Countdown to MIPS* Data Submission Webinar Series Preparing for Fall Without Falling Behind Denise Hudson, NR-CMA Health Informatics Specialist Health Services Advisory Group (HSAG) August 10, 2018 *Merit-based Incentive Payment System
Poll Time Please participate in a poll! Respond and click [Submit] before 1:30 p.m. ET 2
Submit Questions Via the Q&A 1. Click the [Q&A] option at the top right of the presentation. 2. The Q&A panel will open. 3. Indicate that you want to send a question to the HSAG QPP Service Center. 4. Type your question in the box at the bottom of the panel. 5. Click [Send]. 3
Objectives At the completion of this training, the attendee will be able to: Determine current MIPS performance for all categories. Recognize how to use MIPS data to-date to strategize a fourth quarter performance boost. 4
Acronyms Used In Today s Presentation Acronym Definition ACO APM CEHRT CMS CE EOB EIDM EHR FEMA HPSA IA MACRA Accountable Care Organization Alternative Payment Model Certified Electronic Health Record Technology Centers for Medicare & Medicaid Services Continuing Education Explanation of Benefits Enterprise Identity Management System Electronic Health Record Federal Emergency Management Agency Health Professional Shortage Area Improvement Activities Medicare Access and CHIP Reauthorization Act Acronym Definition MIPS NPI PCMH PECOS PI PQRS QCDR QP QPP SNF TIN VBPM XML Merit-based Incentive Payment System National Provider Identifier Patient Centered Medical Home Provider Enrollment, Chain, and Ownership System Promoting Interoperability Physician Quality Reporting System Qualified Clinical Data Registry Qualified Participant Quality Payment Program Skilled Nursing Facility Tax Identification Number Value-based Payment Modifier Extensible Markup Language 5
6 Learning Forum Friday Updates
HSAG QPP Service Center Available www.hsag.com/qpp 7
HSAG s QPP Quest Digest! www.hsag.com/qppquest 8
QPP Technical Assistance Resource Guide 9 Source: CMS https://goo.gl/rudzd9
Next Learning Forum Friday Event: September 14, 2018 Deep-Dive Into the Various Submission Methods For additional event topics and registration information please visit: www.hsag.com/lff Topics and dates are subject to change, so please check the webpage for up-to-date information. 10
CMS Announcements: Upcoming Webinars CMS and the Chief Medical Officers from Regions VII, IX, and X will discuss the Proposed Rule for QPP for Year 3 (2019). Register for the: QPP Year 3 Proposed Rule Webinar Tuesday, August 14, 2018 2 3 p.m. ET at http://bit.ly/2lkitmv. 11
CMS Announcements: Upcoming Webinars (cont.) How to Maximize Your EHR Use to Succeed in MIPS: Advice for Solo and Small Group Practices Tuesday, August 14, 2018 3:30 4:30 p.m. ET Register at: https://adobe.ly/2mc9pbl Thursday, August 16, 2018 11 a.m. 12 noon ET Register at: https://adobe.ly/2oxjcfs Join one of these no-cost sessions to recognize: How to streamline workflows using your EHR and effectively communicate with your EHR vendor to get the support you need. How to successfully use your EHR to achieve better MIPS scores. Practical tips for addressing frequent EHR challenges encountered by solo practitioners and small group practices To view past MIPS no-cost small practice webinars visit https://qppsurs.wordpress.com/resources/. 12
CMS Announcements: Upcoming Webinars (cont.) Physician Fee Schedule Proposed Rule: Understanding 3 Key Topics Listening Session Tuesday, August 22, 2018, 1:30 3:00 p.m. ET Register at https://blh.ier.intercall.com/ CMS experts will briefly cover three provisions from the proposed rule and address clarifying questions to help formulate written comments for comments submission: Streamlining Evaluation and Management (E/M) payment and reducing clinician burden Advancing virtual care Continuing to improve the Quality Payment Program to reduce clinician burden, focus on outcomes, and promote interoperability 13
HSAG Quality Initiatives Spotlight Behavioral Health Initiative Increase Depression and Alcohol Misuse screenings amongst Medicare beneficiaries Cardiac Health Initiative Focus on Million Hearts 2022 Priorities Keeping People Healthy Optimizing Care Focusing on Priority Populations 14
HSAG Quality Initiatives Spotlight (cont.) Immunization Health Initiative August is Immunization Awareness Month Employee Immunization Awareness 15
Resources CMS Quality Payment Program Website https://qpp.cms.gov Subscribe to the QPP ListServe Guide for Obtaining an EIDM Account https://goo.gl/oy3jro Medicare Learning Network (MLN) Learning Management System Booklet (LMS) FAQs https://www.cms.gov/outreach-and-education/medicare- Learning-Network-MLN/MLNProducts/Downloads/LMPOS- FAQs-Booklet-ICN909182.pdf Associations offering credit for MLN events and training https://www.cms.gov/outreach-and-education/medicare- Learning-Network-MLN/MLNGenInfo/CE-Associations.html 16
CE Approval This program has been pre-approved for 1.0 CE unit for the following professional boards: National Board of Registered Nursing (Provider #16578) Florida Board of Clinical Social Work, Marriage & Family Therapy and Mental Health Counseling Board of Nursing Home Administrators Board of Dietetics and Nutrition Practice Council Board of Pharmacy Please Note: To verify CE approval for any other state, license, or certification, please check with your licensing or certification board. 17
CE Credit Process 1. Register at http://bit.ly/2k1r4vk in HSAG s Learning Management Center (LMC). 2. Once you have registered in the LMC, you must complete the evaluation that will appear in WebEx at the conclusion of the webinar. a. Following the event, please do not close the WebEx evaluation window. You will not be able to access the evaluation and request CE if you close the window. b. CEs are only available to attendees that participate in the live event. c. If for some reason you completed the evaluation and do not have the link to the new user registration, please refer to Step #1 or contact Debra Price at dprice@hsag.com for CE certificate questions. 18
CE Credit Process (cont.) 3. After completion of the evaluation, click [Submit] at the bottom of the screen. 4. Log into the LMC to retrieve your CE certificate and submit to your certification body. 19
CE Credit Process: Existing User To login to your existing LMC account visit http://bit.ly/2ls8lcf. 20
CE Credit Process (cont.) Following the conclusion of the webinar, you will also receive a Thank You for Attending email using the email address provided during registration. You will be requested to register in the HSAG Learning Management Center (LMC). This is a separate registration from WebEx. Please use your personal email so you can receive your certificate. Your organization may have firewalls up that block our certificates. 21
CE Certificate Problems If you do not immediately receive a response to the email that you provided in the LMC, you have a firewall up that is blocking the link that was sent. In that case: Please go back to the [New User] link and register your personal email account. Personal emails do not have firewalls. 22
Today s Presenter Denise Hudson, NR-CMA Health Informatics Specialist HSAG 23
2017 Final Performance Report and Targeted Review Wrap-up
Audience Participation Poll Have you logged in to the QPP Portal and reviewed your 2017 MIPS Final Performance Feedback Report? o Yes o No o Waiting on my EIDM account o Not applicable 25
MIPS 2017 Final Report 26 Source: CMS
MIPS 2017 Final Report FAQs Question: Why am I receiving a low payment adjustment when I earned a high 2017 MIPS final performance score? Answer: CMS understood the QPP was a big change for clinicians and designed a scoring system that would reduce burden and increase flexibility during this transition year. As a result, 91 percent of MIPS-eligible clinicians participated successfully in 2017. With more clinicians participating, the distribution of incentive payments was widely spread. Because the MIPS payment adjustment is required to be budget neutral, a scaling factor is applied to positive 2019 MIPS payment adjustment factors, which may result in a lower adjustment than you may have anticipated. Clinicians who were required to participate and did not, received a four percent payment reduction. 27 Source: CMS
MIPS 2017 Final Report FAQs (cont.) Question: If we reported as a group, can we see a breakdown of scoring by clinician? Answer: Group submissions include aggregated data for all clinicians in the group, so your scoring information is only available at the group level. Question: In cases where an eligible clinician was a participant in a MIPS APM, like a Medicare Shared Savings Program (MSSP) Track 1 (i.e., ACO), and he submitted data individually, which score will be awarded to him? Answer: If the eligible clinician was a QP in an ACO and submitted data as an individual, he will receive the score associated with the ACO, even if his individual score was higher. The ACO score trumps all others. 28 Source: CMS
What Is a Targeted Review? A Targeted Review is a process in which MIPS-eligible clinicians or groups can request that CMS review the calculation of their 2019 MIPS payment adjustment factor and, as applicable, their additional MIPS payment adjustment factor for exceptional performance. The deadline to submit a Targeted Review for 2017 is October 1, 2018, at 8 p.m. EDT. 29 Source: CMS
Targeted Review Webinar Join CMS on Tuesday, August 14, 2018, 2 3 p.m. EDT, for the following Webinar: Performance Feedback and Targeted Review Office Hours Session Register at: https://bit.ly/2lcxfwh 30 Source: CMS
Targeted Review FAQs Question: We recently discovered our EHR vendor did not submit our data correctly. Is this something we should file a Targeted Review for? Answer: Yes, you should submit a targeted review request, which includes an explanation of what occurred (the issue) along with any supporting documentation to correct the original submission. This is not a guarantee the decision will be reversed it, but it s a start. Question: We would like to submit a targeted review for certain clinicians in our TIN. Should we request a Targeted Review at the TIN or individual NPI level? Answer: Submit the request at the level where you believe there is an issue. 31 Source: CMS
Targeted Review FAQs (cont.) Question: I practice in an area deemed by FEMA to be a disaster area. My 2017 MIPS Final Report shows a -4 percent payment adjustment. What should I do? Answer: CMS is aware of this issue and is currently working to resolve it for all impacted clinicians and groups under the Extreme Circumstance Policy. They are also working on the Advancing Care Information (now known as Promoting Interoperability) category reweight for eligible clinician types and working to resolve issues with practices that participated in the 2017 Improvement Activities study and did not receive full credit. There is no need to submit a Targeted Review for these issues as they will be addressed soon. 32 Source: CMS
MIPS Final Report and Targeted Review Resources 2017 MIPS Final Reports and Targeted Review Portal: www.qpp.cms.gov 2017 MIPS Payment Adjustment Fact Sheet: https://go.cms.gov/2umr5xk 2017 MIPS Final Report Performance Feedback Fact Sheet: https://go.cms.gov/2n5awo8 Targeted Review Fact Sheet: https://go.cms.gov/2mhusgq Targeted Review Step-by-Step Guide: https://go.cms.gov/2ua8c6b Source: CMS
Final Report and Targeted Review YouTube Videos How to Request a Targeted Review demonstrates how MIPS eligible clinicians or groups can request a targeted review of their 2019 MIPS payment adjustment. Click here: https://bit.ly/2ljffev How to Access Performance Feedback for APM Entities provides an overview of how to access 2017 MIPS performance feedback for APM Entities. Click here: https://bit.ly/2kdmavw How to Access Performance Feedback for Individuals demonstrates how to access 2017 MIPS performance feedback for a clinician whose performance was scored separately from his or her group. Click here: https://bit.ly/2khr3c4 Source: CMS
Preparing for Fall
Year-to-Date LFF Lookback: MIPS Year 2 (2018) Category Focus Timeline www.hsag.com/lff 36 Source: CMS
Fourth Quarter Prep: Stage Your Pace! Spring focused on the Quality and Cost categories. Full year performance required Summer focused on starting either the Improvement Activities category or the Promoting Interoperability category. Minimum 90 consecutive days Fall focus is to begin the fourth category not started over the summer, either the Improvement Activities or Promoting Interoperability category. Minimum 90 consecutive days 37 Source: CMS
Fourth Quarter Prep (cont.) Review 2017 CMS feedback reports. Generate current reports weekly or monthly to check performance status. Make changes to workflow, as needed. Look ahead at MIPS in 2019. In December make your Data Submission Timeline Plan (i.e., check with your vendor for any final system updates). December 31, 2018: Last chance to review and update your security risk analysis. Apply for PI reweighting if applicable. Apply for hardship exemption if applicable. October 2018 November 2018 December 2018 For more strategies, view HSAG s Countdown to MIPS Data Submission Checklist at: https://bit.ly/2mtq0va. 38 Source: CMS
MIPS Category Weights 39 Source: CMS
APM Category Weight 40 Source: CMS
2018 Progress Check: Calculating Your Current MIPS Performance EHR Dashboard vs. Manual Process EHR Dashboards calculate automatically May require an update from your vendor 2018 Manual Process Used when a practice doesn t have an EHR. May be a little more complicated but there are numerous products/software available to help. In your internet browser try entering keywords such as free MIPS estimator. 41
Dashboard Samples 42 Source: Multiple Search Images
Who should Consider Claims Submission? Practices without an EHR Non-patient facing specialties Radiology, Pathology, Anesthesiology, etc. Sample Quality Data Code (QDC) on your claim form. Hospitalists Clinicians who visit multiple facilities Dialysis centers, SNFs, hospitals 43 Source: CMS
Choosing the Claims Submission Method Progress is not easily trackable. Remark Code (N620) can be found on your EOB. Help may be on the way! CMS may release some interim claims feedback for 2018 later this summer. Stay in touch with HSAG to be in the know! 44 Source: CMS
2019 QPP Proposed Rule
2019 QPP Proposed Rule CMS released the Proposed Rule for the QPP Year 3 (2019) on July 12, 2018. The Proposed Rule Fact Sheet is available at: https://go.cms.gov/2ktgko3 CMS is seeking comments on a variety of proposals in the 2019 Proposed Rule. Comments are due by September 10, 2018. Have your voice heard! Stay tuned! HSAG will let you know when the rule is finalized! 46 Source: CMS
Key Takeaways
Key Takeaways Review your 2017 MIPS Final Report Request a Targeted Review by October 1, 2018. Generate current performance reports from available systems or check out free apps/software. Keep your eyes and ears open for notifications from your vendors Updates, upgrades, registration, etc. Review the 2019 Proposed Rule and submit comments. 48 Source: CMS
Poll 49
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Thanks for Attending! HSAG QPP Technical Assistance Line Toll free: 1.844.472.4227 Monday Friday 8 a.m. to 8 p.m. ET HSAG QPP Email Support: HSAGQPPSupport@hsag.com 51
This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for Arizona, California, Florida, Ohio, and the U.S. Virgin Islands, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. QN-11SOW-D.1-08062018-01.