Simple Steps to Avoid the 7% MIPS Penalty for 2019
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Join Marina Verdara, Kareo’s Sr. Training Specialist, as she provides you with simple steps to avoid the 7% MIPS penalty, including how you can check a clinician’s eligibility and where you can earn points for each category. She will also provide you with the resources to help you prepare for 2020.
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Simple Steps to Avoid the 7% MIPS Penalty for 2019
- 1. webinar Simple Steps to Avoid the 7% MIPS Penalty for 2019 Marina Verdara November 20, 2019
- 2. kareo.com Agenda 2 Agenda 2 • Welcome & Introductions • What is MACRA? • Payment Adjustments • Options to Avoid the -7% Payment Adjustment • Prepare for 2020 • How Kareo Can Help • Your Questions
- 3. kareo.com 33 How to Participate Today Type your questions Download today’s resources View today’s presentation
- 4. kareo.com 44 Connect via Social twitter.com@GoKareo facebook.com/GoKareo linkedin.com/company/kareo
- 5. kareo.com 55 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 live webinar to receive credit • 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 live 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.
- 6. kareo.com 66 Speaker Marina is a Sr. Training Specialist guiding Kareo customers to higher levels of success with their CMS Incentive Program reporting. Marina has more than eight years of experience working directly with hundreds of small practice clinicians on a variety of projects. Her specialty is working with clients on CMS Incentive programs such as Meaningful Use, PQRS, and MACRA. Marina Verdara, MBA
- 8. kareo.com 88 What is MACRA? MACRA is the Quality Payment Program (QPP) for Medicare clinicians that was introduced in 2017. The QPP consists of two tracks: • Alternative Payment Models (APMs) • Merit-Based Incentive Payment System (MIPS)
- 9. kareo.com 99 MACRA QPP MIPS Quality 45% - Report up to 6 measures - Full year reporting Promoting Interoperability 25% - 4 objectives - 90 days up to a full year reporting Improvement Activities 15% - Submit 40 points to earn full credit Cost 15% - 10 measures evaluated - Data submission not required APM ACOs Specialty Specific Programs State Specific Programs
- 10. kareo.com 1010 APMs Important facts to know about APMs: • These are Medicare Incentive programs • They are managed by local medical entities such as hospitals, medical groups, or IPAs • Most are known ACOs • The APM/ACO administrator assigns quality measures to clinicians • Clinicians might also be required to submit data for MIPS • Every kind of APM has it’s own requirements and thresholds • Encourage your clinicians to partner up with the medical entity who invited them to join the APM
- 11. kareo.com 1111 MIPS Clinicians are eligible if they meet or exceed the three low-volume threshold criteria: 1. Bill Medicare over $90,000 in Part B allowed charges a year, and 2. Provide care to more than 200 Medicare Part B patients, and 3. Provide 200 or more covered professional services to Part B patients Clinician Types: • Physician • Physician Assistant • Nurse Practitioner • Clinical Nurse Specialist • Certified Registered Nurse Anesthetist • Physical Therapist • Occupational Therapist • Clinical Psychologist • Qualified Speech-Language Pathologist • Qualified Audiologists • Registered dietitians or Nutrition Professionals
- 12. kareo.com 1212 Participation Options There are three Participation Options starting in 2019:
- 13. kareo.com 1313 Where to Start? • Start by confirming the providers eligibility at the QPP website and determine if the provider is in the MIPS track, the APMs track or both
- 14. kareo.com 1414 Are You Eligible? 1. If you are in the APM track, reach out to the APM administrator and: - Obtain a list of Quality measures and any other requirements/deadlines 2. If you are in the MIPS track, identify your goal: - avoid the negative payment adjustment; or - try to earn a positive payment adjustment 3. If the provider is on both the MIPS and APM tracks, and is struggling with the requirements, do both. 4. Determine if the provider has a special status such as Small Practice status. Providers have added benefits when having this special status.
- 16. kareo.com 1616 Payment Adjustments Payment Adjustments: • Negative payment adjustments • MIPS is too confusing to understand • Incentive programs don’t make any sense • I’ll look into it “later” or I still have time • Who has time to look into this? • Why am I getting a negative payment adjustment! Good news: Today you will learn the steps to help you avoid a negative payment adjustment in the upcoming years!
- 17. kareo.com 1717 Payment Adjustments 2020 9% 2019 7% 2018 5% 2017 4% Payment adjustments are increasing and so is the Performance Rate (points required to avoid a negative payment adjustment)
- 18. kareo.com 1818 Payment Adjustments for 2017 Important facts about payment adjustments for 2017: • 93% of clinicians received a positive payment adjustment. Code used is CARC 144 • 5% received a negative payment adjustment. Code used is CARC 237 • ONLY 2% of clinicians received a neutral status • The national mean MIPS score was 74.01 • Clinicians in small practices received an average score of 43.46 points • The national mean APM score was 87.64 • Clinicians in an APM or ACO usually receive additional support from the program administrator
- 19. kareo.com 1919 Payment Adjustments for 2017 According to the CMS’s 2017 QPP Experience Report: Group Size Positive Payment Adjustment Count # Neutral Payment Adjustment Count # Negative Payment Adjustment Count # Individual (1) 55,240 20,137 2,225 Small Group (2 - 15) 23,539 670 20,014 Total 78,779 20,807 22,239 More than 22,000 clinicians could have avoided the 4% negative payment adjustment by submitting only… 0 - 2 3 4 - 74 75 - 100
- 20. kareo.com 2020 Payment Adjustments for 2017 • The minimum positive payment adjustment is 0.28% • The maximum positive payment adjustment for clinicians who submitted 70 to 100 points is -- reason why many clinicians rather just submit enough points to avoid the negative payment adjustment rather than trying to submit the most points possible • The negative 4% payment adjustment taken away from MIPS eligible clinicians who submitted less than 3 points in 2017, is being used to pay the winners 1.88%
- 21. Options to Avoid the -7% Payment Adjustment
- 22. kareo.com 2222 Point Scoring System for 2019 0 – 29 Points 31 – 74 Points 75 – 100 Points What is Your Goal? 1. Submit as many points as possible to try to earn an incentive. 2. Submit enough points to avoid a negative payment adjustment. Either way, don’t ignore MIPS! 30 Points
- 23. kareo.com 2323 How are Points Earned? Submit 60 points to earn full credit Submit 100 points to earn full credit Submit 40 points to earn full credit Earn 100 points to earn full credit Do this: • Submit Quality Measures via claims • Select Improvement Activities • Track your PI score • Ensure you submit all MIPS data during the attestation period and before the deadline • Save all supporting documentation Keep in Mind: • Extra points for additional Outcome measures or High Priority Measures • Bonus points for having a Special Status such as Small Practice status • National Benchmarks
- 24. kareo.com 2424 Finding 30 Points Example: Provider is MIPS eligible and has a Small Practice Status Quality Measures: Submit 60 points to earn full credit Example: Provider has data for 4 Quality Measures • BMI: 7.5 points earned • HA1C: 5.4 points earned • Controlling HBP: 4.9 points earned • Smoking Cessation: 6.9 points earned • 4 bonus points (small practice status) Total= 24.7 + 4 bonus points 28.7 / 60= 47.8 x 45%= 21.5 Points Suggestions: 1. Find additional quality measures 2. Find points in the other MIPS categories
- 25. kareo.com 2525 Finding 30 Points Example: Provider is MIPS eligible and has a Small Practice Status Improvement Activities: Submit 40 points to Earn full credit Example: Provider completed two Improvement Activities that add up to 40 points. Remember that in this example, the provider has a Small Practice status, so his/her points for Improvement Activities double. • 1 Medium-weighted activity= 20 points • 1 Medium-weighted activity= 20 points Total= 40 points earned / 40 Total possible points= 1 x 15%= 15 points *You must come up and save all supporting documentation that proves you met your selected IAs. Create an audit binder and keep it for at least six years.
- 26. kareo.com 2626 Finding 30 Points Calculate your points Quality: 21.5 Points Improvement Activities: 15 points Total: 36.5 Points out of 100 (MIPS Overall Score) 0 -29 31 -74 75 -100 30 Save all supporting documentation: • Copy of Quality Measures Report • Supporting documentation for each Improvement Activity • Attest between Jan 2 and March 31, 2020
- 27. kareo.com 2727 Submitting Your Data We created a step-by-step list: 1. Select up to four Improvement Activities and up to six Quality Measures 2. Calculate the total points earned making sure the total is 30 points or higher 3. Gather and save any supporting documentation (reports, screenshots, other) 4. Create the clinician’s HARP login and password 5. To attest for Improvement Activities: Sign in at https://qpp.cms.gov/login 6. Confirm the clinician’s name, NPI, Practice name and TIN 7. Select the reporting option: Individual or Group 8. Select Improvement Activities 9. Enter the reporting period: 90 days up to a full year 10. Find the selected Improvement Activities and click the Yes check mark 11. Sign out
- 28. kareo.com 2828 Submitting Your Data To Submit Quality Measures: Claims Submission • Submit via claims all year long • No additional submission required Registry Submission • Run and Print the final quality measures report in January 2020 • Hire a registry such as OpenText: https://businessnetwork.opentext.com/merit- based-incentive-payment-system/ • Enter numerator & denominators from your report onto the registry • On Check Out, enter discount code: KareoMIPS (for a $100. discount) and log out Remember that data submission must be done before March 31, 2020 Tip: Log into the QPP website to see the Quality score that CMS has given you based on the Medicare Part B claims submitted for the year.
- 29. Prepare for 2020 What you should do now
- 30. kareo.com 3030 Reporting Year 2020 Point Scoring System for the 2020 Reporting Year Negative Payment Adjustment up to 9% Neutral Neutral or a small Positive Payment Adjustment Neutral or up to a +9% Payment Adjustment 0 -44.99 45.01 -84.99 85.0 -10045.0 9%Negative Positive
- 31. kareo.com 3131 What Should You Do? The 2020 Reporting Year will be the 4th year of the Quality Payment Program. By now you should: • Understand the basics of MACRA • Know how to avoid a negative payment adjustment • Expect CMS to raise the bar Use the suggested checklist below to help you prepare for a successful 2020:
- 32. kareo.com 3232 Beyond Reporting Year 2020 Reporting Year Performance Threshold Threshold for Exceptional Performance Payment Adjustement + or - 2017 3 *Full Year Reporting 4% 2018 15 70 5% 2019 30 75 7% 2020 45 85 9% 2021 60 85 9% *Pick-Your-Pace Why not embrace MACRA and try to earn an incentive? We see in the table below that: • The Performance Threshold is increasing up to 60 points • In 2021, the difference between avoiding a negative payment adjustment and earning an incentive is only 15 points
- 33. kareo.com 3333 How Kareo Can Help Kareo Resources: We strongly believe that having resources available just a click away can make a world of a difference to providers. 1. https://helpme.kareo.com/ 2. https://helpme.kareo.com/CMS_Incentive_Programs 3. https://helpme.kareo.com/CMS_Incentive_Programs/01MACRA/MIPS_2019_Qui ck-Start_Guide 4. We offer weekly MACRA/MIPS training 5. Additional one-on-one support is available via our Professional Services
- 34. kareo.com 3434 Awards and Rankings Growth Awards The speed at which medical practices are moving to Kareo and referring it to other providers. Software Reviews and Rankings 3rd party recognition, driven by direct customer feedback, equals trust and credibility.
- 36. kareo.com 3636 Kareo Platform Extensions
- 37. kareo.com 3737 How to Participate Today… Type your questions -- Questions After the Webinar -- 888.775.2736 x1 sales@kareo.com
- 38. kareo.com 3838 Connect with Kareo Stop by and say hi! Kareo @GoKareo GoKareo 3353 Michelson Drive, Suite 400 Irvine, CA 92612 (888) 775-2736