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.

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.