Healthmonix Advisor

Streamlining MIPS Reporting When Using Data from Multiple Sources

Posted by Christina Zink on May 10, 2019

Health systems face a unique challenge when navigating the CMS Quality Payment Program (QPP). All currently available options to comply with the QPP require the submission of some form of clinical quality measures. With multiple specialties and often multiple sources for tracking billing and clinical data, aggregating all available data in a coherent, efficient, and centralized way can seem nearly impossible for the average health system. This case study demonstrates how MIPSPRO assisted one of their health system clients by streamlining their quality reporting process.

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Topics: PRO Tips, MACRA & MIPS, Interoperability, Healthmonix, Health IT, Hospitals & Health Systems

3 Points To Consider As You Plan Your 2019 MIPS Reporting Strategy

Posted by Christina Zink on April 17, 2019

The 2018 MIPS reporting year is finally behind us, and you know what that means: time to plan for 2019!

Although this may seem like the last thing you want to think about in the days following the 2018 deadline, MIPS can be very rewarding for those who optimize their scores—and devastating for those on the other end of the spectrum. 2019 is no longer considered a transition year, unlike the first two years of MACRA, which means that the program is doing away with much of the leniency that made reporting easier in the past. The financial risk is now as high as 7%, while the performance threshold has increased to 30 points. In other words, there will be winners and losers, and if you want to stay ahead of the curve it’s imperative to strategize as soon as possible.

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Topics: PRO Tips, MACRA & MIPS

MIPS Participation Reaches 95%; Other Insights from Year One of the QPP

Posted by Christina Zink on March 22, 2019

CMS recently released the 2017 Quality Payment Program Experience Report, which provides an overview of the clinician reporting experience during the first year of the QPP with the intent of helping clinicians, stakeholders, researchers, and others to better understand the program. The report discusses both MIPS and Advanced APMs during the 2017 performance year, breaking the data down into the following four categories:

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Topics: MACRA & MIPS, Industry insights

MIPS Hacking: Report as a Group to Maximize ROI

Posted by Mike Lewis on March 14, 2019

I speak with many organizations who are planning to report MIPS individually, only for their eligible providers. What they fail to realize is that they can achieve significant additional revenue by reporting as a group for all providers in their practices, even those that are deemed ineligible. In these cases I like to do a simple cost comparison to show what organizations are missing out on, and while each case is unique, the results are often striking.

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Topics: PRO Tips, MACRA & MIPS, ROI

How To Get Free Help With MIPS And The QPP

Posted by Christina Zink on February 28, 2019

Did you know that CMS has a variety of free resources and organizations dedicated to helping clinicians navigate the Quality Payment Program? In today’s blog, we’ll help you understand your options so that when you have a question, you’ll know where to turn. (This is a good one to bookmark for later!)

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Topics: PRO Tips, MACRA & MIPS

MIPS Final Score Calculation in 2019: What You Need To Know

Posted by Christina Zink on February 20, 2019

The CY 2019 Medicare Physician Fee Schedule Final Rule involves a slew of regulatory changes that will apply to the 2019 performance year. Of course, wading through the final rule to find and understand the most important features of the policy can be grueling; but you’re in luck, because we’ve already done it so you don’t have to! In today’s blog, we’re focusing on how MIPS final scores will be calculated, as well as factors that may lead to reweighting, in 2019.

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Topics: MACRA & MIPS, Policy

The QPP Year 3 Change That May Hugely Impact RCM Companies

Posted by Phillip Spence on February 9, 2019

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.

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

Have You Heard Of Patient Relationship Codes? They May Soon Impact Your Bottom Line.

Posted by Lauren Patrick on January 18, 2019

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.

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Topics: MACRA & MIPS, Policy, Cost Performance Category

Disillusioned About MIPS Incentives? Here’s Why You Shouldn’t Be.

Posted by Christina Zink on January 11, 2019

If your organization invested significant money and time into achieving a high MIPS score in 2017, the final incentive payment you received may have felt… well, disappointing. As easy as it may be to recognize the ideological importance of shifting from fee-for-service to value-based care, many clinicians and organizations feel unable to practically justify such an investment in the absence of a meaningful financial incentive.

But there’s good news: incentives will continue to rise in coming years, and those achieving the highest scores will soon find their efforts rewarded on a much larger scale. Here’s why.

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

Everything You Need To Know About MIPS Facility-Based Quality and Cost Performance Categories

Posted by Lauren Patrick on January 4, 2019

As laid out in the 2019 MACRA final rule*, one of the ways CMS hopes to expand participation options in the program’s third year is by offering certain facility-based clinicians, if they participate as a group, the option to use facility-based Quality and Cost performance measures. CMS expects to release a facility-based scoring preview for this option, which does not require any data submission, in Q1 of 2019. In today’s blog, we’ll take an in-depth look at the details of facility-based scoring and how it will be applied.

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Topics: MACRA & MIPS, Policy, Quality Performance Category, Cost Performance Category