Healthmonix Advisor

Over the last month, there’s been a lot of discussion around the 2020 Medicare Final Rule updates for the QPP and MIPS here at Healthmonix and with our partners and clients. While the last three years of the program were about getting healthcare providers up-to-speed with the program, now the focus is on challenging providers to adhere to tougher rules.  High performers will reap significant rewards, others will see increasing downside.

(Malvern, Pennsylvania) - Healthmonix, the country’s largest provider of quality and MIPS reporting and healthcare data analytics, has announced a national distribution partnership with ChartSpan, the market-leading vendor in chronic care management (CCM) services.

When I was in graduate school, I was the only woman in the department of Computer and Electrical Engineering. At my first job, at an engineering company, out of perhaps 300 engineers, there were 3 women. We became close and were recruited to the company volleyball team because it needed to be co-ed in order to compete in the league. I can go on about the myriad of times I was the only woman in a meeting, group, or department.

The 2020 final rule dropped yesterday and at first glance, there are some interesting highlights.  

It felt as if the Medical Group Management Association (MGMA) Annual Conference, which we have attended for years, was smaller this year. The hall was down 10 percent, and the foot traffic was slower. Regardless, we left with plenty of insights into the state of the industry. Here are some of the highlights of what we learned:

For many years now, Healthmonix has supported clients who engage with the Merit-based Incentive Payment System (MIPS) on a variety of levels, in terms of the maturity of their process. At the lowest level—let’s call it Level 0—we have clients that come to us because they just want to report and avoid a penalty. Just beyond that, at Level 1, are those clients that seek an incentive.

Now, as we continue to settle into the brave new world of value based payments, we have noticed that our clients at Level 1 are starting to get comfortable. Clearly they are investing time and effort into the process, but with incentives still relatively small, MIPS can unfortunately seem more like an annoyance than an opportunity, and it can be hard to see beyond the immediate requirements.

But we’re thinking bigger, and we want you to do the same.

In last week’s blog, Point: The Promise of Blockchain, we discussed some of the exciting features of blockchain technology as it begins to take hold of the healthcare IT field. This week, we’re looking at the other side of the coin by outlining some of the pitfalls related to this technology.

Blockchain. It’s one of the biggest buzzwords in the Health IT industry today⁠—and no wonder, because it seems to be an extremely promising technology, one that we've been keeping our eyes on for a few years now. Still, as cool as it seems, we have a long way to go. That’s why in this pair of blogs, we’re going to look closely first at the possibilities, and then at the hazards, that go hand in hand with this exciting trend.

A recent perspective article in the New England Journal of Medicine begins with a bold claim: that patient relationship categories and billing-code modifiers, which clinicians have been able to voluntarily submit since January 1, 2018, “may be one of the least known but most important provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).” In today’s blog we’ll explore how patient relationship codes may, as the article predicts, end up impacting reimbursement.