Changes in the MIPS 2019 Proposed Rule: Cost Category

The Centers for Medicare & Medicaid Services (CMS) recently issued its Proposed Rule for 2019 under the Quality Payment Program. In this week’s blog we examine changes in the Cost performance measure category.

Changes in the MIPS 2019 Proposed Rule: Promoting Interoperability

The Centers for Medicare & Medicaid Services (CMS) recently issued its Proposed Rule for 2019 under the Quality Payment Program. In this week’s blog we examine changes in the Promoting Interoperability (formerly Meaningful Use and Advancing Care Information) performance measure category.

Changes in the MIPS 2019 Proposed Rule: Quality Category

The Centers for Medicare & Medicaid Services (CMS) recently issued its Proposed Rule for 2019 under the Quality Payment Program. In this week’s blog we examine changes in the Quality performance measure category.
 

High Level Changes for the MIPS 2019 Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) recently issued its Proposed Rule for 2019 under the Quality Payment Program. In addition to changes within each performance measure category, there are some proposed high-level changes that practices should take notice.
 

Review Your Practice’s 2017 MIPS Performance Feedback—Again!

The Centers for Medicare & Medicaid (CMS) has made a correction to the payment adjustment rates originally reported on the Quality Payment Program (QPP) website. This change could affect your 2019 Merit-based Incentive Payment System (MIPS) payment adjustment.
 

2017 MIPS Feedback Reports are Available – Have You Reviewed Yours?

If your practice has not checked your 2017 Merit-based Incentive Payment System (MIPS) Feedback Report, it is suggested you do so as soon as possible. According to recent reports from the Medical Group Management Association (MGMA), there are issues related to “groups” being improperly assessed as “individual” reporters, despite being acknowledged by the Centers for Medicare and Medicaid Services (CMS) as group reporting at the TIN (Taxpayer Identification Number) level in preliminary feedback. Feedback Reports have replaced the Quality and Resource Use Report (QRUR).


The Impact of Therapies on the Genomics of a Tumor

As genomic panels are completed, and genetic mutations are identified, providers can decide on a treatment plan which would target the specific tumor or cancer cell mutations. Those targeted therapies can be one of several approved cancer treatments—hormone therapies, therapies which block a blood supply to a tumor, therapies which try to kill or destroy specific cancer cells or even immunotherapies which try to trigger the patient’s immune system to destroy those cancer cells.

MIPS 2019: Commenting on the Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS) released the Proposed Rule for 2019 and practices are encouraged to comment on the changes here. Although the Proposed Rule states that all comments must be submitted by 5 p.m., Sept. 10, 2018, comments submitted electronically to www.regulations.gov will be accepted until 11:59 p.m. ET.

Overview of the 2019 Medicare Physician Fee Schedule (MPFS) Proposed Rule: Evaluation and Management Codes

Some of the biggest changes to the MPFS Proposed Rule deal with Evaluation and Management (E/M) Codes. The last big change to E/M codes occurred in January 2010 when CMS removed consult codes from the Medicare Claims Processing Manual.

Practices should consider making comments on the MPFS Proposed Rule as it may impact your practice significantly. The proposed rule is available under the PDF link here. Comments are due by Monday, September 10 at 5:00 pm ET and can be made here.  

Overview of the 2019 Medicare Physician Fee Schedule (MPFS) Proposed Rule

Practices should consider making comments on the MPFS Proposed Rule as it may impact your practice significantly. The proposed rule is available under the PDF link here. Comments are due by Monday, September 10 at 5:00 pm ET and can be made here

Just Reporting MIPS is No Longer “Good Enough”

The Centers for Medicare & Medicaid Services (CMS) recently reported that 91 percent of eligible clinicians participated in the first year of MIPS reporting, up from their goal of 90 percent1. What does that mean? That nine percent of the total of clinicians who were eligible to report did nothing–not even the minimal 90-day of data reporting.

In Office Dispensing – Without the Administrative Burden

As the healthcare reimbursement system evolves, oncology practices need increased control of their patients’ health–from adherence to symptom management–avoiding unnecessary hospitalizations and ED visits. The capability to improve continuity of care and increase patient satisfaction will only help to maximize the patient’s experience.

Understanding the QCDR

Qualified Clinical Data Registries (QCDR) were established so that providers could create and choose quality measures that would be more aligned to their specialty. To be used for Merit-based Incentive Payment System (MIPS) reporting under the Quality Payment Program, the Centers for Medicare & Medicaid Services (CMS) must approve each QCDR quality measure not currently listed under the MIPS program.

What Will Patients See on Physician Compare and What Practices Need to Check Immediately

2018 will be the first year that the Centers for Medicare & Medicaid Services (CMS) is adding star ratings to the Physician Compare website. In the past, patients could go on the website to find a physician in their area dealing with their specific disease state or issue. They would see some general information about gender, education, affiliations and office locations, along with limited information about participation in CMS Quality Programs. 

With this year’s website, CMS has published a small number of group measures from PQRS data submitted for 2016.

2017 MIPS Performance Feedback Now Available – and Should be Reviewed

The Centers for Medicare & Medicaid Services (CMS) has announced that eligible clinicians who participated in MIPS in 2017 can now review their final performance feedback, which includes the final score and payment adjustment information for the 2019 reimbursement year.

How is Your Practice Tackling Payer’s Evolving Approach to Reimbursement?

With the new healthcare environment of bundles and episodic payments, providers need to prepare their practice for change – consider the patient’s total episode of care, including what happens after discharge; discuss the best approach to value-based care, and strengthen your revenue cycle management capabilities to manage both patient responsibility and payer denials.
 

Technology Equals Efficiency

Technology equals efficiency. There is a caveat to that. The caveat being “if it is used properly.”
 

Is your Oncology Practice at Risk of a Medicare Audit?

Correct coding is critical for oncologists to maximize reimbursement and mitigate risk of a Medicare audit. Oncology coding has become so complicated that most practices will experience an audit at some point.
 

Understanding How Data Can Affect Your Practice Reputation

Your practice should be reviewing its CMS submission information as well as any additional performance data you collect through the year. Why is that important? It is possible you have a clinician who is not “buying into” the MIPS reporting process. Maybe they are hoping that CMS will change its mind or they think that their data won’t make a significant impact on the practice.

Two New Opportunities for Bonus Points Under MIPS

As your practice continues collecting data for the Merit-based Incentive Payment System (MIPS), you should understand that, in addition to bonus points offered under different performance categories, there are two new opportunities to earn bonus points: Complex Patients and Small Practices. The bonus points apply to the Total Composite Score for the 2018 Performance Year only.
 

Top Ten MIPS Changes from 2017 to 2018: Part 1, Numbers 1 – 5

The Quality Reporting Engagement Group recently reported on their top 10 differences in MIPS (Merit-based Incentive Payment System) reporting from 2017 to 2018. Keep reading to learn about numbers 1 – 5.

Top Ten MIPS Changes from 2017 to 2018: Part 2, Numbers 6 – 10

The Quality Reporting Engagement Group recently reported on their top 10 differences in MIPS reporting from 2017 to 2018. Keep reading to learn about numbers 6 – 10.
 

Maximizing the Return on an APP Program

With the costs involved in running a specialty practice, do you feel you are capturing all potential revenue from your Advanced Practice Provider (APP) program? And how do you know what to look for?
 

Submission Methods for the Quality Payment Program

Under the Quality Payment Program, the Centers for Medicare & Medicaid Services (CMS) allows practices or eligible professionals to submit their data through a variety of methods. Yet only one method may be used for each performance category: Quality, Improvement Activities and Advancing Care Information (CMS has renamed Meaningful Use to Promoting Interoperability). Cost performance data is not submitted but rather directly available to CMS through administrative claims data for the Total Per Capita Cost, Medicare Spending Per Beneficiary and episode-based measures.


Reporting MIPS: The 1 Report You Need to Understand the Cost Category

Practices may have already chosen their measures to report for the 2018 performance year (to be submitted to CMS in early 2019), and hopefully understand all the implications of changes from the previous year. This article will focus on the Cost performance category in MIPS reporting.


Reporting MIPS: 2018 Updates to the Improvement Activities Category

Practices may have already chosen their measures to report for the 2018 performance year (to be submitted to CMS in early 2019), and hopefully understand all the implications of changes from the previous year. This article will focus on the Improvement Activities category in MIPS reporting.


Reporting MIPS: Advancing Care Information Category

Practices may have already chosen their measures to report for the 2018 performance year (to be submitted to CMS in early 2019), and hopefully understand all the implications of changes from the previous year. This article will focus on the Advancing Care Information category in MIPS reporting. Advancing Care activities represent 25 of the possible 100 total points overall.

Take Control of These Clinical Challenges in Your Practice

There are several clinical challenges which can influence your practice’s success. Taking control of those issues will allow you to better control costs. We have included a couple of challenges that we address during our consulting assessment.

Reporting MIPS: How to Earn Rewards in the Quality Category

Practices have already chosen their measures to report for the 2018 performance year (to be submitted to CMS in early 2019) and, hopefully, understand all the implications of changes from the previous year. This article will focus on the Quality category in MIPS reporting.

How Do You Ready Your Practice for the Future?

The American Cancer Society (ACS) estimated that roughly 1.7 million new cases of cancer will be diagnosed in the U.S. in 2017, and the impact to patients for out-of-pocket costs reached nearly $4 billion

Part 1: What a Practice Must Consider when Transitioning to Patient-Centered Care Design

With the change to value-based reimbursement and patients living with chronic conditions, practices may need to evaluate their care delivery model design. With the shift, payers are making reimbursement decisions based on the delivery of high-quality, cost-effective care.

Part 2: Considerations when Transitioning to Patient-Centered Care Design

As you reevaluate your practice’s care delivery model, there are more areas to consider beyond Patient-Centered Care, Evidence-Based Medicine, Patient Navigation and Access to Care.