October 2nd has just passed, bringing the beginning of the last 90-day MIPS performance period for 2017. If plans aren’t already in place, this is the last opportunity you have to decide what to do if you are an Eligible Clinician (EC) impacted by MIPS. If there is any doubt about your participation status go here and enter your NPI number. That will let you know immediately if you need to do something in 2017 to protect your 2019 Medicare Part B reimbursement and professional reputation.
The MIPS Composite score is extremely important. There are four participation options for 2017 and at least one of them should be disregarded immediately. Option 1, doing nothing, will give you an automatic 4% Medicare Part B penalty in 2019 and a public MIPS score of 0. Option 2, test reporting, will avoid penalties in 2019 but leaves you with a MIPS score of 3. Option 4 requires submission of an entire year of data to Medicare. Probably not too many can pull that one off. That only leaves Option 3 as the only acceptable path for MIPS in 2017 for most ECs.
Option 3: CMS calls this “Partial Participation” and lays out the requirements: “If you submit 90 days of 2017 data to Medicare, you may earn a neutral or positive payment adjustment and may even earn the max adjustment.” In addition, with the right strategy (individual vs. group reporting, submission method, choice of “MIPS friendly” vs. clinical quality measures, etc.) a high MIPS score can bring numerous advantages: positive scoring on public sites when rolled out, higher reimbursements, and more.
As we have entered the beginning of the last 90-day reporting period decisions and strategies will need to be in place to assure a high MIPS score. There will not be an opportunity to back pedal or second guess. Don’t let indecision or lack of knowledge of the MACRA/MIPS program adversely affect your Medicare Part B reimbursement, practice value, and professional reputation.
Our goal is not only to avoid penalties, but deliver actionable strategic decisions that lead to the highest possible MIPS score.
Contact the Kentucky REC now for help: 859-323-3090
Source: http://www.mipsconsulting.com by Jim Tate
MIPScast™, an interactive web-app designed to accurately estimate your MIPS final score, is now available for FREE for those signed up for the Quality Payment Program Resource Center: www.qppresourcecenter.com.
MIPScast™ is designed to easily import your actual practice data to calculate your points earned, and accurately estimate your Merit-based Incentive Payment System, or MIPS, Final Score under the Centers for Medicare & Medicaid Services’ Quality Payment Program (QPP). MIPScast™ provides simple score comparisons so you can pick the quality measures, specialty set, and reporting methods that yield the highest scores across all MIPS categories, allowing you to prioritize your quality improvement efforts.
If you are a small practice (15 or fewer clinicians) that provides Medicare Part B services, you can get started using MIPScast™ for free by becoming a member of the Quality Payment Program Resource Center™. Go to www.qppresourcecenter.com and click Join Now to register or Login if you are already a member.
After you have gone through the steps of creating your practice profile and viewed the educational materials, you will complete your Readiness Assessment and then have access to MIPScast™ along with all of our other helpful tools and resources!
Contact our team of expert advisors with any questions: 859-323-3090.
We are pleased to announce that two healthcare organizations participating in our Patient-Centered Medical Home (PCMH) Cohort have received national recognition from the National Committee for Quality Assurance (NCQA), a well-respected, non-profit organization that has been a central figure in driving improvement throughout the healthcare system. PCMH designation by NCQA is an indicator that healthcare practices and clinics are providing high-quality, patient-centered care to their clients and in their communities.
Congratulations to: Danville Pediatrics – Danville, KY – Level 3 and Kentucky Mountain Health Alliance, Inc. – Hazard, KY – Level 2
“The transformation process helped us to step back and take a closer look at written policies and processes for care of patients, allowing us to focus on specific groups of patients with chronic illnesses that sometimes may fail to receive improved health outcomes. It also enhanced the access to care through open scheduling, extended hours and new options for communication with the care team. Now each patient has an ongoing relationship with a personal physician that provides first contact, continuous and comprehensive care. We improved a more developed approach to helping adolescents transition from pediatrics into the adult care setting by providing a direct patient care team. The process also allowed more efficient use of staff and practice resources, resulting in cost savings.” -Front office manager of Danville Pediatrics
These organizations have worked diligently to improve patient care in their practices and communities.
Kentucky REC provides coaching and assistance to support practices and clinics as they transform from a traditional sick care model to new models focused on comprehensive, coordinated care that keeps patients healthier and reduces complications. Care provided by clinicians in a PCMH is consistently associated with better outcomes, reduced mortality, fewer preventable hospital admissions for patients with chronic diseases, lower utilization, improved patient compliance with recommended care, and lower Medicare costs.
By receiving recognition as a PCMH, your organization will receive full points in the Improvement Activities category of the Merit-Based Incentive Payment System under the Medicare Access and CHIP Reauthorization Act (MACRA).
The Kentucky REC is enrolling practices now for new PCMH cohort to start on September 22. Contact us to find out about how this program can help you and your practice. Call us at 859-323-3090 to find out more.
It’s always nice to hear positive feedback from our clients. Here is a testimonial by one of our client practices that participated in our Patient Centered Specialty Practice (PCSP) program.
“Kentucky REC has been one of the best learning environments and innovative programs I have encountered throughout this healthcare transformation journey that effectively met the needs and improved our organization. I was impressed with how quickly they implemented suggestions from feedback to make our continued learning process truly catered to the needs of the cohort. Our advisors are always so positive and encouraging even if we simply needed a supportive voice to motivate. Our advisors were readily available to answer any question we had or to promptly get questions answered, communicate changes, navigate some of those changes alongside us, and cultivated a trusting relationship with our practice to overcome any barriers or challenges we encountered. Through the Kentucky REC, we were able to apply PCSP principles in ways that were meaningful to our organization, our staff, and the patients we serve.”
The Patient-Centered Specialty Practice (PCSP) is a National Committee for Quality Assurance (NCQA) recognition program that extends the Patient-Centered Medical Home (PCMH) concepts to specialists. Specialty practices committed to access, communication and care coordination can earn accolades as the “neighbors” that surround and inform the medical home and colleagues in primary care.
Our new PCSP Cohort will begin on August 4th and the next PCMH Cohort will begin on September 22nd. Please let us know if you would like to join or would like to request additional information. The cohort framework is designed to accelerate your journey to NCQA PCSP Recognition within a 14-16 month period. Through our expert training, coaching, and resources, your staff will be well-prepared to carry out the practice transformation process.
By receiving recognition as a PCSP, your organization will receive full points in the Improvement Activities category of the Merit-Based Incentive Payment System under the Medicare Access and CHIP Reauthorization Act (MACRA).
Don’t miss the opportunity to be a part of something special as we work to transform healthcare in Kentucky! Call us at 859-323-3090 for more information.
Update: We have extended the deadline and will now begin our Patient-Centered Specialty Practice (PCSP) cohort on August 4th.
The Patient-Centered Specialty Practice is a National Committee for Quality Assurance (NCQA) recognition program that extends the Patient-Centered Medical Home (PCMH) concepts to specialists. Specialty practices committed to access, communication and care coordination can earn accolades as the “neighbors” that surround and inform the medical home and colleagues in primary care.
This cohort framework is designed to accelerate your journey to NCQA PCSP Recognition within a 14-16 month period. Through our expert training, coaching, and resources, your staff will be well-prepared to carry out the practice transformation process.
Our cohort will begin on August 4th. Please let us know if you would like to join or would like to request additional information.
Now is the perfect time! By receiving recognition as a PCSP, your organization will receive full points in the Improvement Activities category of the Merit-Based Incentive Payment System under the Medicare Access and CHIP Reauthorization Act (MACRA).
Don’t miss the opportunity to be a part of something special as we work to transform healthcare in Kentucky!
To learn about the PCSP program and our Cohort services:
Watch our FREE educational webinar recording
For more information about joining the Kentucky REC PCSP Cohort, please email Megan Housley or Stephen Williams or call 859-323-3090.
Be Ready! A recent audit by the OIG revealed that CMS issued hundreds of millions of dollars worth of incorrect EHR incentive payments.
Per the EHR Incentive Program, documentation to support attestation data for meaningful use objectives and clinical quality measures should be retained for six years post-attestation.
From The Wall Street Journal:
Medicare erroneously paid an estimated $729 million to doctors and other health professionals under a multibillion-dollar federal initiative designed to shift the health-care system from paper records to computer files, according to a new federal audit.
The U.S. Department of Health and Human Services Office of Inspector General, which conducted the audit, said Medicare, over a three-year period, improperly paid health professionals who vouched they earned bonus payments under the initiative, but who either lacked required proof or failed to meet bonus criteria.
The Centers for Medicare and Medicaid Services, the agency that oversees Medicare, should review its incentive payments and recoup any money erroneously paid and do more to scrutinize spending under the incentive program, OIG auditors said in a report of its audit. The program was created by 2009 legislation to accelerate use of electronic health records.
CMS “conducted minimal documentation reviews,” the report said, “leaving the EHR program vulnerable to abuse and misuse of federal funds.”
The audit estimated improper payments totaled 12% of the approximately $6.1 billion Medicare paid out as electronic health-record incentives to professionals during the three years reviewed by auditors. Auditors based the estimate on a review of 100 health professionals who vouched they earned bonuses between May 2011 and June 2014. To do so, health professionals must meet several criteria, such as using computers to order prescriptions and transfer health data electronically. Rules also require professionals to monitor cybersecurity.
Auditors said they found, in that sample of 100, 14 health professionals who reported incorrect information or who couldn’t produce required documents or other proof they met bonus criteria, including six without evidence of cybersecurity efforts. The 14 professionals were paid $291,222 in that three-year period.
In a February letter responding to the OIG findings, then-acting CMS Administrator Patrick Conway touted the rapid use of electronic health records under the initiative and said Medicare would recoup improper payments to professionals included in the sample audited by the OIG. Dr. Conway said CMS also launched targeted audits “to strengthen the program integrity,” which continue this year. The OIG report, however, said it didn’t believe the targeted audits would be enough. “This administration is committed to turning the page and ushering in a new era of accountability,” CMS officials said in a statement responding to the audit. “Providing high-quality care to Medicare beneficiaries while being responsible stewards of taxpayer dollars remains a top CMS priority, and we recognize the value data validation and auditing bring to our programs.”
The audit also found Medicare overpaid health-care professionals by $2.3 million during the same period as some professionals moved between incentive programs run by Medicare and Medicaid. Health-care workers are allowed to earn such electronic-health-record incentives from either Medicare or Medicaid, but not from both. The OIG found some who switched incorrectly received higher payments than they would have otherwise.
See the original WSJ article here.
No one likes to think about being audited, but we at Kentucky REC would like to help you be better prepared when facing a Meaningful Use Audit. Kentucky REC can help you prepare for pre and post payment Meaningful Use Audits. When receiving an audit notice, most practices find that a large amount of information is requested and must be provided in a very short time period. Kentucky REC offers a Meaningful Use Mock Audit service that will assist you in knowing what documents may be requested during an audit. We will help you make sure that your practice is organized and prepared with the items needed at your finger tips for each program year.
If a provider is unable to prove they have met each objective and measure for Meaningful Use, they face the risk of failing the audit and their incentive money may be recouped. Providers and staff have worked hard to meet Meaningful Use objectives. Make sure you are ready for a Meaningful Use Audit and contact us at Kentucky REC to find out more and receive a quote for this helpful service.
Read the Office of Inspector General notice here. The OIG complete report is available here.
Our experts at Kentucky REC are here to answer your questions. Call us at 859-323-3090.