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.