medicaid Services) has established for high or reasonable performers in the healthcare industry. Eligible Medicare clinicians can report their data that translates quality healthcare, improvement activities, and interoperability while keeping the cost factor in control. General Surgery Billing Services

This payment program rewards physicians with positive payment adjustment, incentives, bonuses, and gives a penalty to those, who don’t meet even the basic performance threshold.

All participants must familiarize themselves with the deadlines and reporting criteria to maximize revenue in the end. There are many MIPS submission methods through the reporting process. However, the most preferable method by hospitals, clinicians, and groups is MIPS Qualified Registries.

Updates Related to MIPS 2020

Every year, CMS modifies some of its rules to accommodate changes or to reduce the administrative burden on physicians. On November 1, 2019, some updates were also released for the performance year 2020. New specialty sets were introduced including chiropractic medicine as part of the quality performance category.

Other updates are:

• Data completeness constraint is raised to seventy percent.
• The performance or penalty-free threshold is raised to forty-five points.
• Cost (15) and quality (45) performance categories have the same points as 2019.
• Moreover, MIPS Value Pathways (MVPs) has also been proposed that refers to the conceptual participation framework. It works to increase understanding and collaboration among physicians and offers measures that align more with the expertise of medical practice.

Given below are the measures that chiropractors can use to report their performance for MIPS 2020.

Quality Performance Category

Total points: 45 of the total MIPS score

Eligible physicians have to report 6 measures with one Outcome or High Priority measure for 12 months. Report at least one eligible case to earn 1 or 3 points on a measure. For more than 3 points on a measure, physicians can report at least 60 percent of eligible cases.

Some of the reporting measures for this category are:

• #182 Functional outcome assessment
• #131 Pain assessment prior to initiation of patient therapy and follow-up
• #218 Functional Status Change for Patients with Hip Impairments
• #219 Functional Status Change for Patients with Lower Leg, Foot or Ankle Impairments
• #220 Functional Status Change for Patients with Low Back Impairments
• #222 Functional Status Change for Patients with Elbow, Wrist or Hand Impairments
• #223 Functional Status Change for Patients with General Orthopedic Impairments
• #221 Functional Status Change for Patients with Shoulder Impairments
• #217 Functional Status Change for Patients with Knee Impairments

Promoting Interoperability (PI)

Total points: 25 of the total MIPS score

Eligible chiropractors are required to report all required measures for a minimum of 90 days. 2015 Edition certification must be in place by October 3, 2019.

Some exclusions are available for all eleven reporting measures. Physicians can check their eligibility status on QPP MIPS official website https://qpp.cms.gov/participation-lookup. If physicians are unable to report for this category, the score will be re-weighted to the quality category.

Some of the reporting measures for this category are:

• e-Prescribing
• The query of the Prescription Drug Monitoring Program (PDMP) (optional)
• Provide Patients Electronic Access to Their Health Information
• Support Electronic Referral Loops by Sending Health Information
• Support Electronic Referral Loops by Receiving and Incorporating Health Information
• Immunization Registry Reporting
• Syndromic Surveillance Reporting
• Electronic Case Reporting
• Public Health Registry Reporting
• Clinical Data Registry Reporting

Read More: Promoting Interoperability Requirements in QPP MIPS 2020 Reporting Services

Improvement Activities (IA)

Total points: 25 of the total MIPS score

Physicians should report 2 high-weighted activities or 4 medium-weighted activities for a minimum of 90 days. Groups with 15 or fewer participants or if you are in a rural area or health professional shortage facility, you can report 1 high-weighted or 2 medium-weighted measures for a minimum of 90 days. Neurology Billing Services

A total of ninety possible measures are available to choose from.

Some of the reporting measures for this category are:

• IA_EPA_3 - Collection and use of patient experience and satisfaction data on access (medium-weighted).
• IA_BE_14 - Engage patients and families to guide improvement in the system of healthcare (medium-weighted).
• IA_CC_8 - Implementation of documentation improvements for practice/process improvements (medium weighted).
• IA_CC_2 - Implementation of improvements that contribute to cohesive communication of test results (medium-weighted).
• IA_BE_16 - Evidenced-based techniques to promote self-management into usual care (medium-weighted).
• IA_BE_17 - Use of tools to assist patient self-management (medium-weighted).
• IA_BE_21 - Improved Practices that Disseminate Appropriate Self-Management Materials (medium-weighted).
• IA_AHE_1 - Engagement of new Medicaid patients and follow-up (high weighted).
• IA_EPA_1 - Provide 24/7 access to clinicians/groups who have real-time access to the patient’s medical record (high weighted).
• IA_AHE_3 - Promote Use of Patient-Reported Outcome Tools (high weighted).

For further details on QPP MIPS data submission, contact - https://qppmips.com/ | (888) 902-1035

The Quality Payment Program (QPP) under the Medicare Access and CHIP Reauthorization Act (MACRA) includes the Merit-based Incentive Payment System (MIPS). Chiropractors participating in MIPS must understand the 2020 reporting guidelines to ensure compliance and maximize their reimbursement potential.

Overview of MIPS

MIPS aims to improve healthcare quality by tying reimbursement rates to performance. Chiropractors can earn positive adjustments to their Medicare payments based on their scores in four performance categories: Quality, Improvement Activities, Promoting Interoperability, and Cost.

Performance Categories

1. Quality

• What It Is: This category assesses the quality of care provided to patients.
• Requirements: Chiropractors must report on at least six quality measures, including one outcome measure.
• Reporting Options: Measures can be reported through claims, a qualified registry, or EHR systems.

2. Improvement Activities

• What It Is: This category rewards practitioners for engaging in activities that improve clinical practice.
• Requirements: Chiropractors need to attest to completing at least two improvement activities for a minimum of 90 days.
• Examples: Activities may include patient safety initiatives, participation in clinical data registries, and implementing care coordination practices.

3. Promoting Interoperability

• What It Is: Focuses on the use of technology and electronic health records to improve patient care.
• Requirements: Chiropractors must use certified EHR technology (CEHRT) and report on specific measures, such as patient electronic access and health information exchange.
• Importance: This category emphasizes the need for secure, efficient data sharing among healthcare providers.

4. Cost

• What It Is: This category measures the total cost of care provided to patients.
• Requirements: While there are no specific reporting requirements, chiropractors will be assessed based on Medicare claims data.
• Key Point: Efficient care delivery can positively influence performance in this category.

Conclusion

Understanding the QPP MIPS 2020 reporting guidelines is essential for chiropractors aiming to optimize their Medicare reimbursement. By actively participating in quality improvement activities and utilizing technology, chiropractors can enhance patient care while securing their financial future under Medicare.

Promoting Interoperability Requirements in QPP MIPS 2020 Reporting Services

Promoting Interoperability (PI) in QPP MIPS is all about technology incorporation in the healthcare industry to empower patients and making information transmission easy. Certified electronic health record technology (CEHRT) is the most appreciated medium to achieve this.

Each year, CMS changes some of its requirements and policies to better facilitate physicians. In the performance year 2020, some of the requirements are also changed. General Surgery Billing Services

Here is an overview of everything related to promoting interoperability in MIPS 2020.

Final Score Percentage

This category has a total of 25 points in the final MIPS score.

Changes can be expected due to hardship exceptional applications and other special statuses, reweighting other categories.

What Data is to be submitted for this Category?

Eligible physicians are required to submit data and measures that translate the 2015 version of CEHRT.

PI has the following four objectives and the submitted data should translate these objectives.

What are the Requirements for PI QPP MIPS 2020?

2015 Edition CEHRT is the most important feature to participate in the ongoing MIPS year for PI. The data is to be submitted for consecutive ninety or more days with the following objectives unless there is an exception.

Alongside the related data, CMS requires the physicians’ EHR CMS Identification code from the Certified Health IT Product List (CHPL).

Moreover, physicians or MIPS Qualified Registries on their behalves must submit an affirmative response to the following categories.

·         The prevention of information blocking attestation

·         The ONC direct review confirmation

·         The security risk analysis

What are the Hardship Exceptions?

In case, eligible physicians are unable to report for this category, they can apply for the hardship exception for any of the following reasons.

·         If the clinician works in a small practice

·         If the clinician uses decertified EHR technology

·         No or Insufficient Internet connectivity

·         Extreme and uncontrollable circumstances

·         Lack of control over the availability of CEHRT

If the reason is accepted by the CMS, the weight of this category will be distributed to another category or categories (Quality, Improvement Activities (IA), & Cost), unless the stream less data submission.

Some types of clinicians such as physical therapists, occupational therapists, or clinical psychologists don’t need to apply for an exception for this category. They receive special status for QPP MIPS reporting; therefore, their percentage will automatically be reweighted.

Another requirement is that from groups or virtual groups, all participants must qualify for the reweight unless the group is exempted by a special status.

How to Submit Data?

For promoting interoperability performance year, there are three methods to submit data.

·         Attestation method via sign up

·         Upload data via sign up

·         Direct submission via API

However, the submission method depends upon the submitter type. The following table shows the details of the data submission.

Submitter Type	Sign up & Upload	Sign up & Upload	Direct Submission via API
MIPS eligible clinician	Allowed	Allowed	Not Allowed
Any representative on behalf of medical practice or virtual group	Allowed	Allowed	Not Allowed
Third-party Intermediaries	Not Allowed	Allowed	Allowed

How CMS Scores PI measures?

CMS scores every measure by multiplying the performance rate by the available points of the measure. The Public Health and Clinical Data Exchange awards full points if data is submitted for two registries or one registry with one exclusion. Neurology Billing Services

Eligible clinicians should report all necessary required measures, i.e. submit data for at least one patient in the numerator, as applicable, or exclusion. Otherwise, clinicians can receive zero points.

If groups or eligible clinicians claim exclusions, points of those measures are reallocated to other measures.

How to Get Bonus Points?

If clinicians or MIPS Qualified Registries report data for the optional measure, Query of Prescription Drug Monitoring (PDMP), they can earn 5 bonus points in this category.

This is some of the information that clinicians need to know for reporting the promoting interoperability category in QPP MIPS. If you have participated for four years, you would be updated with the changes for MIPS 2020 reporting, otherwise, you can consult a MIPS Qualified Registry for maximum benefits. For more details, visit, https://qppmips.com/

You must be thinking that it is long before the MIPS 2020 reporting, we can start later on, but with the on-going crisis, clinicians who would start planning today would be benefitted more with accurate data submission and ultimately, more points.

The Quality Payment Program (QPP) under the Medicare Access and CHIP Reauthorization Act (MACRA) emphasizes the importance of interoperability in healthcare. For the 2020 reporting year, the Promoting Interoperability (PI) performance category plays a crucial role in the Merit-based Incentive Payment System (MIPS). Here’s a breakdown of the requirements and their significance.

Understanding Promoting Interoperability

Promoting Interoperability aims to enhance patient care by ensuring seamless data exchange among healthcare providers. It promotes the use of certified electronic health record technology (CEHRT) to facilitate effective communication and improve healthcare outcomes.

Key Requirements for 2020

For MIPS 2020, providers must report on specific measures to fulfill the PI category:

1. Use of CEHRT

Healthcare providers must utilize CEHRT that meets the 2015 Edition certification criteria. This ensures that the technology supports interoperability standards.

2. Reporting Measures

Providers need to report on a minimum of four measures, which include:

• e-Prescribing: Measure how effectively you send prescriptions electronically.
• Health Information Exchange: Demonstrate the ability to send and receive patient information with other providers.
• Patient-Specific Education: Provide patients with tailored educational resources based on their health conditions.
• Provider to Patient Exchange: Facilitate patients' access to their health information.

3. Required Objectives

The PI category has specific objectives that must be met, including:

• Secure Messaging: Encourage the use of secure messaging to communicate with patients.
• Patient Access: Ensure patients can easily access their health data online.

4. Performance Scoring

MIPS uses a scoring system to evaluate the performance in the PI category. Providers can earn up to 40 points based on their performance in the required measures.

Read More: Things Physicians for Medicare Payment 2020 in MIPS Reporting Services

Importance of Interoperability

Interoperability is vital in today’s healthcare landscape, enabling better care coordination and improved patient outcomes. By promoting data sharing, healthcare providers can reduce duplicate testing, enhance patient safety, and ultimately improve the quality of care.

Conclusion

The Promoting Interoperability requirements in QPP MIPS 2020 are essential for healthcare providers aiming to enhance patient care through effective data exchange. Understanding and meeting these requirements not only boosts performance scores but also contributes to the broader goal of achieving a more integrated healthcare system.

FAQs

1. What is the main goal of Promoting Interoperability?

   • To enhance patient care through effective data exchange among healthcare providers.

2. How many measures must be reported for PI in 2020?

   • A minimum of four measures must be reported.

3. What is CEHRT?

   • Certified Electronic Health Record Technology, which meets specific certification criteria.

4. How are performance scores calculated in the PI category?

   • Providers can earn up to 40 points based on their performance in required measures.

5. Why is interoperability important in healthcare?

   • It improves care coordination, reduces duplicate testing, and enhances overall patient safety.

Things Physicians for Medicare Payment 2020 in MIPS Reporting Services

 

Payment plans and schedules are changed every year to accommodate changes and diverse situations. Talking about the Medicare Physician Payment Schedule 2020, it has also been modified to reduce the administrative burden in effect from 2021.

The codes have been revised for outpatient evaluation and management (E/M), and there is a lot of information that tells about tweaks in the details of how physicians will be paid for their services.

Given below are five important factors that physicians need to know. We will investigate them all through that how will they impact the Medicare Quality Payment Program (QPP). Ultimately, QPP MIPS 2020 participants and MIPS Qualified Registries can have an insight into what’s going to change and implement strategies accordingly.

Escaping from Penalty Requires Higher Margins

CMS (The Centers for Medicare and Medicaid Services) has set the bar very high for QPP MIPS 2020. This year, the minimum points to avoid a penalty are 45 points that were 30 points last year. In the upcoming year, it’s set for 60 points to be minimum. Moreover, the penalty percentage is also raised to 9% from 7%. The higher penalty threshold is expected to leave an impact on the cost parameter of the MIPS. However, statistics say that more clinicians are performing on the higher end of the score scale than on the lower end. Looking into MIPS 2018, CMS observed the average score was 86.9.

Exceptional Performance Threshold Goes High

CMS has a policy where exceptional performers in the MIPS can take part in the additional bonus pool of $500 million. At first, the exceptional performance was supposed to be 80 points, but in the final rule, it is set to be 85 points.

The high-performance threshold is surely high, and CMS states to reward the outstanding performers quite well. They have worked all year long with quality, consistency, and played with innovation so they deserve all the praise.

CMS estimates in MIPS 2020, 92.5% of the 880,000 MIPS-eligible clinicians will achieve more score than the penalty threshold and earn incentives. Moreover, they expect 45% of the total eligible physicians as high-performers.

Cost and Quality MIPS Performance Categories Remained Unchanged

CMS wished to lower the weight of quality category in 2020 from 45 to 40 points and raise the weight for cost from 15 to 20. But in the final rule, it all remained the same as the previous year.

The later decision was empowered by the AMA’s concerns that there are no detailed or timely feedback constraints for the cost category. Therefore, it wouldn’t be fair for physicians to increase the points of the cost parameter. Neurology Billing Services

According to the CMS, they are in constant efforts to devising new rules for real-time data access for eligible clinicians to get a better understanding of these measures and their performance criteria. Moreover, it will also help them in keeping the cost factor in check.

CMS, however, plans to increase the weight of cost category only when eligible clinicians will be able to comprehend the data effectively based on performance feedback reports on episode-based measures.

AMA (American Medical Association) states that they are concerned over the cost measures as Medicare Spending per Beneficiary and Total Per Capita Cost as physicians have no control over them.

CMS believes that their approach will help to align incentives across the board.

Small medical practices via any MIPS data submission method can receive bonus points for treating patients with high-risk or complex medical conditions or for patients with double Medicare-Medicaid eligibility.

Administrative Burden is Cutting Down

CMS is moving ahead with a framework “MIPS Value Pathways”, starting from 2021 to counter the administrative issues and complexities that we hear associated with MIPS.

The four MIPS performance categories seem like different programs so CMS decides to replace with a pathway that:

• Aligns with eligible physicians’ specialties
• Includes lesser MIPS reporting measures
• Compatible to move towards advanced Alternative Payment Models (APMs)

AMA and CMS are working together to relive every stressful aspect of the MIPS, and we can expect fruitful outcomes in the future.

Navigating the complexities of Medicare payments can feel like wandering through a maze—especially with the evolving rules and regulations. For physicians, understanding the ins and outs of the Merit-Based Incentive Payment System (MIPS) is crucial. So, what’s the deal with MIPS in 2020? Let’s break it down.

Understanding Medicare and MIPS

Medicare is a federal health insurance program primarily for people aged 65 and older. But it also serves younger individuals with disabilities. Within this framework, MIPS was introduced to tie physician payments to the quality of care provided rather than the quantity of services rendered.

Importance of Compliance for Physicians

Staying compliant isn’t just about avoiding penalties; it’s about delivering better patient care. By adhering to MIPS requirements, physicians can enhance their practice's efficiency and ensure they’re reimbursed fairly for their services.

Overview of MIPS (Merit-Based Incentive Payment System)

What is MIPS?

MIPS is part of the Quality Payment Program (QPP), aimed at incentivizing high-quality patient care and improving outcomes. It replaces older programs like the Physician Quality Reporting System (PQRS) and the Value-Based Payment Modifier.

MIPS Components

To understand how MIPS works, you need to know its four main components:

• Quality: This is about how well you provide care. Physicians must report on various quality measures that reflect their patients' outcomes.

• Cost: This component evaluates the cost of care provided, comparing it to similar practices.

• Improvement Activities: Physicians can earn points for engaging in activities that improve patient outcomes, such as expanding access to care or enhancing patient engagement.

• Promoting Interoperability: This focuses on how well practices use technology to share information and engage with patients.

Key Changes for 2020

Adjustments in Scoring

In 2020, there were some notable shifts in how scores were calculated. The scoring weights were adjusted, affecting how practices received their payments. For instance, quality reporting has a significant impact, which means getting it right is more crucial than ever.

New Measures and Standards

The Centers for Medicare & Medicaid Services (CMS) introduced new quality measures and standards for 2020. Keeping up with these updates ensures you’re reporting accurately and maximizing your scores.

Changes in Reporting Requirements

Every year brings new requirements, and 2020 is no exception. Familiarize yourself with the latest reporting requirements to avoid last-minute scrambles. General Surgery Billing Services

Read More Physicians Guide: Briefing QPP MIPS Cost Category and Managed in Finance Program

Preparing for MIPS Reporting

Data Collection and Management

Collecting data isn’t just about hitting a few buttons; it’s about having an organized system in place. Ensure your practice has efficient processes for gathering, analyzing, and reporting data.

Leveraging Technology for Reporting

Utilizing electronic health records (EHRs) and other reporting software can streamline the MIPS reporting process. Technology not only saves time but can also enhance accuracy.

Timelines and Deadlines

Keeping track of deadlines is essential. Missing a reporting deadline can result in penalties, so stay organized and plan ahead.

Common Challenges Physicians Face

Understanding Complex Regulations

MIPS can be confusing, and many physicians struggle with its complex regulations. Regular training sessions can help demystify these rules.

Data Reporting Issues

Sometimes, data isn’t reported accurately, leading to discrepancies in scores. Regular audits can help identify and correct these issues before they become a problem.

Navigating Performance Categories

With multiple performance categories, knowing where to focus can be daunting. Prioritizing categories that align with your practice goals is vital for success.

Best Practices for Successful MIPS Reporting

Engaging Your Staff

Your team plays a critical role in MIPS success. Engage them in the process to ensure everyone understands their responsibilities.

Regular Training and Updates

Stay updated on the latest MIPS changes and train your staff accordingly. Knowledge is power, and it can save you from potential pitfalls.

Utilizing Support Services

Don’t hesitate to seek out resources and support services that can assist with MIPS reporting. They can provide valuable insights and help you navigate the complexities.

The Importance of Documentation

Keeping Accurate Records

Documentation is key. Maintain accurate records to support your MIPS reporting and to prepare for audits.

The Role of Audits in MIPS

Regular audits can ensure compliance and help identify areas for improvement, making them an essential part of your MIPS strategy.

Conclusion

Navigating MIPS for Medicare payments can be a daunting task, but with the right knowledge and preparation, physicians can turn it into an opportunity for growth. By staying informed and engaged, practices can not only comply with regulations but also enhance patient care.