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Are you ready for the New Quality Programs Coming in 2017 ?

These programs are now  mandatory  for physician practices!

 

If you bill Medicare more than $30,000 annually or provide care for more than 100 Medicare patients each year, you will be affected by MACRA.

What’s the MACRA Quality Payment Program?

MACRA is designed to move toward the goal of paying for value and better care. The program has two paths:

  1. Merit-Based Incentive Payment System (MIPS)
  2. Alternative Payment Models (APMs)

MIPS and APMs will go into effect in 2017 through 2022 and beyond

 

What is MIPS?

Starting in 2017, MIPS will annually measure Medicare Part B providers in four performance categories to derive a “MIPS score” (0 to 100), which can significantly change a provider’s Medicare reimbursement in each payment year.  The performance categories are: MU (25 points), VBM quality based upon PQRS measures (up to 30 points), VBM cost or resource use performance (30 points), and a new category named “clinical practice improvement” (15 points).

mips-components

 

The financial impacts of the MIPS scoring system can be very significant!!    Penalties will climb to 9%

With training from our staff we can help you receive Payments instead of Penalties

 

mips fees

 

Top performing Physicians have the potential to receive up to a 3x bonus payment adjustment.

By 2022 the potential to receive up to +27% BONUS exists!!

In 2022 MIPS scores can impact your Medicare reimbursement from -9% to +27%

Under this new program only a provider earning exactly 50 points will get 0% payment adjustment.  A provider earning 51 + points earns an incentive, whereas one achieving only 49 points or less will be assessed a penalty.

MIPS Eligible Professionals 2017-2018

    • Physicians, physicians assistants, nurse practitioners, clinical nurse specialists, and nurse anesthetists
  • More EPs added in 2019
    • Physical or occupational therapists, speech-language pathologists, audiologists, nurse midwives, clinical social workers, clinical psychologists, and dietitians or nutrition professionals

 

For the first time, consumers will be able to see their provider’s rating on a scale of 0 to 100 and how their providers compare to peers nationally.

Each MIPS-eligible professional’s score  will be available on the Physician Compare Website, including the ranges of all scores for eligible professionals across the country.

MIPS consolidates Medicare MU, PQRS, and VBM incentives and penalties while continuing to measure provider performance as specified by those three component programs.

MIPS sunsets separate MU payment adjustments starting with the 2019 payment year (the 2017 MU performance year), but continues MU for purposes of MIPS—  The EP can then earn up to 25 points for complying with MU in the performance year.

Program Timeline

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CMS has created multiple paths for 2017

Submit no data in 2017 you will receive a negative 4% payment adjustment in 2019.

 Submit some data to avoid a negative payment adjustment.

 Participate for part of the year. If you submit 90 days of data, you may earn a neutral  or small payment adjustment.

 Participate for the full year and you can earn a moderate positive payment  adjustment.

 Participate in an Advanced Alternative Payment Model APM. If you receive a  sufficient portion of Medicare payments or see a sufficient portion of Medicare  patients through the Advanced APM then you may qualify for the APM bonus  payment

                  mips-penalty

 

APM- Advanced Alternative Payment Model

This is for providers who go the furthest in delivering high-quality and efficient care.

The Centers for Medicare & Medicaid Services (CMS) will provide a list of care models each year that qualify for APM incentive payments. Clinicians who meet the criteria for APM incentive payments do not receive a payment adjustment under the Merit-based Incentive Payment System (MIPS) and instead receive a 5% Medicare Part B incentive payment.

Almost all Medicare Part B clinicians should expect to report through MIPS in the first year.

MIPS APMs
Purpose. MIPS streamlines current Medicare value and quality program measures into one program. Clinicians will receive a MIPS score to assess payment adjustment. Purpose. Qualifying APMs go further than MIPS to deliver high quality, efficient care, requiring clinicians to take on more risk. Only a subset of alternative payment models qualify for APM bonus payments.
Participation All providers should plan on receiving a payment adjustment through MIPS for the first performance year. Clinicians who do not meet APM criteria will be given a MIPS score instead. Participation All providers should plan on receiving a payment adjustment through MIPS for the first performance year. CMS will inform clinicians at end of first performance year if they qualified for an APM bonus payment.
Payment. -4% to 12% payment adjustment depending on MIPS score for 1st performance year. Increases every year until hitting a -9% to 27% payment adjustment in 4th performance year. Payment. 5% Medicare Part B incentive bonus payment. Will receive MIPS adjustment if clinicians don’t meet APM requirements.

Meaningful Use

Meaningful Use is a set of specific objectives that eligible professionals (EPs) and hospitals must achieve to avoid the penalties set by the Centers for Medicare & Medicaid Services (CMS). These objectives require the use of certified electronic health record (EHR) technology and are designed to:

  •  Improve quality, safety, and efficiency
  • Engage patients and their families
  • Improve care coordination and public health
  • Maintain the privacy and security of patient health information

PQRS

The Physician Quality Reporting System (PQRS) is a quality reporting program that requires eligible professionals (EPs)  to report on the quality of care to Medicare by choosing and reporting on at least 9 quality measures.

The program will apply a negative payment adjustment to individual EPs and PQRS group practices who did not satisfactorily report data on quality measures.

 

ITMedRx, is a specialized Healthcare IT company that offers fully customizable solutions to healthcare practices. We can install and maintain everything you need to be in compliance with the mandates and avoid the Government Penalties!

We have experienced consultants that will work with your office staff to review  your current systems, determine the solutions needed to improve workflow, meet requirements, and provide all the training you need to be successful.

Our services include:

  •   EHR Implementation, Customization, and Training

  •   Medical Coding and Billing – Revenue Cycle Managment

  •   Meaningful Use registration, compliance, and Filing

  •   Quality Care Programs (MIPS, APM, MU, PQRS, VBM, CCM)

  •   Staff training to improve Office Efficiency & Workflow

  •   Lab and Imaging Integration

  •   Device Application and Mobile Technology Solutions (Wireless BP Cuffs,  Pulse Oximeters, EKG, and iPads)

 

We know that switching your practice to an Electronic Health Record (EHR/EMR) is one of the biggest changes and challenges you’ll face today as a healthcare provider. Implementing all new technology, training your staff, trying to meet the government’s requirements, and understanding all the rules and regulations that go along with it can be overwhelming!  That’s why we’re here, we can help guide you every step of the way.

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