The Centers for Medicare and Medicaid Services (CMS) have initiated the development of a Universal Foundation of quality measures to improve healthcare quality and transform care.

CMS operates more than 20 quality programs, each with its own set of quality measures. The lack of alignment across these programs has contributed to challenges for clinicians, facilities, and health insurers in prioritizing meaningful outcomes for patients.

By identifying CMS's priority areas for measurement and revealing gaps, the Universal Foundation will evolve over time, with the intent of reducing provider burden and improving patient outcomes.

MIPS, the Merit-Based Incentive Payment System, is evolving. CMS has laid out a plan to increase quality of care while controlling costs, and all Medicare providers are expected to participate in eligible alternative payment models by 2030.  

In this blog post, we'll discuss the changes for 2023 and how small practices can maximize their scores and reimbursement.

Back in January of 2021 our CEO, Lauren Patrick, wrote "MVPs – Will they replace ‘traditional’ MIPS?"  At that time there were a lot of questions about how CMS would implement their new reporting framework, MIPS Value Pathways (MVPs).  Starting with the 2023 Program Year (PY), MIPS eligible providers have two pathways they can take to satisfy their obligations.  In this blog, I will review what an MVP looks like and how you may want to implement them within your practice. 

The 2023 Physician Fee Schedule (PFS) Final Rule was released in November 2022, finalizing many of the promised features of accountable care organizations (ACO) quality reporting.  A couple weeks ago, I wrote about the Quality reporting requirements and Healthmonix's strategies to approach the upcoming changes. For Part 2 of this discussion, I will be introducing the new Health Equity Adjustment and why it will impact quality reporting moving forward. 

Part 3 will cover the move from all or nothing scoring to a scaled approach. 

Once again, if you are a visual learner, you can get most of this information from  our latest webinar. 

If you are a dermatology practice, you probably breathed a sigh of relief when the Centers for Medicare & Medicaid Services (CMS) announced that dermatologists, along with many other specialists, would no longer be attributed patients for the Total per Capita Cost (TPCC) measure, as part of the Cost component of the Merit-based Incentive Payment System (MIPS).  However, in 2022, CMS introduced a Melanoma Resection Cost measure that is attributed to those specialists that perform these resections. So the Cost category is back for many dermatologists.  Even if this is the only Cost measure that is attributed to your practice, it is worth 30 of your total 100 MIPS points - as much as all your Quality measures combined!

With the release of the 2023 PFS Final Rule, the Centers for Medicare & Medicaid Services (CMS) finalized most of the proposed changes for the QPP / Merit-based Incentive Payment System (MIPS) program that had been released in the Proposed Rule last July.  

We are seeing that while the payment threshold is holding at 75 points, it can be tougher to achieve that threshold score with the changes in the program for 2023.

The 2023 Physician Fee Schedule (PFS) Final Rule was released on November 6, 2023 and included over 3,000 pages of the Centers for Medicare & Medicaid Services (CMS) regulations and rulings for the 2023 year. While there is a ton of information to cover the entire rule, I would like to share what you need to know about the impact on the Medicare Shared Saving Program (MSSP) for Accountable Care Organizations (ACOs). In the first of this three-part series, I will cover Quality Reporting Requirements and Strategy. Subsequent blogs will cover Introduction to the Health Equity Adjustment and The Move from All or Nothing Scoring to a Scaled Approach .

If you are a visual learner, you can get most of this information from our latest webinar.

As we prepare for the final months of 2022, are you prepared to be successful in the Promoting Interoperability (PI) performance category for the 2022 reporting year? Merit-based Incentive payment System (MIPS) experts know that PI data must be reported for any consecutive 90-day period throughout the year. October 3rd begins the last 90 days of the calendar year, and Healthmonix wants to make sure you are positioned for success. This blog will give an overview of the performance category and offer some helpful tips about how to proceed.  

Electronic health record (EHR) companies have their single biggest technical update to complete by September 2023, as announced in a recent a meeting with the Deputy National Coordinator of Health Information Technology.  All EHR enhancements that are required to comply with the 2015 Cures Act standards must be completed by September 2023.   All data that is shared must be normalized by that time and EHR technology vendors are required to certify with real world testing.  

If you are managing a Medicare Shared Savings Program accountable care organization (MSSP ACO), you have heard the mandate from the Centers for Medicare & Medicaid Services (CMS) to move to eCQM/CQM reporting, replacing the Web Interface reporting.  You may also be aware of the significant pushback that ACOs, collectively and independently, have provided to CMS.  At this year’s fall National Association of ACOs (NAACOS) conference, the tenor changed to accepting the move, optional in 2022 through 2024, but required in 2025.