Healthmonix Advisor

This Could Be Your First Year to Receive a MIPS Penalty. Here's Why.

Posted by Lauren Patrick on November 18, 2021

With the release of the 2020 feedback report detailing the 2.2% maximum possible payment adjustment and the release of the 2022 Final Rule, CMS has demonstrated that MIPS will be both financially rewarding and challenging, in terms of reporting requirements, in 2021 and beyond.

   

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Topics: Quality Performance Category, IA Performance Category, Cost Performance Category, PI Performance Category, 2022 PFS Final Rule

Key Takeaways from the NAACOS 2021 Fall Conference

Posted by Lauren Patrick on October 15, 2021

The NAACOS Fall 2021 Conference was the first live meeting that the Healthmonix team attended since HIMSS 2020 was cancelled in March of that year. It was certainly reinvigorating to meet in person, discuss the state of payment models, and hear from CMS regarding their vision.

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Topics: CMS, ACO, Industry insights, 2021 PFS Proposed Rule

New Challenges Brought on by Changes to MIPS Threshold & Performance Categories

Posted by Lauren Patrick on September 24, 2021

With the release of the 2020 feedback report detailing the 2.2% maximum possible payment adjustment and the release of the 2022 Proposed Rule, MIPS participants find themselves wrestling with lingering disappointment from participation in the program in previous years, and resistance to the idea that MIPS will be financially rewarding and challenging, in terms of reporting requirements, in 2021 and beyond.    

This is the second in a series of blog posts on the 2020 payment adjustment and the 2022 Proposed Rule, that will address this sense of disappointment and show how the future of MIPS will contain much more rigorous program requirements and create greater financial rewards.  To see financial and program success, you will need to be prepared to meet the new challenges.  We have the guidance you need to succeed in 2021 and beyond.    

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Topics: MACRA & MIPS, Quality Performance Category, Cost Performance Category, 2022 PFS Proposed Rule

MIPS Disappointed, But It All Changes in 2021

Posted by Lauren Patrick on August 26, 2021

With the release of the 2020 feedback report detailing the 2.2% maximum possible payment adjustment and the release of the 2022 Proposed Rule, MIPS participants find themselves wrestling with lingering disappointment from participation in the program in previous years, and resistance to the idea that MIPS will be financially rewarding and challenging, in terms of reporting requirements, in 2021 and beyond.   

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Topics: MACRA & MIPS, COVID-19, 2022 PFS Proposed Rule

Registry Impact on Shared Savings in the APM Performance Pathway (APP)

Posted by Lauren Patrick on May 14, 2021

For ACOs participating in the Medicare Shared Savings Program (MSSP), CMS is implementing rules in 2021 and 2022 for quality reporting which include a sweeping change. This change will require a new reporting approach, in order to aggregate data from electronic health record systems used across an ACO for all patients seen by any provider, regardless of payer or participation in the ACO. In a recent survey, nearly 75% of the ACO respondents indicated concern with the challenge of these requirements. The Web Interface reporting is being sunset, and ACOs need to devote attention to determining their strategy for transitioning quality reporting. Success will require thoughtful planning and experienced system implementation.

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Topics: ACO, APM Performance Pathway, Medicare Shared Savings Program

MIPS - How Many Options Do I Have?

Posted by Lauren Patrick on March 10, 2021

As we move into 2021 and beyond, we see CMS putting some real teeth into the Merit-based Incentive Payment System (MIPS) program.  This is the first year where we see more than two percent incentives possible.  Exemptions and exclusions are narrowing.  Participants in other value-based programs are being forced into MIPS reporting because of higher thresholds for exclusion and elimination of other reporting options.

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Topics: MACRA & MIPS, MIPS Value Pathways, APM Performance Pathway

MVPs - Will they replace 'traditional' MIPS?

Posted by Lauren Patrick on January 28, 2021

There has been much talk around MVPs in the CMS quality reporting arena. MVP means MIPS Value Pathway, and it’s a reporting framework that CMS is communicating as (a) the next evolution of MIPS and (b) a transition tool for getting to other alternative payment modules. As CMS continues to define and refine their vision of the MVPs, they have started to call the current framework 'traditional MIPS' to prepare for the inclusion of the MVP option. You’ll see this when you visit the QPP site. That said, how can MVPs affect MIPS?

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Topics: MACRA & MIPS, CMS, 2021 PFS Proposed Rule, MIPS Value Pathways

MIPS 2021 Incentives and Penalties | How Can You Prepare?

Posted by Lauren Patrick on January 14, 2021

For years, we’ve heard that the Merit-based Incentive Payment System (MIPS) will provide a noticeable incentive for participants in this Medicare FFS program. And for years, there have been reasons why that has not occurred. First, CMS wanted to ‘start slow’ with the MIPS program in 2017 and 2018, so the caps on penalties and incentives were small. Then the potential penalties and incentives were raised, but the threshold for qualifying for an incentive remained low. This, coupled with the program’s budget neutrality meant there was not much revenue to distribute to high performers. Then COVID-19 negated much of the program for the last two years. So here we are, in year five, and we see that the program, for the first time, will have a significant downside and upside potential.

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Topics: MACRA & MIPS, CMS, APMs, Cost Performance Category, 2021 PFS Final Rule

The 2021 Final Rule: New Programs, Higher Standards and COVID-19

Posted by Seretha Curry on December 16, 2020

 

The long-awaited CY 2021 Medicare Physician Fee Schedule Final Rule update is now here. Despite the disruptions of the Public Health Emergency COVID-19, participation in performance year 2019 was strong. Thus the 2021 Final Rule moved forward with finalizing a number of proposed changes, including a higher performance threshold for performance year 2021, anticipated changes in weight to the Quality and Cost performance categories of the Merit-based Incentive Payment System (MIPS), and the introduction of the APM Performance Pathway. Other expected initiatives, such as MIPS Value Pathways, the requirement for registries to build their own benchmarks for certain measures, and the sunsetting of the CMS Web Interface, have been pushed back to at least the 2022 performance year.

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Topics: MACRA & MIPS, APMs, COVID-19, 2021 PFS Proposed Rule, APM Performance Pathway

Maximizing ROI on Primary Care First Participation

Posted by Mike Lewis on December 10, 2020

Starting in January, 920 primary care practices will embark on the one of the newest payment models from the Centers for Medicare & Medicaid Services (CMS) via the Primary Care First (PCF) Program.  The main criteria for participation in the program are:

  • 70% or more of the practice’s collective billing must be for primary care services.
  • Use of a 2015 Certified Electronic Health Record Technology (CEHRT) by the practice.
  • At least 125 services provided for attributed Medicare beneficiaries.

Also, for the first year of the program, there is a limited geographical area for participation.

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Topics: APMs, Primary Care First, 2021 PFS Final Rule