2017 MIPS Quality Program Welcome to MACRA/MIPS 2017 New Medicare Quality Program Becky Walter, MCS-P KMC University Medicare Quality Payment Program Pay-For-Performance New Incentivized Quality Program Established by MACRA legislation Quality measurements will determine payment levels SGR is gone Exemption threshold is changed 2017 EHR attestation simplified Practice Improvement Activities Reporting Incentive in payments The Major Changes New Reporting Systems APMs Accountable Care Organizations Medical Homes Assumed Risk Repayment for failure <5% Providers in 2017 MIPS Claims, Registry, EHR Pick reporting period PQRS, Attestation, Plus Practice Improvement 2017 reporting affects 2019 Transition year 2017 1
Exclusions for 2017 MIPS First year as a Part B Provider Bill through Facility or Hospital $30,000 or less in allowable charges OR less than 100 unique patients Submit Something o 1 Quality Measure or o 1 Improvement Activity or o c) Base ACI information Submit Full year or 90 days Use the exclusion or decide to practice submitting Pick Your Pace Results of Choice Choices Bring Results Some Medicare Advantage Plans can be an Advanced APM or a Kaiser-like model. Carefully review your contracts. Quality is Primary 271 measures Chiropractic has 2 Advancing Care Information (EHR) 5 basic measures Improvement Activities New Segment Choose from list Cost Will Come in 2018 New Measures Former EHR attestation Former PQRS measures 2
Your To-Do List More Detail on Payment Changes Run Practice Reports Do Some Math on Payments Learn Your Quality Measures Pick Your Reporting Time and Method Update your EHR if necessary 1. Merit Based Payment (MIP) beginning 2019 incorporates one system 2. Alternative Payment Models (APM) for ACO s Medical homes, etc provides incentive lump-sum payments 2019-2024 with higher payments in 2026 Based on $20,000 allowable per year: $800 $1000 $1400 $1800 $5,000 Do Report What Happens If You... Fee protection or improvement Listings on Physician Compare Website Continued inclusion Don t Report 2019 Fee reduction Fewer Medicare Patients Lowered threshold in 2018 and you ll have to learn it then Advancing Care Information Formerly EHR attestation incentive 3
New Quality Section 2017 Quality Reporting Only 2 Measures 1 Must be an Outcomes Measure Quality Benchmark 50% 2019 Fee Impact Claims or Registry 4
Incentives Reporting Individual Measures Make a choice Plan for how you ll report Claims is in real time Registry, EHR, QCDR gives you until first quarter 2018 How to Find Your Fee in 2017 Non-par providers must know their Limiting Charge PQRS and EHR for 2015 affect which column you will look to for your fee schedule Most Fee Schedules for your carrier are searchable What Do I Charge in 2017 Participating doctors can submit claims for full fee or allowable charge Allowable charge will be reduced on EOB 5
Tools for Finding Your Fee Physician Compare Website Tools to confidently and accurately determine your fees Use your MAC website Know your status PQRS in 2015 EHR in 2015 Letter received in 2016 Learn how to check your own profile on the patient-centric Physician Compare website Started January 1, 2016 patients were given access to your rating Ordered list based on quality ratings Physician Compare Website How Do I Look? How Do I Look? Options for Reporting Quality Successfully Received On Your EOMB Individual Reporting Group Reporting N620 CO 246 N572 QCDR Unique Registry Qualified Registry - General Certified EHR w/capability Claims QCDR Unique Registry Qualified Registry - General Certified EHR w/capability Claims CMS Web Interface (groups of 25 and above) CAHPS for MIPS Survey 6
Successful Reporting on Claims Clear Reporting Standards On CMS-1500 Claim Form On the same form page as the CMT service Qpp.cms.gov Need Help? Info@kmcuniversity.com 7