MACRA/MIPS Tips: Don't Leave Money on the Table
•
0 j'aime•24 vues
2022 is the sixth year of the CMS Incentive Program, MACRA /MIPS, and as a practice or billing company, you have seen payment adjustments that have affected your business in more than one way. The biggest impact is payment adjustments, where we see up to a negative 9% of claims paid. So what can you do about it, and how can we minimize those adjustments? Marina Verdara, CMS Incentive Program SME and Sr. Training Specialist at Kareo will explore what you need to know about MACRA/MIPS and how you can improve your bottom line. She will walk you through: -The overview of MACRA -MIPS eligibility, training, and tracking progress for providers -Billing companies & the claims submission process -Supporting documentation & attestation
Recommandé
Recommandé
Contenu connexe
Similaire à MACRA/MIPS Tips: Don't Leave Money on the Table
Similaire à MACRA/MIPS Tips: Don't Leave Money on the Table (20)
Plus de Kareo
Plus de Kareo (20)
Dernier
Dernier (20)
MACRA/MIPS Tips: Don't Leave Money on the Table
- 1. Marina Verdara Regulatory Subject Matter Expert /Customer Education MACRA/MIPS 2022 Update: Don't Leave Money on the Table
- 2. Safe Harbor The information in this presentation is confidential and proprietary to Kareo® and may not be disclosed without the permission of Kareo. This presentation is not subject to your license agreement or any other service or subscription agreement with Kareo. Kareo has no obligation to pursue any course of business outlined in this document or any related presentation, or to develop or release any functionality mentioned therein. This document, or any related presentation and Kareo’s strategy and possible future development, product, and/or platform direction and functionality are all subject to change and may be changed by Kareo at any time for any reason without notice. The information on this document is not a commitment, promise, or legal obligation to deliver any material, code, or functionality. This document is for informational purposes and may not be incorporated into a contract. Kareo assumes no responsibility for errors or omissions in this document.
- 3. Agenda • MACRA/MIPS Overview • Claims Submission Process • 5 Easy Steps for Compliance • What’s New in 2022 • What You Should Do Now • Q&A
- 5. Kareo and PAHCOM Supporting Your Professional Development • PAHCOM has approved 1 CEU credit • You’ll be asked at the end of the webinar if you want a CEU certificate • Certificates will be emailed within the next few days • Attendees must be logged into the webinar to receive credit
- 6. Kareo and AAPC Supporting Your Professional Development • AAPC has approved 1 CEU credit • If you would like a certificate, please email webinars@kareo.com • Certificates will be emailed within the next few days • Attendees must be logged into the webinar to receive credit *This program has the prior approval of AAPC for 1 continuing education hour. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.
- 7. Marina Verdara Regulatory SME- Customer Education • 10+ years experience with hundreds of small practice clinicians • CMS Incentive Programs SME • Trains clinicians on meeting MIPS requirements using tools in Kareo Clinical EHR
- 8. QPP Overview
- 9. The Quality Payment Program (QPP) ● QPP: MIPS & APMs ● Goal is better care for patients ● Help reduce healthcare cost ● Motivate clinicians to provide better quality care ● Improve patient communications ● Increase security in Data Exchange between providers QPP MIPS APMs
- 10. QPP Options • Quality • Promoting interoperability • Improvement activities • Cost • Accountable Care Organizations (ACOs) • Specialty-specific programs • State-specific programs Merit-Based Incentive Payment System Alternative Payment Models MIPS APMs
- 11. MIPS-Important Facts • Bill $90K+ in Medicare Part B charges per year • Have 200+ Medicare Part B patients • Render 200+ covered professional services Eligibility Criteria • Quality 30% • Promoting Interoperability 25% • Improvement Activities 15% • Cost 30% Four Categories • Between -9% and +9% Payment Adjustments
- 12. MIPS-Important Facts (cont.) • Minimum Performance Threshold = 75 Points • Exceptional Performance Threshold = 89 points Thresholds • Individual or group • Quality: full year submission • Promoting Interoperability: 90- 365 days • Improvement Activities: 90 - 365 days • Cost: full year evaluation of Medicare Part B claims Submission Options
- 13. APM Basics • Most are known Accountable Care Organizations (ACOs) • Managed by local hospitals, medical groups, IPAs • Administrator assigns quality measures to clinicians • Clinicians may or may not be required to submit data for MIPS • Each APM has its own requirements and thresholds • Providers can earn more incentive dollars than in traditional MIPS • MIPS Category scores are different for APM participants
- 15. Claims Submission Process • Go to QPP.CMS.gov • From MIPS, select Quality Requirements • Scroll down & click on Explore Measures • Scroll down to the filters & select • Your Specialty • Medicare Part B claims measures
- 16. Claims Submission Process (cont.) • Select Quality Measures from list • Find Collection Type and Documentation • Select Medicare Part B Claims measures Specifications (PDF) • Measure Specification opens in PDF format • Identify if a measure is classified as a High Priority Measure, Outcome measure or both as in this example.
- 17. Claims Submission Process (cont.) • Review Description and Instructions • Understand how Denominator is calculated • Find required codes in Numerator section • Submit via Claims as they apply to your patients • Quality Measures must be submitted for full year
- 18. 5 Easy Steps to Meet MIPS Compliance
- 19. Practice & Biller Partnership 1. Confirm MIPS eligibility 2. Learn the Program 3. Track progress 4. Gather supporting documentation 5. Attest
- 20. Step 1: Confirm Eligibility • Are you eligible? • MIPS • APM • Both • Define your goal • Avoid Negative Payment Adjustment (60 pts) • Earn Positive Payment Adjustment (85 pts) • Create a team • Provider • Clinical Assistant • Office Manager • Biller
- 21. Step 2: Learn the Program Prepare Your Team Kareo University Support • Select measures and set goals • Share responsibilities • Identify team trainer • Set recurring reminders to run reports • Find the MACRA/MIPS course • Complete all 4 sessions (live or recorded) • Attend attestation webinars provided yearly from January through March • https://helpme.kareo.com/CMS_Incentive _Programs • Step-by-step guides • Short videos
- 22. Step 3: Track Progress • Run Quality Measures Report • Run Promoting Interoperability Report • Identify measures needing improvement and review guides for each • Verify that scores align with goals • Repeat every two weeks
- 23. Create MIPS Audit Folders • Hard copy saved in the practice • Electronic backup version Store in folders: 1. Security risk assessment 2. Supporting docs for improvement activities 3. Copies of final reports • Quality Measures Report (QRDA /xml) • Promoting Interoperability (PDF) 4. Kareo Certification ID Number Step 4: Gather Supporting Documentation
- 24. Step 5: Attest • Attend Kareo’s free Attestation Webinars (mid-January through end of March) • Find EIDM/HARP login credentials at QPP.CMS.gov • Have MIPS audit binder accessible • Log into attestation webinar and submit MIPS data • Check preliminary score • Receive final score after attestation deadline
- 25. Readiness Checklist • Free training (live and recorded) for Clinicians and Billing Companies • Step-by-step guides • One-on-one support via professional services • Free attestation webinar • Kareo University Training Modules
- 26. What’s New in 2022
- 27. ● Group-level scores only for group submissions ● No more bonus points for: ○ Reporting additional outcomes ○ Patient experience ○ High-priority measures beyond the one required ○ Measures meeting end-to-end electronic reporting criteria Note: ● The Eligible Measure Applicability (EMA) process is applied to providers who submit fewer than 6 measures or submit more than 6 measures, but no Outcome or High Priority measures. ● EMA applies to providers who report quality measures through Medicare Part B claims or submit MIPS CQMs. Quality Measure Performance Category Changes You can help: ● Go to: https://qpp.cms.gov/resources/resource- library ● Use the following filters:
- 28. Exceptions: ● Small practices automatically reweighted to 0% ● No need to report data for reweighting ● No need to submit hardship exception application for reweighting Participants: ● New SAFER Guides attestation measure ● Immunization Registry & Electronic Case Reporting now required: https://www.healthit.gov/topic/safety/safer- guides ● Bonus points for optional measures ● 21st Century Cures Act: Information Blocking ○ Direct Message ○ Patient Portal Promoting Interoperability Performance Category Changes You can help: ● Go to: https://qpp.cms.gov/resources/resource- library ● Use the following filters:
- 29. New episode-based measures for: ● 2 Procedural Measures ● 1 Acute inpatient medical measure ● 2 Chronic Condition Measures: ○ Diabetes ○ Asthma/COPD Medicare Part B Claims ● Medicare Part B claims are reviewed for the full calendar year Cost Performance Category Changes You can help: ● Go to: https://qpp.cms.gov/resources/resource- library ● Use the following filters:
- 30. What You Should Do Now
- 31. ● Monitor reports every 2 weeks ● Use Kareo resources such as: ○ https://helpme.kareo.com/CMS_Incentive_Programs ○ https://helpme.kareo.com/CMS_Incentive_Programs/Dashboards_and_Supporting_ Documentation/Create_Quality_Measures_Report ○ https://helpme.kareo.com/CMS_Incentive_Programs/01MACRA/MIPS_Action_Plan Helping your customers now, will help prevent possible negative adjustments Stay On Top of MIPS
- 36. Marina Verdara Regulatory Subject Matter Expert MACRA/MIPS 2022 Update: Don't Leave Money on the Table