Healthmonix Advisor

The QPP Year 3 Change That May Hugely Impact RCM Companies

Posted by Phillip Spence on February 9, 2019
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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.

What does this mean for RCMs?

Clients who have in the past reported via claims, who might have worked with billing or RCM companies to do claims coding for MIPS, may now need to consider alternative submission options if they are a large practice (ie a practice with 16 or more providers). This means that RCMs need to be ready to answer the question that will soon become pressing for many of their clients: “what are you going to do that will help my group navigate through this?”

And what answer will you give them? Sure, RCMs can direct their clients to individual reporting, or to reporting through their EHR… but group reporting can be a strategic advantage for many organizations, and EHR reporting can create a situation where your RCM is unable to provide value.

There is another option worth consideration, though, which can allow you to support your large practices by offering to provide them with a group reporting option. If you can provide a group reporting option, you’ll not only find it easier to retain the clients you already have, but you’ll also give your team a competitive edge that will make you that much more attractive to new clients looking for alternative solutions.


Consider partnering with a registry.

In addition to offering group reporting options, registries can allow providers to monitor their scores, create a clear route for submission, and provide a wider range of measures to report. Further, by partnering with a registry solution like MIPSPRO, billing and RCM companies can also eliminate the need to add codes manually to claims in order to calculate performance, which can save your team valuable time.

Healthmonix has provided streamlined reporting options as a CMS Qualified Registry since 2009. From solo providers to large Health Systems, we provide unmatched support and adaptable reporting plans to match your goals. In 2017, we successfully submitted data from 24,000,000 patient visits and 233 different EHRs, leading to a 98.6% Customer Satisfaction Rating for our MIPSPRO Registry.

If you have questions about partnership options, schedule time with me here or reach out directly via email ( or by phone (888-720-4100 x21).


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Topics: PRO Tips, MACRA & MIPS, Policy, RCM