QPP MIPS Reporting 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 autho...

  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. Medicare Spending per Beneficiary (MSPB) Total per Capita Cost Eight ep...