Tag Archives: MIPS Tips

MIPS Tips (November)

Are you ready to finish strong? The Merit-based Incentive Payment System (MIPS) 2019 reporting year is now in its last few weeks.

Category Corner – Cost performance category of MIPS.
Although the Cost category is not tracked in CQR and is entirely claims-based, it is still important for providers to understand how it is scored as it accounts for 15% of the overall score in 2019. Reference the 2019 Cost Performance Category Fact Sheet for more information.

Program Perks – New and important updates from CMS on the Quality Payment Program.
CMS released the 2020 Final Rule on November 4, 2019, via a QPP Listserv announcement (reference the 2020 QPP Final Rule Fact Sheet for more information). 2020 QPP Final Rule Policy Highlights and key finalized policies for 2020 include:

  • Maintaining the weights of the Cost (15%) and Quality (45%) performance categories.
  • Increasing the performance threshold from 30 points to 45 points.
  • Increasing the data completeness threshold for the quality data that clinicians submit to 70%.
  • Increasing the Improvement Activity performance category participation threshold for group reporting from a single clinician to 50% of the clinicians in the practice.
  • Revising the specifications for the Total Per Capita Cost (TPCC) and Medicare Spending Per Beneficiary (MSPB) Clinician measures.
  • Updating requirements for Qualified Clinical Data Registry (QCDR) measures and the services that third-party intermediaries must provide (beginning with the 2021 performance period).

Measurement Metrics – Specific measures and how to improve your scores.

  • Support Electronic Referral Loops by Receiving and Incorporating Health Information – this specific measure requires the Regulatory Hotfix: Click here for more information and to see if your practice needs to take action.
  • Security Risk Analysis – If you are not reporting the PI category of MIPS, you will not have to complete a Security Risk Analysis for 2019. We still recommend that a Security Risk Analysis be done annually to ensure HIPAA compliance.

Toolbox Tactics – Tips for how to use CQR, the Quality Reporting tool to manage and monitor your progress. 
Providers and administrators can find the CMS specifications for various measures or Improvement Activities for MIPS via CQR.

  • Promoting Interoperability Measures – Under the “Measure name” column, click the blue measure name (example, “Supporting Electronic Referral Loops by Sending Health Information” will take you directly to the CMS specification for the measure).
  • Quality Measures – Under the “CMS #” column, click the blue measure number (example, “CMS69,” and this will take you directly to the CMS guidance for the measure). Below the CMS guidance, it will outline how the measure is being calculated using athenaPractice and CQR for the Initial Patient Population, Denominator, Numerator, Exceptions and Exclusions.
  • Improvement Activity – under the “Activity ID” column, click the blue activity ID (example, “IA_PM_16,” and this will take you directly to the CMS definition of the Improvement Activity).

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 program.

MIPS Tips (October)

The Merit-based Incentive Payment System (MIPS) 2019 reporting year is now in its last 90-days, and Quatris Healthco wants to ensure you are staying on track.

Category Corner – In this edition, we will focus on the Quality performance category of MIPS. Did you know that you can report more than six Quality measures? Below is additional information on how you could potentially earn more points towards your Quality performance category score:

  • Ways to earn bonus points:
    • Submit additional outcome or high-priority measures beyond the one required.
      • Two (2) bonus points for each additional outcome measure that meet case minimum and data completeness requirements and have a performance rate > 0% or < 100% for inverse measures.
      • One (1) bonus point each for additional high-priority measures that meet case minimum and data completeness requirements and have a performance rate > 0% or < 100% for inverse measures.
    • These bonus points are capped at 10% of the Quality performance category denominator (or the total number of available measure achievement points). This cap is separate from the cap on bonus points earned for end-to-end electronic reporting.
    • Please see the Toolbox Tactics section below on how to use CQR to determine which measures to report.
  • Data Completeness Standard defined:
    • Met or exceeded the minimum case volume of twenty (20) eligible cases (has enough data for it to be reliably measured);
    • Met or exceeded the 60% data completeness criteria; and
    • Had performance greater than 0% (or less than 100% for inverse measures).  
  • The above information is from the “2019 MIPS Scoring Guide” (found in the QPP Resource Library). 

Program Perks – In this section, we will focus on new and important updates from CMS on the Quality Payment Program. 

  • Did you miss the October 3, 2019 deadline for having all 2015 CEHRT requirements in place to report for the PI category of MIPS? You may be eligible for the PI Hardship Application.
    • The QPP Promoting Interoperability Hardship Application deadline is December 31, 2019.
    • For information on who is eligible to request a PI Hardship Application and the application process visit: QPP Exception Application.
    • This application does not prevent or exclude you from reporting the Quality and Improvement Activities using athenaPractice and CQR, however, if you are reporting the Quality category using CQR, you will still need to be upgraded to a version of 12.3 no later than December 31, 2019, to be compliant.
  • First vs. Second Eligibility Run
    • It is important to understand which provider(s) in your practice are REQUIRED to report to MIPS.  This is done through the QPP Participation Status tool. There are two (2) eligibility runs that CMS performs for the reporting year. Below is the explanation of the timing of the eligibility runs. Currently, only the FIRST eligibility run results are available on the QPP website.
      • Currently displays MIPS eligibility information for the performance year 2019 from the first review period (PECOS data and claims data from October 1, 2017-September 30, 2018). CMS will complete the second review and update the tool with the final 2019 eligibility information in November 2019. This will incorporate Medicare Part B claims data from October 1, 2018-September 30, 2019, and PECOS data. Your MIPS eligibility status may change from what is displayed in the tool upon completion of the first review period to completion of the second review period.
      • If you were determined to be ineligible after the first review period, that determination will not change. However, it is possible for a clinician and/or practice to be deemed “eligible” after the first review period and then deemed “ineligible” after completion of the second review period. It is very important to use the tool to review your MIPS eligibility information more than once: both after the first and second review periods are complete.

Measurement Metrics – In this section, we will focus on specific measures and how to improve your scores. 

  • Support Electronic Referral Loops by Receiving and Incorporating Health Information
    • This is a new measure for 2019. To further clarify this measure, let’s take a closer look at how the denominator and numerator are calculated.
      • Denominator count – For a patient to be counted in the denominator of the measure there are two (2) criteria:
        • The patient must have an imported CCDA on their chart
        • The patient must either be a new patient or, if they are established, have an office visit marked as “Encounter is Transition of Care.”
      • Numerator count – Of the patients in the denominator, the imported CCDA must be reconciled for the following three (3) criteria, even if no changes are made:
        • Medication – Review of the patient’s medication, including the name, dosage, frequency, and route of each medication
        • Medication allergy – Review of the patient’s known medication allergies
        • Current Problem List – Review of the patient’s current and active diagnoses.
  • CMS68 – Documentation of Current Medications
    • IMPORTANT REMINDER: While checking the box for Medications Reviewed provides credit in CQR, don’t lose sight of what will be requested in the event of an audit. If you are audited for this measure, they will be looking for the following criteria, as stated by the CMS specification for this measure, “This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications’ name, dosage, frequency and route of administration.”
  • CMS138 – Preventive Care and Screening for Tobacco Use and Cessation Intervention
    • If you have achieved scores of 90% or higher but are still only seeing 3 points being given for this measure this may be an explanation as to why this is happening.
      • CMS is only looking at the second numerator/denominator results for this measure. Because of this change, there is not a benchmark available from CMS for this measure, therefore the maximum points to be achieved for this measure in 2019 are three (3). However, if there is enough data submitted during 2019, CMS will review this data and could benchmark the measure at the time the final scores are released. Eligible clinicians and groups are still encouraged to report this measure so that it can be benchmarked moving forward. 

Toolbox Tactics – In this section, we will focus on tips for how to use CQR the Quality Reporting tool to manage and monitor your progress. 

  • Using CQR to select your Quality measures
    • If you read the Category Corner section of this MIPS Tips, you know that you can receive additional points towards your Quality score by selecting more than six (6) measures on your CQR dashboard for attestation. Below is what to look for when selecting Quality measures for attestation:
      • Select your six (6) best performing measures, making sure to select at least one that is an Outcome measure or High Priority measure.
      • Look for any measures that are labeled as Outcome measures or High Priority measures that are not a part of your top six (6).
        • Outcome measures will be labeled in CQR under the “Type” Column as “Outcome” or “ITM Outcome”.
        • High Priority measures will be identified as those having an orange triangle with an exclamation mark next to the measure number under the “CMS#” column.
          • NOTE: You will not be able to “Select” more than six (6) measures with a checkmark in the “Sel” column, however any Quality measure appearing on the Dashboard at the time the QRDA-III is created will be included in the report. 
      • For those that are identified as additional Outcome and/or High Priority measures, make sure they meet the following criteria for earning additional bonus points:
        • Must have at least twenty (20) patients in the denominator. To view the number of patients in the denominator, click the green button next to the measure.
        • Must have a performance greater than 0 % (or less than 100% for inverse measures).
  • To create a worklist and print the list of unmet patients in CQR follow these steps:
    • PI Tab – Click on the blue number in the unmet column > click on the Last Name column header to put patients in alphabetic order (optional) > click PDF > select the desired location to save the PDF document to > Save > go to where the file was saved > open the PDF > Print the PDF.
    • Quality Tab – Click the green button next to the measure > click on the blue number in the unmet column > click on the Last Name column header to put patients in alphabetic order (optional) > click PDF > select the desired location to save the PDF document to > Save > go to where the file was saved > open the PDF > Print the PDF.

NOTE: If the option for PDF does not appear and you are only seeing what appears to be 3 “puzzle-looking” pieces > click one of the “puzzle-looking” pieces > you will receive a pop-up to Allow or Block > Click Allow > this may kick you out, but just go back through the above-listed steps and you will be able to save the list to a PDF document.

MIPS Consulting – Quatris Healthco offers quality consulting services to all of customers and will once again offer services for the 2020 reporting year. 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 program.

MIPS Tips (August)

The Merit-based Incentive Payment System (MIPS) 2019 reporting year is approaching the last 90-days. If you are required to or are planning to report to the PI Category of MIPS, pay special attention to the Category Corner for the Upgrade and 2015 CEHRT resources that are available.

Category Corner – In this section, we will review the 2015 CEHRT Requirements as they relate to reporting the PI category of MIPS.

  • The deadline to have all the 2015 CEHRT requirements in place is October 1, 2019, to be able to report for the last 90-day reporting period in 2019.
  • 12.3.3 has been released!
    • Quatris Healthco is currently in the process of planning and scheduling for upgrades. If you do not have an upgrade request logged, contact us to start this process.
      • You will be asked to complete an upgrade survey. The upgrade will not be scheduled until the survey is completed and returned.
      • If you are a cloud-hosted customer our upgrade team will contact you with your scheduled upgrade date. You do not need to request or complete the upgrade survey).
  • The information regarding the 2015 CEHRT Requirements is CRITICAL to your success if reporting to the PI category. Refer to the Quatris Healthco Knowledgebase site frequently for updated information. 
    • ONC 2015 CEHRT Requirements
      • This resource provides step-by-step instructions that practices/Local IT must take to be fully 2015 CEHRT compliant prior to starting a 90-day reporting period for the PI category of MIPS.
      • New Interface section, updated API Access Guide, and new API Access recording were recently added.
      • If you do not have access to the Quatris Healthco Knowledgebase REGISTER HERE.

Program Perks – If you are uncertain about meeting the October 1, 2019 deadline, there may be other reporting options available (if you qualify).

  • CMS released the PI Hardship Exception Application on August 15, 2019, via a QPP Listserv announcement. To see if you qualify to apply, learn how to apply, and what this could mean in terms of reporting options for your practice, visit the QPP Exception Application website.
  • If you qualify, you have until December 31, 2019, to submit your PI Hardship Exception Application.
  • This application does not prevent you from reporting to Quality and Improvement Activities using athenaPractice and CQR, however; if you are reporting the Quality category using CQR, you will still need to be upgraded to a version of 12.3 no later than December 31, 2019, to be compliant.

Measurement Metrics – In this section, we will focus on specific measures and how to improve your scores.

  • Provide Patients Electronic Access to Their Health Information – While this measure has been in existence for some time (Meaningful Use), there is an added component that must be met in 2019. For the patient to be on the numerator met list, two criteria must be met:
    • (1) The patient (or the patient-authorized representative) is provided timely access to view online, download, and transmit his or her health information. (This is what we have been doing for years and requires that the patient be given access or opted out of the patient portal service either before or within four business days of their first visit during the reporting period).
    • (2) The MIPS eligible clinician ensures the patient’s health information is available for the patient (or patient-authorized representative) to access using any application of their choice that is configured to meet the technical specifications of the Application Programming Interface (API) in the MIPS eligible clinician’s certified electronic health record technology (CEHRT). Checkbox in Registration:
      • This is what is NEW in 2019.
        • Once upgraded to a version of 12.3 (preferably 12.3.3) there will be a new checkbox in Registration for “Patient Data Access Authorized”. 
        • While checking the box for “Patient Data Access Authorized” is what will provide credit in CQR, in the event of an audit the provider/group must be able to prove that their system has the capability of providing this level of access. 
        • Athenahealth has provided sample wording that can be provided to patients to meet this requirement.
          • “We support our patients having access to their health information through the Patient Portal. Beyond the Patient Portal, we can enable certain mobile apps that meet requisite technical specification and security requirements to provide you access to your health information in a safe and secure way. Currently, no mobile apps have been configured to connect to our system. Our website, orgname.com, will be updated if any additional apps become available for you to use to access your health information. Please contact our office if you have questions.”
  • Patient Data Access Checkbox Patch now available.
    • If you notice your numbers are lower than expected for the Provide Patients Electronic Access to Their Health Information measure contact Support and have us review and determine if applying this patch will help. (You must be on CPS 12.3.x for this patch to be applicable).

Toolbox Tactics – In this section, we will focus on tips for how to use athenaPractice and CQR the Quality Reporting tool to manage and monitor your progress.

  • CMS68 and CMS156
    • Did you notice the difference with the latest update to CQR?
      • Both measures have been designated by CMS as capped topped-out measures. This means that the highest point value that anyone will receive for these measures is a point value of seven even if the score is 100%.
      • What does this mean for you?
        • Providers/Groups need to review their latest dashboard reports and determine if this significantly impacts their overall Quality category score. If so, now is the time to consider if additional or other measures need to be reported.
        • Quatris MIPS 2019: Ready or Not Webinar – Quatris Healthco will host a webinar to review MIPS readiness for 2019 on Wednesday, September 11, 2019. REGISTER HERE

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 program.

MIPS Tips (July)

The Merit-based Incentive Payment System (MIPS) 2019 reporting year is approaching the last 90-day reporting period for Promoting Interoperability. Be sure you are staying on track with the changes for 2019 and review the following if applicable to your practice.

12.3 SP3 Upgrades 
Quatris Healthco will announce the release of CPS 12.3 SP3 soon and begin upgrades shortly after that.

2015 CEHRT Compliance for Promoting Interoperability 
Information regarding the 2015 CEHRT Requirements for PI is vital to your success if reporting to the PI category! Because the website is updated frequently, we recommend you review any new information.

  • 2015 CEHRT Requirements on the Quatris Healthco Knowledgebase
    A new resource was added to the Quatris Healthco Knowledgebase and provides step-by-step instructions for providers and practices to 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.

CPS12.3 and 2015 CEHRT Compliance Timing
The timing of your upgrade and the additional 2015 CEHRT requirements that must be in place are dependent upon special statuses and the categories of MIPS that will be reported in 2019.

  • If you are reporting to the Promoting Interoperability category of MIPS then you must have the following completed no later than October 1, 2019:
    • Upgrade to a version of CPS12.3 (preferably 12.3 SP3) 
    • Additional 2015 CEHRT requirements – Azure, API, CCDA 2.1
  • If you are NOT reporting to the Promoting Interoperability category of MIPS but are reporting to the Quality category using athenaPractice and CQR, then you must be upgraded to version of 12.3 (preferably 12.3 SP3) no later than December 31, 2019.
    • The additional 2015 CERHT requirements do not apply for this option as those are only applicable if reporting to the Promoting Interoperability category.
  • To determine if a special status applies to your practice and if you qualify for a Promoting Interoperability Hardship, visit the Exception Applications section of the QPP website. The QPP Participation Look-Up Tool will provide details as to whether or not any special statuses apply at the individual and group levels.

2018 Final Scores Released
On July 3 CMS released the final scores and payment adjustments for the 2018 reporting year via this Quality Payment Program listserv announcement:

“If you submitted 2018 Merit-based Incentive Payment System (MIPS) data, you can now view your performance feedback and MIPS final score on the Quality Payment Program website.”  

You can access your 2018 MIPS performance feedback and final score via this link: cms.gov/login

  • Log-in using your HCQIS Access Roles and Profile (HARP) system credentials (these are the same credentials used to submit your 2018 MIPS data). If you don’t have a HARP account, refer to the QPP Access User Guide to start the process.
  • To learn more about performance feedback, view these frequently asked questions (FAQs). The FAQ’s highlight what is performance feedback, who receives the feedback, and how to access it on the Quality Payment Program website.

Targeted Review period opened with the release of the 2018 final scores and payment adjustments. Information was provided via the July 3rd Quality Payment Program listserv announcement:

“The MIPS payment adjustment you will receive in 2020 is based on your final score. A positive, negative, or neutral payment adjustment will be applied to the Medicare paid amount for covered professional services furnished by a MIPS eligible clinician in 2020.”

MIPS eligible clinicians, groups, and virtual groups (along with their designated support staff or authorized third-party intermediary), including APM participants, may request CMS to review the calculation of their 2020 MIPS payment adjustment factor(s) through a process called targeted review. 

When to Request a Targeted Review
If you believe an error has been made in your 2020 MIPS payment adjustment factor(s) calculation, you can request a targeted review until September 30, 2019. The following are examples of circumstances in which you may wish to request a targeted review: 

  • Errors or data quality issues for the measures and activities you submitted.
  • Eligibility and special status issues (e.g., you fall below the low-volume threshold and should not have received a payment adjustment).
  • Erroneously excluded from the APM participation list and not being scored under the APM scoring standard.
  • Performance categories were not automatically reweighted even though you qualify for automatic reweighting due to extreme and uncontrollable circumstances.

How to Request a Targeted Review
You can access your MIPS final score and performance feedback and request a targeted review by:

  • Visiting the Quality Payment Program website
  • Logging in using your HCQIS Access Roles and Profile System (HARP) credentials (these are the same credentials that allowed you to submit your MIPS data.) Refer to the QPP Access Guide for additional details.

When evaluating a targeted review request, CMS may require documentation to support the request. If your targeted review request is approved, CMS may update your final score and the associated payment adjustment (if applicable), as soon as technically feasible. Note: targeted review decisions are final and not eligible for further review.

For information about how to request a targeted review, refer to the 2018 Targeted Review Fact Sheet and the 2018 Targeted Review FAQs.

Questions?
If you have questions about your performance feedback or MIPS final score, contact the Quality Payment Program via phone 1-866-288-8292/TTY: 1-877-715-6222 or email: QPP@cms.hhs.gov”.  

MIPS Consulting
Quatris Healthco offers quality consulting services to our 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.

MIPS Tips (June)

The Merit-based Incentive Payment System (MIPS) 2019 reporting year is now past the half-way point in the reporting year. Be sure you are staying on track with all the changes for 2019.

Category Corner (MIPS performance categories) 
Eligible clinicians must report active engagement in the Improvement Activity(s) selected for a minimum of a 90-day reporting period and be able to support their active engagement in the activity(s) for the full 90-days. In the event of an audit, remember these important tips:

  • Select your Improvement Activity(s) early – A full list of activities can be found in CQR and on the QPP website in the Resource Library.
  • Select your 90-day reporting period – This can be any 90-days within the reporting year as this no longer needs to align with the PI component of MIPS. PI bonus points are no longer being given for selecting Improvement Activities that require CEHRT.
  • Create and save supporting documentation – While supporting documentation is not required at the time of attestation, in the event of an audit they will ask for proof of the eligible clinician (group) being actively engaged in the activity that was reported.
  • The best way to prove active engagement for a full 90-day reporting period is to have at least one example for each month of the 90-day reporting period.

Program Perks (new and important updates from CMS on the Quality Payment Program) 
On June 20th via the QPP Listserv, The Centers for Medicare & Medicaid Services (CMS) announced the following:

  • Merit-based Incentive Payment System (MIPS) Data Validation and Audit to begin June 2019 for Performance Years 2017 and 2018 
    • CMS has contracted with Guidehouse to conduct data validation and audits of a select number of Merit-based Incentive Payment System (MIPS) eligible clinicians. Data validation and audits are processes that will help ensure MIPS is operating with accurate and useful data. MIPS eligible clinicians, groups and virtual groups are required by regulation to comply with data sharing requests, providing all data as requested by CMS.
    • If you are selected for data validation and/or audit, you will receive a request for information from Guidehouse via email or certified mail. You have forty-five calendar days from the date of the notice to provide the requested information.
      • If you do not provide the requested information, CMS may take further action, to include the possibility that you will be selected for future audits. To avoid this, CMS is in the process of developing resources to support clinicians selected to participate.

Measurement Metrics (how to improve your scores)
The 2015 CEHRT Requirements for the PI category can be found on the Quatris Healthco Knowledgebase. View the step-by-step instructions to be fully 2015 CEHRT compliant before starting a 90-day reporting period. If you are a Quatris Healthco customer and do not have access to the Quatris Healthco Knowledgebase, click here to register.

Athenahealth recently hosted a webinar and reviewed the setup and workflow for the Receiving and Incorporating Health Information measure. Click here to view the webinar and click here to view the slides.

  • The key to understanding this measure is how the denominator is calculated. It requires two indicators for a patient to be included in the denominator count.
    • Indicator 1: The patient must be a new patient to the provider or if the patient is established the checkbox for “Encounter is Transition of Care” must be checked on the office visit document.
    • Indicator 2: The patient must have an imported CCDA on their chart.
      • If either of these is not present on the chart, then the patient will not be included in the measure.

Toolbox Tactics (how to use the Quality Reporting tool to manage and monitor your progress)

  • CQR Version 1.6.10 Release
    • Click here to view the recorded webinar outlining the upgrade features.
    • Click here to download the new Quality Reporting Guide. 
  • CPC+ 2019 Patient Roster Report
    • Quatris Healthco has proactively uploaded this report for customers that participate in CPC+. If you have any questions regarding this report, log a case at support@qhco.com.

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.

MIPS Tips (May)

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.