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.

The Centers for Medicare & Medicaid (CMS) is working rapidly to update policies and allow healthcare providers to flexibly apply best practices in response to the COVID-19 pandemic.  Programs such as Hospitals without Walls and the existing Patients over Paperwork have been deployed.  Removal of barriers have resulted in exponential growth of telehealth and remote patient monitoring.   Advanced payments to healthcare providers are being provided to counter the effects of changing patterns of healthcare use,  reduction in elective procedure, increase in ICU utilization and other ongoing unanticipated changes.

In our last blog we gave an overview of the MIPS Quality Performance Category and discussed its reporting requirements. This week, we'll look more in-depth at how this category will be scored for the 2019 performance year.

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 the MIPS Quality Performance category.

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.

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.

Apply to help CMS in its new study, running from April 2018 through March 2019, and make your voice heard.

CMS is looking for groups and individuals that are eligilbe for MIPS to help study the burden that the MIPS program, particularly the Quality component, place on eligible clinicians. In return, successful participants will receive full credit for the Improvement Activity component of MIPS this year (2018).

In year two of MIPS and beyond, CMS is including an Improvement score for Quality and Cost measures. This week we take a deep dive into what this score entails, as well as what you need to know to keep yours ahead of the curve.

With the first performance year of the Merit-based Incentive Payment System (MIPS) drawing to a close, you may have just started getting accustomed to how MIPS reporting works. Although the 2018 MACRA final rule introduced changes to how MIPS performance data should be captured for the upcoming performance year, it may be a relief to hear that largely the changes just build upon the existing 2017 regulations.

Over the last two weeks, we've shown you how to select quality measures. Now that you've decided which measures to collect data for, it's time to start reporting! If you have reported PQRS in the past, the process will be similar with a few major changes. Eligible clinicians who are new to reporting may want to first check out our article on the basics of quality measures prior to understanding how to completely report a quality measure.