Healthmonix Advisor

CMS reports that for 2017, just over 90% of eligible clinicians participated in the Quality Payment Program (QPP). That number is impressive, but what about the nearly 10% who declined to participate? Many adopted a “wait-and-see” approach, or were concerned that the required investment of time, money, and effort wasn’t worth the reward. But the QPP is here to stay, and some physicians may only now be wondering where to start, or even whether they can succeed at all after avoiding it for so long.

If you find yourself among that number, don’t worry, because it’s not too late! This week we’re laying out the first things you should know, and the first steps to take.

Note: This article will update as we learn more, and to reflect any changes that may happen before the rule is officially published to the Federal Register on November 23, 2018. To view the entirety of the final rule, view the unpublished pdf version.

There’s no doubt that MIPS involves a learning curve. The program’s rules can be complex and can require cumbersome initial investments of time and money, leading many doctors to try to avoid it altogether. But MIPS matters, and the most successful doctors in coming years will be those who invested wholeheartedly in the reporting process. Here’s why.

In a recent update on 2017 MIPS Performance Feedback, CMS announced that they have identified errors in their scoring logic. CMS wrote that their targeted review process “worked exactly as intended, as the incoming requests quickly alerted us to these issues and allowed us to take immediate action.”

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.

You have been dealing with the bureaucracy behind quality reporting for years - silly questions with no relevance to your field or specialty, EMRs changing the way measures are recorded, CMS changing requirements during the reporting period. It’s hard enough to get your fingers around the changes as a manager or provider, but imagine the confusion on your staff’s side! Plus, they don’t have the incentive of financial responsibility or a reputation to uphold.

So, how do we get their buy-in?

The new proposed rule for 2019 features a lot of changes to the Quality Payment Program, but CMS has also announced changes impacting Medicare reimbursement in general. One big change proposed would affect how much money a clinician receives for billing office or outpatient Evaluation and Management (E&M) visits for new and existing patients.

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.

The Centers for Medicare & Medicaid Services (CMS) released the 2019 Proposed Rule for the Medicare Physician Fee Schedule on July 12, 2018. The release of the 2019 proposed rule is advantageous in deciding what to conquer under the Quality Payment Program for both this year and in the future, which is why we published a series of posts summarizing the major proposed changes you should be aware of. But what if you have a suggestion that would improve the rule?

It’s that time of year again: CMS has released final QPP performance feedback for 2017, including final scores and payment adjustment information. Here at Healthmonix, we believe in turning data into outcomes, taking control of performance, and driving revenue through value-based payments—which is why, now that you have access to your feedback, we’re outlining a few important next steps your practice can take to use that feedback in a meaningful way.