2017 MIPS Feedback Reports are Available – Have You Reviewed Yours?

Courtney Willingham 9/10/2018 11:42:39 AM

If your practice has not checked your 2017 Merit-based Incentive Payment System (MIPS) Feedback Report, it is suggested you do so as soon as possible. According to recent reports from the Medical Group Management Association (MGMA), there are issues related to “groups” being improperly assessed as “individual” reporters, despite being acknowledged by the Centers for Medicare and Medicaid Services (CMS) as group reporting at the TIN (Taxpayer Identification Number) level in preliminary feedback. Feedback Reports have replaced the Quality and Resource Use Report (QRUR).

Just Reporting MIPS is No Longer “Good Enough”

Courtney Willingham 9/4/2018 10:53:06 AM

The Centers for Medicare & Medicaid Services (CMS) recently reported that 91 percent of eligible clinicians participated in the first year of MIPS reporting, up from their goal of 90 percent1. What does that mean? That nine percent of the total of clinicians who were eligible to report did nothing–not even the minimal 90-day of data reporting.

MIPS 2019: Commenting on the Proposed Rule

Courtney Willingham 9/4/2018 10:43:56 AM

The Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS) released the Proposed Rule for 2019 and practices are encouraged to comment on the changes here. Although the Proposed Rule states that all comments must be submitted by 5 p.m., Sept. 10, 2018, comments submitted electronically to www.regulations.gov will be accepted until 11:59 p.m. ET.

Overview of the 2019 Medicare Physician Fee Schedule (MPFS) Proposed Rule: Evaluation and Management Codes

Courtney Willingham 8/28/2018 3:59:21 PM

Some of the biggest changes to the MPFS Proposed Rule deal with Evaluation and Management (E/M) Codes. The last big change to E/M codes occurred in January 2010 when CMS removed consult codes from the Medicare Claims Processing Manual.

Practices should consider making comments on the MPFS Proposed Rule as it may impact your practice significantly. The proposed rule is available under the PDF link here. Comments are due by Monday, September 10 at 5:00 pm ET and can be made here.

Overview of the 2019 Medicare Physician Fee Schedule (MPFS) Proposed Rule

Courtney Willingham 8/28/2018 3:42:48 PM

Practices should consider making comments on the MPFS Proposed Rule as it may impact your practice significantly. The proposed rule is available under the PDF link here. Comments are due by Monday, September 10 at 5:00 pm ET and can be made here.                             

What Will Patients See on Physician Compare and What Practices Need to Check Immediately

Courtney Willingham 7/16/2018 2:45:12 PM

2018 will be the first year that the Centers for Medicare & Medicaid Services (CMS) is adding star ratings to the Physician Compare website. In the past, patients could go on the website to find a physician in their area dealing with their specific disease state or issue. They would see some general information about gender, education, affiliations and office locations, along with limited information about participation in CMS Quality Programs.

With this year’s website, CMS has published a small number of group measures from PQRS data submitted for 2016.

How is Your Practice Tackling Payer’s Evolving Approach to Reimbursement?

Courtney Willingham 7/13/2018 3:18:15 PM

With the new healthcare environment of bundles and episodic payments, providers need to prepare their practice for change – consider the patient’s total episode of care, including what happens after discharge; discuss the best approach to value-based care, and strengthen your revenue cycle management capabilities to manage both patient responsibility and payer denials.

2017 MIPS Performance Feedback Now Available – and Should be Reviewed

Courtney Willingham 7/13/2018 2:36:56 PM

The Centers for Medicare & Medicaid Services (CMS) has announced that eligible clinicians who participated in MIPS in 2017 can now review their final performance feedback, which includes the final score and payment adjustment information for the 2019 reimbursement year.

Understanding the QCDR

Courtney Willingham 7/5/2018 11:04:49 AM

Qualified Clinical Data Registries (QCDR) were established so that providers could create and choose quality measures that would be more aligned to their specialty. To be used for Merit-based Incentive Payment System (MIPS) reporting under the Quality Payment Program, the Centers for Medicare & Medicaid Services (CMS) must approve each QCDR quality measure not currently listed under the MIPS program.

Understanding How Data Can Affect Your Practice Reputation

Courtney Willingham 6/21/2018 3:53:10 PM

Your practice should be reviewing its CMS submission information as well as any additional performance data you collect through the year. Why is that important? It is possible you have a clinician who is not “buying into” the MIPS reporting process. Maybe they are hoping that CMS will change its mind or they think that their data won’t make a significant impact on the practice.

Top Ten MIPS Changes from 2017 to 2018: Part 2, Numbers 6 – 10

Courtney Willingham 6/21/2018 3:49:37 PM

The Quality Reporting Engagement Group recently reported on their top 10 differences in MIPS reporting from 2017 to 2018. Keep reading to learn about numbers 6 – 10.

Top Ten MIPS Changes from 2017 to 2018: Part 1, Numbers 1 – 5

Courtney Willingham 6/21/2018 3:48:09 PM

The Quality Reporting Engagement Group recently reported on their top 10 differences in MIPS (Merit-based Incentive Payment System) reporting from 2017 to 2018.  Read more to learn about numbers 1 – 5.

Two New Opportunities for Bonus Points under MIPS

Courtney Willingham 6/21/2018 3:46:30 PM

As your practice continues collecting data for the Merit-based Incentive Payment System (MIPS), you should understand that, in addition to bonus points offered under different performance categories, there are two new opportunities to earn bonus points: Complex Patients and Small Practices. The bonus points apply to the Total Composite Score for the 2018 Performance Year only.

Negotiating with Payers – How does your Practice Manage Contracts and Maximize Them?

Courtney Willingham 4/13/2018 2:04:51 PM

Negotiating with payers can have a significant impact on the financial success of your practice. Have you reviewed your contracts and taken opportunities to highlight your accomplishments in patient satisfaction and improved outcomes?

Checklist for MIPS Reporting: Helping Your Practice Organize for a Potential Audit

Courtney Willingham 3/9/2018 3:05:37 PM

With gathering the data and preparing submissions for MIPS reporting for the 2018 Quality Payment Program, practices need to document their submissions and supporting records in case of a CMS or ONC audit. The Quality Reporting Engagement Group has created a checklist to help those practices keep track of what they need for MIPS reporting.

New Budget Bill Excludes Medicare Part B Drug Cost from MIPS Payment Adjustments

Courtney Willingham 3/9/2018 2:49:02 PM

Recently, the Bipartisan Budget Act of 2018 was passed by Congress and signed by President Trump. Most importantly, the new bill significantly impacts medical practices when it comes to reporting and reimbursement under MIPS.

Practices Should Care About Reputation Management

Courtney Willingham 1/29/2018 4:55:50 PM

Reputation management is critical for physician practices. Providers should look at the ‘opportunities’ to improve their online reputation through optimizing and improving their patients’ journey, especially as patients gain more influence in provider choice.

Conducting a Security Risk Analysis

Courtney Willingham 1/17/2018 11:04:14 AM

With reimbursement reporting under CMS, formerly under Meaningful Use (MU) and now under the Merit-based Incentive Payment System (MIPS), practices are required to report on their security risk analysis or protection of patient information.

Understanding the QRUR for Your Practice

8/21/2017 4:26:02 PM

The Quality and Resource Use Report (QRUR) is a document from CMS that provides feedback about your practice’s resources used (cost) and quality of care provided by physicians and group practices to Medicare patients. The reports will provide comparative performance data that practices can use to help make adjustments in their practice processes, or course-correct, to help improve care or create more efficiencies in practice.

CMS Opens Hardship Application Process under Quality Payment Program for CEHRT

8/21/2017 4:25:16 PM

Under CMS’ Quality Payment Program, practices and their eligible clinicians are required to use certified electronic health record technology (CEHRT). That requirement will give practices a positive score under the Advancing Care Information performance category when reporting MIPS.

Specialty Measures for MIPS

8/21/2017 4:23:33 PM

Under CMS’ Quality Payment Programs, eligible clinicians are going to have to report on specific categories in order to be reimbursed for patients’ treatment under Medicare. Physicians can avoid a negative 4 percent Medicare Part B payment adjustment in 2019 by fulfilling 2017 quality reporting requirements for the Medicare Access and CHIP Reauthorization Act’s (MACRA) Merit-based Incentive Payment System (MIPS).

Taking a Deeper Dive into MIPS – Non-Patient Facing Clinicians

8/3/2017 3:53:36 PM

How do you determine a non-patient facing eligible clinician in your practice who still has to report for the Quality Payment Program under MIPS?

CMS to Issue new Medicare Beneficiary Identifiers Next Year

8/3/2017 3:51:28 PM

Beginning in April 2018, the Medicare Access and CHIP Reauthorization Act of 2015 requires CMS to remove Social Security numbers from all Medicare cards. In the next year, CMS will generate new identifiers for all Medicare patients, including those who are deceased. CMS is required to do so to address the risk of beneficiary medical identity theft.

Do Not Ignore MACRA – It’s Not Going Away

8/3/2017 3:47:32 PM

Even with all the proposed healthcare changes under the new administration, MACRA is not going away. Government agencies and payers are committed to value-based care and reimbursements.

The Shift to Value­Based Care: Practices and Pharma

8/3/2017 3:42:04 PM

As CMS and private insurers move to a value­based reimbursement system, physicians will have to prove efficacy and vale for the treatments and drugs they order. In turn, pharmaceutical companies will have to follow suit – concentrating more on the effectiveness messaging and value provided to the patient. Real world evidence, beyond the clinical trial data will become more important.

MACRA Update

8/3/2017 3:38:23 PM

In late April, CMS issued almost 1000 pages in a proposed rule for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The first performance year begins January 1, 2017, which will affect the 2019 payment year.

CMS Issues Change Request for Unused Portion of Drugs

8/3/2017 3:37:13 PM

CMS has issued a Change Request to alert providers and Medicare Administrative Contractors of a change in policy beginning January 1, 2017 (not July 2016 as previously stated) in regards to the drug amount discarded when treating a patient.

Revenue Leaks and Payer Issues

8/3/2017 3:35:11 PM

Practices need to identify and minimize their financial risk in order to stay viable. One of the biggest concerns are the issues with payers. Patients are dealing with rising costs for premiums and deductibles, and they may be paying more out­of­pocket for medications and co­pays, often with a cap or limit to their out­of­pocket costs.

Orthopedics: Bundled Payments for Joint Replacement Surgery and Associated Care

8/3/2017 3:33:55 PM

Beginning April 1, CMS is targeting nearly 70 markets in a project to combine all the costs for joint replacement surgery for knees and hips. Medicare will look for a bundled payment for the surgeries and all associated costs, hoping to save $343 million over the next five years. For the first time, the bundled payment pilot will be mandatory.

Medicare Temporarily Abandons Penalty for

8/3/2017 3:29:44 PM

Negative comments on a CMS proposed measure penalizing doctors for ordering specific antigen tests to screen for prostate cancer prompted the organization to temporarily abandon the proposal. Urologists and others, including the American Urological Association, lobbied against the proposal.

Meaningful Use Audits ­ the Process and Your Responsibility

8/3/2017 3:26:18 PM

“In the early stages of the meaningful use program, eligible providers attest that they use a certified electronic health record (EHR), have the capability to electronically exchange health information to improve the quality of care, and report on clinical quality and other measures using the certified EHRs. Upon attestation, the providers are eligible to receive an incentive payment.

Plugging Revenue Leaks in Your Practice: Patient Issues

8/3/2017 3:23:36 PM

There are numerous ways medical practices can lose revenue without noticing, sometimes until too late. Many of those leaks in the revenue can start right from the beginning – with patient information records.

Is Your Patient Information at Risk?

8/3/2017 3:09:26 PM

If you have ever watched Bruce Willis in the Die Hard movie series, you’ve seen the ‘bad guys’ hack into a national computer system and threaten to shut down the entire country in return for millions of dollars.

CMS Releases Core Quality Measurement Plans for Review

8/3/2017 3:07:01 PM

CMS and America’s Health Insurance Plans (AHIP) recently released the core set of quality measures for use in a total of seven areas, including cardiology, medical oncology, orthopedics and other specialty areas. Future releases of these measures could render applicable to urology, as well.

Clinical Data ­Positive

8/3/2017 2:39:17 PM

Over the next few years, reimbursements will be based on both value and quality initiatives. Instead of billing for the number of office visits and tests ordered, payments will be based on the value of care. Providers will have to measure compliance with clinical guidelines and achieve improved outcomes in order to secure reimbursements.

Deadline Extended for PQRS Submission and Attestation for Meaningful Use

8/3/2017 2:32:58 PM

CMS announced that they are extending the deadlines for the 2015 Physician Quality Reporting System (PQRS) Electronic Health Record (EHR) Submission AND the Attestation deadline for EHR Incentive Programs(Meaningful Use) to Friday, March 11, 2016.

Strategies for Using Benchmarks to Maximize Revenue

8/3/2017 2:31:12 PM

Practices can maximize revenue when using benchmark data if a practice can see data from other like practices (similar in size for number of practicing physicians, geographic area, etc.). The relevant data will help in making improvements to their own practice.

Meaningful Use ­ What it Means for Your Practice

8/3/2017 12:39:36 PM

In early January, CMS acting administrator Andy Slavitt announced that Meaningful Use would be replaced and the focus of the Medicare reimbursement program would be redirected to patient outcomes, catching the healthcare industry by surprise.

OIG Update for Urology

Global Administrator 10/11/2016 12:22:17 PM

The Office of the Inspector General (OIG), as the investigative and enforcement arm of the Department of Health and Human Service (HHS), released a work plan for the upcoming year.

ICD­10 Physician Survey

Global Administrator

Physicians Practice recently conducted an online poll about the transition to ICD­10.

Medicare Proposed Changes for 2016

Global Administrator 1/7/2016 12:00:00 AM

The Medicare Physician Fee Schedule final rulings were in mid­November, doing away with the Sustainable Growth Rate Formula and shifting towards value­based payments.