MIPS Tips (May)

June 17, 2019

The Merit-based Incentive Payment System (MIPS) 2019 reporting year is in full swing, and we are about to reach the half-way mark in the reporting year. Be sure you are staying on track with all the changes for 2019?

Category Corner (MIPS performance categories) 
The Cost category of MIPS remains somewhat of an unknown since we are not able to track this in CQR as it is entirely claims based. Here are examples of what providers can do to control costs and accurately reflect the patient population being treated? 

  • Controlling Cost
    • Reduce ordering duplicative tests
    • Minimize ER visits and hospitalizations (when possible)
    • Implement a good referral network with open communication and information sharing on tests and procedures that have already been ordered and performed.
  • Patient Population
    • Did you know that your ICD-10 coding contributes to your Cost category score? There are Hierarchical Condition Categories (HCC-chronic conditions used to create a risk adjustment methodology) categories of codes that put patients in a higher risk category and level of complexity (typically patients with diseases in these categories “cost” more to care for). When providers include these codes on their claims during the reporting year, this is taken into consideration in determining the Cost category score. Examples of HCC categories:
      • Diabetes – DM with complications
      • Vascular – Peripheral vascular disease (PVD)
      • Psychiatric – Major depression disorder
      • Kidney – Chronic kidney disease, stage 4
      • Substance Abuse – Alcohol/Opioid dependence
    • Risk Adjustment Factor (RAF) – Assessing the acuity of illness based on reported ICD-10 codes and demographics.

The Bottom Line – If the patient has a chronic condition that is contributing/impacting the treatment decisions being made in the care of the patient, they should be reported on the claim to provide an accurate reflection of the patient population being treated.  

Program Perks (new and important updates from CMS on the Quality Payment Program) 
Now that we have passed the 2018 attestation period and are in the middle of the 2019 reporting year, there has not been a lot of “chatter” coming from QPP. Now would be a great time, if you have not already done so, to make sure that you are signed up for the QPP Listserv and take advantage of the available resources.

  • QPP Listserv – To sign up for the QPP Listserv click HERE > scroll to the bottom > enter your e-mail in the “Subscribe to Updates” section > click Subscribe.  
  • QPP Resource Library – QPP offers an extensive resource library with links to Fact Sheets, FAQs, Webinars, and more!  

Measurement Metrics (how to improve your scores)
2015 CEHRT Requirements for Promoting InteroperabilityTo report for the PI category of MIPS, eligible clinicians/groups are REQUIRED to upgrade to all components of 2015 CEHRT. These include CPS 12.3/CEMR 9.12 – Azure AD, API and CCDA 2.1

  • A new resource has recently been added to the Quatris Healthco Knowledgebase website that provides step-by-step instructions providers/practices must take to be fully 2015 CEHRT compliant before starting a 90-day reporting period for the PI category of MIPS. Click HERE to review this new resource! (if you do not have access to the Quatris Healthco Knowledgebase REGISTER HERE)

Supporting Electronic Referral Loops Measures – It is important that providers are sending and receiving Transition of Care documents electronically with providers that they are referring to and receiving referrals from. Below are a few recommendations for obtaining and updating secure electronic addresses:

  • Outgoing referrals – Review the list of providers routinely being referred to. If there is not a secure electronic address use the “Map Service Providers” option in the ezAccess Patient Portal to see if there is one listed in this directory or reach out to the practice and ask for the secure electronic address.  
    • Incoming Referrals – Consider drafting a standard letter to send to those providers that are referring to you and let them know that you are actively participating in MIPS. Request that they send a Transition of Care document electronically when they refer a patient to your practice and include your secure electronic address.  

Toolbox Tactics (how to use the Quality Reporting tool to manage and monitor your progress)
2019 QSS Enrollment is now OPEN.

  • MIPS QSS (2019 MIPS QSS Enrollment Webinar)
    • Enrollment is open from May 20, 2019, to March 2, 2020
    • Submission authorization is from January 24 to March 16, 2020
    • MIPS submission by athenahealth to CMS using the EHR reporting method is $400/provider* for all reporting options (individual, group, any performance category)
    • A $200 per practice QSS assistance fee will be quoted if assistance beyond the self-service tools are required for QSS set-up, enrollment, authorization, etc.
    • CPC+ QSS (2019 CPC+ QSS Enrollment Webinar)
      • Enrollment is open from May 20, 2019, to Feb 2, 2020
      • Submission authorization is from January 13 to February 14, 2020
      • CPC+ submission by athenahealth to CMS using the EHR reporting method is $500/provider
      • A $200 per practice QSS assistance fee will be quoted if assistance beyond the self-service tools are required for QSS set-up, enrollment, authorization, etc.
    • Audit Assistance – Did you know that a MIPS audit can happen up to six years after attestation? Did you also know that Level 3 MIPS Consulting customers receive an audit tool kit to proactively prepare for an audit and assistance in the event of audit as part of their package? If you are not a MIPS Consulting customer, it is important to note that if you are audited Quatris Healthco does provide documentation on best practices to assist you in responding to an audit, but if you need further assistance, this is a billable service.

MIPS Consulting
Quatris Healthco offers quality consulting services to all of our customers. For information contact mkeller@qhco.com.

*Note: The content of this email may not apply to your practice. Contact your EMR vendor on processes for support and quality reporting programs.

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