Healthmonix Advisor

The last 90 days of the year. Many might be ready to say goodbye to 2020 as a year filled with challenges, adjustments and ever-shifting expectations in our personal and professional lives. For those clinicians who are eligible for participation in the Merit-Based Incentive Payment System (MIPS), the last 90 days of the year also represents the beginning of some measurement periods and the final opportunity to improve in others.

Since the latest Physician Fee Schedule and Quality Payment Program final rule was released in November 2018, organizations across the country have scrambled to understand key changes that have been made and adapt to their implications. In today’s blog, I want to focus on one change that may well prove significant to billing and Revenue Cycle Management teams: groups of 16 or more can no longer report via claims.

According to the proposed rule for 2019, use of 2015 Certified EHR Technology (CEHRT) will be required in the 2019 performance year. Many EHRs have already become 2015 CEHRT or plan to do so before next year, but not all have.

If you are a clinician trying to stay compliant and meet MIPS reporting requirements, there are a few things you should keep in mind to make sure that this new change won’t negatively affect you.

I speak with a lot of different types of practices and healthcare organizations on a weekly basis, and so I get to learn about a lot of different challenges that organizations face in the shift towards value-based care and the adoption and implementation of Certified EHR Technology. Both are critical to maintaining a high level of quality of care and maximizing reimbursements from Medicare.

Clients may consider options outside of their EHR to report MIPS for a number of reasons. They may want to combine Quality data from multiple EHRs, or report on measures only supported by registries. They may need to report for a practice that is transitioning to a new EHR.

Healthmonix has worked with clients using over 200 different EHRs to successfully report for MIPS through MIPSPRO, and in that time we’ve identified a few steps that EHRs can take right now to help keep their clients satisfied and stress-free when it comes to external MIPS reporting.

For many practices, one of the biggest differences between MIPS reporting for 2017 and 2018 is the amount of information that needs to be reported to achieve a high score. Gone is the test option that allowed clinicians to simply report on 90 days worth of patient visit information for the Quality performance category—now clinicians need to report on 60% of eligible patient visits per measure for all payers. This is typically a phrase I repeat a few times when discussing MIPS with practices who reported minimally for 2017.

In an environment of ever-increasing demands for information, healthcare providers must ask more, document more and learn more about their patients. With more information comes more insight; this is evident as some of the hottest topics for healthcare IT include Big Data, Artificial Intelligence and patient data analytics. But to get to the point where patient data can successfully be used to identify care gaps and provide predictive insights, the information must be documented correctly.

Congrats everyone, we survived the first year of MIPS! Whether 2017 represented the first time your practice participated in value-based care initiatives—or an opportunity for your organization to continue performing at a high level in CMS programs—the Merit-Based Incentive Payment System was new for everyone. As we transition to the second year of MIPS, one of the key changes your practice will need to address is the amount of information necessary to achieve reporting success.