On April 16, 2015, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law. The legislation’s purpose was two-fold. It repealed the sustainable growth rate (SGR) and introduced a new quality reporting program called the Merit-Based Incentive Payments System (MIPS). As we enter into 2016, MIPS will take on more importance as some of the requirements of the program start to take shape.
MIPS will measure Medicare Part B providers in four performance categories to derive a MIPS composite score which is based on a scale of 0-100. The score will determine a positive, negative or neutral payment adjustment which can greatly impact a provider’s Medicare reimbursement each year.
The performance categories are: Meaningful Use (MU), Quality (based upon PQRS measures), Resource Use, and Clinical Practice Improvement.
Below are 10 tips to help you prepare for MIPS:
1. Understand that Meaningful Use and PQRS are NOT going away. Elements of those programs will, in fact, along with their cousin, Value Based Modifier, compose up to 85% of your future composite performance score, and resultantly, reimbursement. Master your efforts in these programs NOW. MIPS performance year begins on January 1, 2017!
2. Become familiar with the depth of the details of clinical quality measures in these current programs and identify the potentially highest performing clinical quality measures appropriate to your scope of practice. Nail those!
3. Check measures against crosswalks of other quality program initiatives from which you may also benefit. This is the best way to maximize efficiency and performance levels.
4. Assure that your certified electronic health records technology can collect quality data appropriate to you, so that you can collect data and report on those measures. Not all products are certified to collect data on all measures.
5. Research and select the best PQRS reporting vehicle to match the measures identified. Not all measures can be reported via all reporting mechanisms, ie: claims-based reporting, registry reporting, EHR-Direct reporting have different measures available to select from.
6. Monitor quality report card dashboards early and often to identify deficiencies, remediate and advance to the next performance level.
7. Expand your community-of-care network for optimal patient care and reimbursement.
8. Become familiar with the Alternative Payment Models concept and investigate participation in one of them. (ACO, Medicare Shared Savings Program, PCMH etc.) The most lucrative performance opportunities will exist for the highest achieving providers in these organizations.
9. Embrace change and evaluate often. This transition is not a once-and-done project. It will require routine self-evaluations along the way to avoid revenue loss in the future.
10. Check out Physician Compare! Clinical quality statistics are now publicly reported via this consumer-facing provider evaluation tool. It is currently available for anyone’s review, online. Attaining your highest quality scores now, allows this to reflect both the physician effort as well as the customer opinion. Check out your profile today!
Be sure to create a strong relationship with a trusted advisor. Kentucky REC has years of successful attestation, submission and compliance experience, advising clients in all incentive programs. Get in touch with us today to see how we can help you on your journey to Value-Based Payment.
SOURCE: RCM Answers
