Getting the Most Reimbursement From MACRA/MIPS

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by Selena Hood, M.S., SAFe SP, PMPO, SASM, Program Manager, Quality Payment Programs at Change Healthcare

 In Medical Billing & Claims

5 Opportunities to Help Improve Your MACRA/MIPS Scores and Increase Reimbursement2019-07-30changehealthcare-bloghttps://www.changehealthcare.com/blog/wp-content/uploads/rpa-macra19-blog-1037×450.jpg200px200px

An estimated 798,000 clinicians will be MIPS eligible in the 2019 performance period.[1] CMS predicts 74% will earn an “exceptional performance” bonus for 2018 with a minimum distribution of 0.25%[2], while those choosing to not participate will be assigned a maximum penalty of 7%[3].

Five Opportunities to Help You Succeed with MACRA/MIPS

Fortunately, there are steps you can take now to help streamline the MACRA/MIPS reporting process and achieve the best possible financial outcome.

  1. Engagement and education. A commitment for continued performance improvement by all members of the practice is key as well as continued education. Knowing the major requirements under the program will help clinicians align their quality goals.
  2. Use CMS’s previous feedback to drive future quality-performance efforts. For example, check your Medicare reports from 2016, 2017, and preliminary 2018 reports, plus your 2016 QRUR reports and your 2017 cost analysis. This feedback can be invaluable for identifying organizational gaps and opportunities to help improve performance levels for 2021. Additionally, check your participation status on the CMS QPP site.
  3. While it might be tempting, don’t rely on the same set of measures year after year. Eventually, those measures will reach a topped-out list. Consider using new measurements that might be better matched to your specialty. MIPS offers more than 270 quality measures from which to choose. Another option is to work with a qualified clinical data registry (QCDR), which can provide additional measurements based on your practice’s unique needs. A QCDR also offers a variety of additional pertinent details you may want to capture and report. Find what works best for you.
  4. Leverage your revenue cycle management vendor to help ensure you have the analytics necessary to enable baseline measurements and continuous performance improvements. This is essential to your practice’s success and to the effectiveness of your MACRA/MIPS efforts. Analytics are necessary to understand where you stand in comparison to previous quality measurements, as well as to those of other similar entities.
  5. Finally—and this cannot be over-emphasized—make sure you submit your data. Neglecting to do so will result in a zero score from CMS, along with the maximum negative adjustment of -5% in 2020 and -7% in 2021.

Not Eligible?

In 2019, CMS has expanded its offerings for exempt providers. If you meet at least one of the low-volume threshold criteria, you can opt into MIPS and submit data based on the 2019 requirements, get scored, and receive a payment adjustment.

Begin Preparing Today

The goal of MACRA/MIPS is to improve outcomes and reduce costs by increasing the effectiveness of reporting. Start preparing today for the next payment period to help ensure you are focusing on the right measurements to achieve the best possible scores and financial rewards. Doing so can help positively impact your long-term viability.

Whether you are prepared to tackle quality programs in-house or need expert external resources to guide you, the time to act is now to ensure you receive the maximum reimbursement for your practice.



Getting the Most Reimbursement From MACRA/MIPS