Now that Merit-based Incentive Payment System (MIPS system) is implemented, there are numerous questions that are still unanswered about MACRA. Medicare approaches the providers with two different opportunities. The providers can get hold of both opportunities – Advanced alternative payment models (APMs) and the Merit-based Incentive Payment System (MIPS).
There are some changes CMS has made when it comes to the eligibility. Before only providers, certified nurses, anesthetists and assistants were included. But now, even physical and occupational therapists, pathologists, registered nutritionists, and clinical psychologists are eligible for MIPS. There was debate on whether to include Social Workers, but they are eliminated from the final rule.
CMS has also given the opportunity for the small practices with low-volume threshold to participate. The MIPS program payment for the providers who ‘Opt-in’ will depend on neutral, negative or positive payment adjustments based on their final score.
Some of the other changes for small practices are that it will receive small incentive which will be included in the quality performance category score instead of stand-alone bonus in 2019. There will be increment of 6 points if the provider submits data on at least one quality measure. There are also changes in cost, improvement activity and promoting interoperability.
When it comes to interoperability there are ways to promote it through e-prescribing, Health information Exchange, provider to patient exchange, public health and clinical data exchange. Other advanced APM changes like MIPS, CMS have gradually implemented the advanced APM pathway to ensure provider success in the risk-based reimbursement program.
When proper APM criteria is given, it reduces confusion and burden for payers and eligible providers submitting payments to CMS. Applying the certified electronic health record technology threshold gives around 75% of eligible providers. There is also extension of 8% revenue-based nominal amount standard for advanced APMs and other payer advanced APMs through the 2024 performance year.
A proactive support is required to clarify the requirements for MIPS APMs to access performance on quality measures and cost, and updating the MIPS APM measure sets for the APM scoring standard. iPatientCare MIPS support, has a dedicated SME to work with your practice throughout the year. They create a plan and set goals, identify and solve any problems that come in the way for meeting quality requirements. The experts at iPatientCare even provide training on how to achieve MIPS success, and support for the Audit. They even offer personalized consulting plan that helps stay compliant throughout the year.
The iPatientCare PCMH 2017 support also provides understanding of the process and coaching on how to go about. The experts also assist in redesigning the workflow to ensure easy experience for providers, staff and patients. The practice staff or trainer ensures the integration of PCMH requirement measures into workflow, policies and procedures.
There is also support for demonstration of requirements compliances and generate meaningful reports for population management, care coordination, and care management staff, so that they are able to effectively analyze data. There is also a dedicated SME assigned for incident based support, where complete responsibility is taken if there is any trouble with the software. There is also maintenance and renewal support that provides support for submitting data, reports and documentation annually. The audit support is scheduled upon request, where SME will gather all documentation and reports to support attestation.
With all the given support, the ultimate aim is to reduce all the administrative burden, so that the providers can do their duty towards patients. Firstly, when it comes to documentation changes, the providers are given choices to which type of method they want to follow – medical decision making only, providers’ time spent face to face with patients or E&M guidelines for history, physical exam and medical decision making.
The providers may focus on items that have changed since last visit or the items that have not changed and they do not have to re-record if the information is already updated. For instance, if the ancillary staff or beneficiary has already entered the information on patient’s history then only thing required is for provider to indicate that the information is reviewed and verified.
When it comes to changes in billing the same-day visits, there is restriction by CMS to do the payment for two E/M visits billed by the provider for the same beneficiary on the same day. CMS proposed major reforms to E&M payments including single blended payment rates.
This applies for both new and old patients for office/outpatient E&M level 2 through 5 visits, essentially proposing to collapse the number of codes from five levels to two. There is also separate level of payment for the most complex patient care and there is adaption of a new extended visit (add-on codes) for primary care, specialty care and prolonged services too.
There is also payment for communication technology services. CMS is finalizing proposals to pay separately for virtual check-in and remote evaluation of recorded video and images that are submitted by an established patient. For instance, have to pay separately for chronic care remote physiologic monitoring and internet consultation. This applies to telehealth services, where they have to make separate payment for bundled episode for care for management and counseling that is done for substance use disorders.
CMS is constantly changing its regulations and codes in every aspect of healthcare. Therefore, it is impossible for the practices to balance their patients and documentation. iPatientCare has team of experts that are ready to assist you 24/7 and take all the hurdles out of your practices’ way.