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.

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.

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

 

Under MACRA (Medicare Access and CHIP Reauthorization Act), clinicians can participate in either two payment models, a Merit-based Incentive Payment System (MIPS), or an Advanced Alternative Payment Model (AAPM), defined as Quality Payment Program (QPP).

In MIPs Reporting, eligible physicians are required to submit yearly data to CMS to receive a total score. There are four performance categories, Quality, Improvement Activities (IA), Promoting Interoperability (PI), and Cost, for which data is recorded and analyzed.

Today, we are discussing the Cost category and its reporting.

Let’s keep going.

Cost Performance Category

The cost category weighs 15% of the total MIPS score for the performance year 2020.

Reporting Requirements

CMS doesn’t expect any data submission for the cost category. They analyze the performance by reviewing claims data.

The following factors impact the analysis of this performance.

1. Medicare Spending per Beneficiary (MSPB)
2. Total per Capita Cost
3. Eight episode-based cost measures

Medicare Spending per Beneficiary (MSPB)

The MSPB assessment refers to the Medicare Part A and B costs generally incurred in an episode.

An episode includes the dates falling between three days prior to an Inpatient Prospective Payment System (IPPS) hospital admission (an index admission) and 30 days post-hospital discharge. It measures the actual cost of episodes as per their expected expenditure. General Surgery Billing Services

To score for this measure, physicians or MIPS Qualified Registry on their behalf need to consider the following aspects.

Physicians, who don’t treat in-house patients don’t qualify for an episode, and no points will be awarded.

Episodes will be attributed to those clinicians, who provide the plurality of Medicare Part B services to a beneficiary during the index admission.

Physicians must report at least 35 cases to get a score for this category.

Total per Capita Cost

The total per capita cast measure analyzes all Medicare Part A and B costs for each attributed beneficiary.  However, the following factors are to be considered for maximum points in MIPS.

Clinicians are supposed to be attributed to at least 20 beneficiaries.

Attribution refers to:

A beneficiary refers to a tax identification number-national provider identifier (TIN-NPI), provided if the beneficiary (patient) received primary healthcare services from primary care physicians, nurse practitioners, physician assistants, or clinical nurse specialists under the same TIN.

If the beneficiary doesn’t qualify as per the above-mentioned requirement, he/she will be attributed to the TIN-NPI, if they received services from specialist physicians within a TIN than from physicians in any other TIN.

New episode-based cost measures don’t apply to family physicians.

CMS is working on developing new episode-based measures in the future to fit diverse needs. Given below are the episode-based cost measures.

• Elective Outpatient Percutaneous Coronary Intervention
• Intracranial Hemorrhage or Cerebral Infarction
• Knee Arthroplasty
• Revascularization for Lower Extremity Chronic Critical Limb Ischemia
• Routine Cataract Removal with Intraocular Lens Implantation
• Screening/Surveillance Colonoscopy
• Simple Pneumonia with Hospitalization
• ST-Elevation Myocardial Infarction with Percutaneous Coronary Intervention
• Acute Kidney Injury Requiring New Inpatient Dialysis
• Elective Primary Hip Arthroplasty
• Femoral or Inguinal Hernia Repair
• Hemodialysis Access Creation
• Inpatient Chronic Obstructive Pulmonary Disease Exacerbation
• Lower Gastrointestinal Hemorrhage
• Lumbar Spine Fusion for Degenerative Disease, 1-3 Levels
• Lumpectomy, Partial Mastectomy, Simple Mastectomy
• Non-Emergent Coronary Artery Bypass Graft
• Psychoses/Related Conditions   Renal or Ureteral Stone Surgical Treatment

It is to be noted that cost measures are risk-adjusted (based on the hierarchal condition category (HCC) risk scores) for the difference in patients’ medical conditions. For Instance, for multiple chronic conditions affecting physician’s performance.

The performance benchmarks are set based on the data collected by the CMS.

A measure will be benchmarked if it has 20 groups or individual clinicians who attribute to the measure’s minimum case.

For a fact, any measure without a benchmark cannot be scored or included in the performance category scorecard.

Eligible clinicians can be assigned up to 10 points on average of all scored cost measures concerning the performance benchmark.

For group participation in QPP MIPS, the final score will be the aggregated value of all individual scores under the TIN.

For Instance, if a clinician has 8 attributes and another has 12 attributed cases, so the group will receive a collective score as they reached the minimum threshold point 20.

If any individual or group doesn’t receive a score for this category, the weight will be redistributed to the Quality performance category.

Hey there, fellow physicians! As the healthcare landscape continues to evolve, understanding the intricacies of quality payment programs (QPP) is essential for providing optimal patient care and maintaining financial stability. In this guide, we’ll delve into the MIPS (Merit-based Incentive Payment System) Cost Category, explore how it’s managed within the finance program, and provide strategies for improving your scores. Let’s get started!

What is QPP?

The Quality Payment Program (QPP) is a comprehensive initiative by the Centers for Medicare & Medicaid Services (CMS) aimed at enhancing healthcare quality while reducing costs. Through the QPP, physicians can participate in MIPS or Advanced Alternative Payment Models (APMs). MIPS is designed to evaluate and reward healthcare providers based on their performance in various categories, including quality, improvement activities, promoting interoperability, and cost.

Overview of MIPS

MIPS combines several existing quality reporting programs into a single framework. This system allows for a more streamlined approach to measuring performance and incentivizing better care. One of the critical components of MIPS is the Cost Category, which examines how efficiently providers manage resources in delivering patient care.

Understanding the MIPS Cost Category

Definition of the Cost Category

The MIPS Cost Category evaluates the total cost of care provided to Medicare beneficiaries. It looks at how well healthcare providers manage resources while maintaining high-quality care.

Importance of the Cost Category in MIPS

Understanding the cost category is crucial for healthcare providers. It not only impacts reimbursement rates but also reflects on the overall performance of a practice. Providers who manage costs effectively can receive positive adjustments to their Medicare payments. Neurology Billing Services

How the Cost Category is Measured

The cost category is measured through various metrics, including total cost of care, Medicare spending per beneficiary, and episode-based measures. CMS uses claims data to evaluate these metrics, which means the efficiency of your practice is constantly under review.

Components of the MIPS Cost Category

Total Cost of Care

This metric assesses the overall expenses incurred for a patient’s care across a specific timeframe. The goal is to promote cost-effective treatment methods without compromising quality.

Medicare Spending per Beneficiary

This measure looks at the average costs associated with treating a Medicare beneficiary during a specified period. It takes into account all claims submitted for the beneficiary, allowing for a comprehensive view of spending patterns.

Episode-Based Measures

These measures evaluate the costs associated with specific episodes of care, such as surgeries or chronic disease management. By focusing on episodes, providers can pinpoint areas for improvement and implement cost-saving strategies.

The Role of Managed Care in MIPS

Definition of Managed Care

Managed care refers to a variety of techniques designed to reduce the cost of healthcare while improving the quality of care. This includes coordinating care among providers and utilizing preventive care to reduce unnecessary expenses.

How Managed Care Influences Costs

Managed care can significantly influence the cost category by promoting efficiency and reducing duplication of services. By managing resources effectively, healthcare providers can deliver better care while also saving money.

Benefits of Managed Care in MIPS

Implementing managed care strategies can lead to improved MIPS scores, as providers who coordinate care and focus on prevention typically see lower costs and better outcomes. It’s a win-win for both patients and providers!

Strategies for Improving MIPS Cost Scores

Data Analysis and Reporting

Understanding your practice’s data is essential. Analyzing claims data can reveal trends and identify areas for improvement. Regular reporting can also help in tracking progress toward cost management goals.

Engaging Patients in Care

Active patient engagement can lead to better health outcomes and reduced costs. Educating patients about their conditions and treatment options empowers them to take charge of their health, which can lead to fewer unnecessary visits and interventions.

Coordinating Care with Other Providers

Collaboration with other healthcare providers is vital. By ensuring that all members of a patient’s care team are on the same page, you can reduce the risk of duplicated services and streamline the overall care process.

Challenges in Managing MIPS Cost Category

Variability in Patient Populations

One of the biggest challenges is the variability in patient populations. Different patients have unique needs and complexities, making it difficult to apply a one-size-fits-all approach to cost management.

Data Collection and Reporting Issues

Collecting accurate data for reporting can be daunting. Many providers struggle with the administrative burden associated with data collection, which can lead to inaccuracies in reporting and ultimately impact MIPS scores.

Balancing Cost and Quality

Striking the right balance between cost savings and quality care is essential. Providers must ensure that cost-cutting measures do not compromise the quality of care provided to patients.

Future Trends in MIPS Cost Management

Advancements in Technology

Technology will continue to play a significant role in MIPS cost management. Innovations such as telehealth and data analytics tools can enhance care delivery and improve efficiency, leading to better cost management.

Policy Changes and Their Impact

Healthcare policies are constantly evolving. Staying informed about changes in legislation and CMS guidelines can help providers adapt their strategies to maintain compliance and optimize their MIPS performance.

The Shift Towards Value-Based Care

As the healthcare landscape shifts towards value-based care, understanding cost management will become even more critical. Providers must be prepared to adapt their practices to thrive in this new environment.

Read More: What Quality Measures Can Physicians Report for MIPS 2020 Reporting Services?

Conclusion

In summary, understanding the MIPS Cost Category and its implications is essential for physicians aiming to succeed in the evolving healthcare landscape. By embracing managed care strategies, leveraging technology, and focusing on patient engagement, providers can enhance their cost management efforts and ultimately improve their MIPS scores.

Let’s take these insights and implement them into our practices for better patient care and financial sustainability.

FAQs

What is the purpose of the MIPS cost category?

The MIPS cost category aims to evaluate how efficiently healthcare providers manage resources while delivering care to Medicare beneficiaries. It impacts reimbursement rates and reflects overall practice performance.

How can physicians improve their cost category scores?

Physicians can improve their scores by engaging patients, coordinating care with other providers, analyzing data for trends, and implementing cost-saving strategies without compromising quality.

What role does managed care play in MIPS?

Managed care helps control healthcare costs while improving quality by coordinating care, promoting preventive measures, and reducing unnecessary services.

Are there penalties for low cost category scores?

Yes, providers with low cost category scores may face penalties in the form of reduced Medicare reimbursements.

How can technology help in managing MIPS costs?

Technology can enhance data analytics, streamline reporting processes, and facilitate telehealth services, all of which contribute to better cost management and improved care delivery.

New Drug Prescription Cost Rule Allows Negotiation Patient Outcomes MIPS Reporting

How the New Drug Prescription Rule Facilitates Physicians?

As the new proposed rules will come into action, drug manufacturers will have more say in the payment arrangements. In addition, the patients' outcomes will make clinicians accountable for their services, and they can invest in opportunities to earn more revenue, particularly via MIPs Reporting.

Right now, the payment arrangements are made on the quantity of the product rather than the quality of the product. 

In such circumstances, it is impossible to move towards innovation; consequently, medical billing companies can't drive value to the claims nor can payers promote access to innovative therapies or drugs due to cost prohibitions.

CMS promised to address rising healthcare expenses, administrative burden, and the lack of quality systems, and they are gradually settling every concern that is restricting progression. In the same context, recently, we heard the great news, especially for medical billing and QPP MIPS reporting.

CMS has decided to base prescription drug payments on the patients’ outcomes. They proposed a rule on June 17 to counter rising drug prescription prices.

The healthcare landscape is constantly evolving, and a recent development in drug pricing is the new prescription cost rule that permits negotiation, even within the framework of MIPS (Merit-based Incentive Payment System) reporting. This rule aims to provide some relief from skyrocketing drug prices while keeping patient outcomes front and center. But what exactly does this new rule entail, and why does it matter for both healthcare providers and patients?

In a time when controlling healthcare costs is more critical than ever, this rule opens up new pathways to reduce the burden of prescription drugs on patients, without compromising on the quality of care they receive.

What is MIPS Reporting?

MIPS, or the Merit-based Incentive Payment System, is a program that determines Medicare payment adjustments based on the performance of healthcare providers. It factors in several categories, including the quality of care, improvement activities, and cost efficiency, all of which directly impact the provider’s reimbursement rates. General Surgery Billing Services

Essentially, MIPS serves as a way to reward healthcare providers who deliver high-quality, cost-efficient care. The inclusion of prescription drug costs in MIPS reporting emphasizes how essential it is to balance patient care with financial responsibility.

The Role of Drug Prescription Costs in MIPS

Prescription drug costs have long been a significant concern for both healthcare providers and patients. Under MIPS, drug costs contribute to the cost-efficiency metric, meaning that providers who can control these costs without sacrificing care quality may benefit from better performance scores.

As drug prices continue to rise, this has posed a challenge for providers, who are often caught between prescribing the best treatment and keeping costs down. With the new rule allowing negotiation, there's a new tool in the toolbox to help control these expenses.

Why Prescription Costs Matter in Patient Outcomes

The link between drug costs and patient outcomes is undeniable. High prescription costs can lead to treatment delays or even non-compliance, as patients may be unable to afford the necessary medication. This, in turn, leads to poorer health outcomes, increased hospitalizations, and, ultimately, higher costs for the healthcare system as a whole.

For example, a patient with diabetes who cannot afford their insulin may skip doses, leading to uncontrolled blood sugar levels and severe complications like neuropathy or kidney damage. The new rule aims to reduce such scenarios by making essential medications more affordable through negotiation.

The Shift Towards Negotiation in Drug Pricing

One of the key aspects of the new rule is the ability for healthcare providers and payers to negotiate drug prices directly with pharmaceutical companies. This shift is significant, as it moves away from the previous system where drug prices were largely dictated by manufacturers.

By allowing negotiation, the rule aims to strike a balance between ensuring pharmaceutical companies can continue innovating and reducing the financial strain on patients and the healthcare system.

Key Stakeholders in the Negotiation Process

The negotiation process involves several key stakeholders, including the government, healthcare providers, insurers, and pharmaceutical companies. Each has a vested interest in the outcome, with the government and insurers seeking to reduce healthcare costs, providers aiming to offer the best possible care, and pharmaceutical companies protecting their profit margins.

While these interests may sometimes conflict, the negotiation process is designed to find common ground that benefits patients most of all.

Benefits of Negotiating Drug Prices

Negotiating drug prices can offer a wide range of benefits. For patients, it means more affordable medications, fewer treatment delays, and better overall health outcomes. For providers, it allows them to prescribe the most effective treatments without worrying about cost constraints affecting their MIPS scores.

In the long term, widespread negotiation of drug prices could lead to a more sustainable healthcare system where costs are better controlled without sacrificing innovation or patient care.

How Negotiation Impacts Patient Outcomes

When patients have access to affordable medications, their chances of adhering to prescribed treatments improve significantly. This can lead to better management of chronic conditions, fewer complications, and overall healthier populations.

For instance, a patient with high blood pressure may be able to consistently afford their medication if prices are lowered through negotiation, reducing their risk of heart attack or stroke.

Challenges and Concerns with the New Rule

Despite the benefits, there are also challenges to implementing this new rule. One of the primary concerns is how pharmaceutical companies will respond. Many may resist price negotiations, citing the high costs of research and development for new drugs.

Additionally, the administrative burden of managing these negotiations could be significant for healthcare providers and insurers.

Addressing Pharmaceutical Company Concerns

Pharmaceutical companies argue that their pricing reflects the extensive research, testing, and regulatory approval processes required to bring new drugs to market. However, the new rule seeks to balance this reality with the need to make essential medications more accessible.

Potential compromises could include tiered pricing models based on the volume of drugs purchased or performance-based pricing, where the cost of a drug is tied to its effectiveness in real-world settings.

The Future of MIPS Reporting with the New Rule

The new rule is likely to bring about significant changes to MIPS reporting. Providers will need to carefully monitor both the costs of the drugs they prescribe and the outcomes for their patients. Over time, this could lead to more efficient, outcome-focused healthcare delivery.

Monitoring Patient Outcomes Post-Implementation

To ensure the success of the rule, healthcare providers and payers will need to closely track patient outcomes following its implementation. This will involve utilizing tools like electronic health records (EHRs) to monitor medication adherence, treatment success, and overall patient health trends. Neurology Billing Services

The Broader Impact on Healthcare Policy

If the new rule proves successful, it could pave the way for broader healthcare reforms. For example, other aspects of care, such as medical devices or hospital services, could also be subject to negotiation in the future.

The Role of Healthcare Providers in Implementation

Healthcare providers will play a crucial role in the success of the new rule. They must ensure they are fully informed about the available drug pricing options and work closely with patients to help them access affordable medications. This could involve educating patients on generic alternatives or working with insurers to find cost-effective solutions.

Preparing for the New MIPS Reporting Guidelines

To prepare for the new MIPS reporting guidelines, healthcare providers should start reviewing their current drug prescribing practices and the associated costs. By proactively addressing these issues, providers can optimize their MIPS scores while ensuring the best possible patient outcomes.

Read More: MIPS Reporting IA Requirements That Every Eligible Clinician Must Know Patients

Conclusion

The new drug prescription cost rule represents a significant shift in how drug prices are managed within the MIPS framework. By allowing negotiation, it offers a powerful tool to control healthcare costs while prioritizing patient outcomes. However, successful implementation will require collaboration among all stakeholders, including healthcare providers, insurers,

What Statistics Say About Drug Prescription Spending?

Statistics reflect that the average growth spending of 5.7 percent on national health is expected between 2020 to 2027. However, the new rule will help establish a system with lesser regulations on Value-Based Purchasing (VBP). 

How CMS defines VBP?

The proposed rule will allow commercial payers to negotiate with manufacturers under new rules. However, the deal is that Medicaid beneficiaries always get the best price. The new rule will also ensure to pay the price that aligns with both objectives:

• New types of payment models

• Situations under which prices are negotiated

This value-based purchasing rule intends to accommodate new changes in the healthcare industry while giving details to stakeholders.

In actual terms, CMS defines it as and I quote:

“An arrangement or agreement intended to align pricing and/or payments to an observed or expected therapeutic or clinical value in a population (that is, outcomes relative to costs) and includes (but is not limited to):

• Evidence-based measures: linking drug expense of a drug to the effectiveness of the product, and/or
• Outcomes-based measures: linking expense of a drug to the product's actual performance in a patient or a population as compared to the other medical expenses.”

It will offer flexibility to medical billing services, Medicaid, insurance companies, and drug manufacturers.

Current Drug Regulation Rules Lack Flexibility

Seema Verma, the CMS administrator, states that the rules for Medicaid receiving the competitive price for drug prescription have not been updated in nearly thirty years. 

With no new rules to accommodate the changing environment, healthcare leaders lack the opportunity to design new payment models for physicians.

The Effect on Healthcare Industry

The new proposed rule is, however, like a breath of fresh air that will support all private and governmental healthcare stakeholders based on clinical outcomes. Providers can prescribe new medicines for better results, enhancing their QPP MIPS reporting performance.

The connection between the payment and the quality of drugs will eventually create paths for innovative medical treatments, and the effectiveness of medication and therapies is likely to increase - An effective way to promote MIPS quality measures.

The Effect on Opioid Crisis 

The high consumption of opioids has led to a crisis in the country. The acting secretary of Health and Human Services (HHS) says that around seventy percent of drug overdoses are related to opioids. Thus, the misuse of this drug has been alarming.

CMS counters this situation via the proposed rule, as there would be a safe passage for drug prescription, which will eventually reduce misuse or abuse of opioids.

The Future of Drug Prescription

Luckily, CMS has settled concerns that were raised by medical billing services. Moreover, the proposed drug prescription rule caters to everyone for easy access to quality healthcare, promoting QPP MIPS while reducing expenses.

We hope that this rule when implemented properly fixes many payment-related issues and reimburse physicians via value-driven methods.