Find out why you need to pay attention to this Final Rule and what adjustments you need to make to ensure you end up on the winning side of MIPS. It's a complicated program, and results from the Final Rule don't make it any easier.
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2016 MIPS Final Rule: What you need to know NOW
1.
2. Submit by
March 31, 2018
Feedback
2018
Adjustment
January 1, 2019
The Medicare Access and CHIP
Reauthorization Act of 2015 (MACRA)
Quality Payment Program
Timeline
Performance Year
2017
4. Support for small and
independent practices
New opportunities for
Advanced Alternative
Payment Models
A flexible, pick-your-
own-pace approach
One unified program
supporting
Clinician-Driven
Quality Improvement
Changes in the Final Rule
5. • Less than or equal to $30,000
in Medicare Part B allowed
charges
• Less than or equal to 100
Medicare patients
Small Practice Exclusion
Small, independent
practices will be
excluded from new
requirements if
volume is:
6. What Is An Advanced Alternative
Payment Model?
Under the new law, Advanced APMs are the
CMS Innovation Center models, Shared
Savings Program tracks, or demonstrations
where clinicians accept both risk and reward
for providing coordinated, high quality, and
efficient care. These models must also meet
criteria for payment based on quality
measurement and for the use of EHRs.
7. APM Path
You earn a
5%
incentive payment in 2019*
* If you receive 25% of Medicare payments
* If you see 20% of your Medicare patients through
an Advanced APM in 2017
8. What is MIPS?
• MACRA combines the existing Medicare Meaningful
Use (MU), Physician Quality Reporting System (PQRS),
and Value-Based Modifier (VBM) programs into MIPS,
starting with the 2017 performance year.
• MIPS payment adjustments are applied to Medicare
Part B payments two years after the performance year,
with 2019 being the payment adjustment year for the
2017 performance year.
• MIPS defines four categories of eligible Provider
performance, contributing to a MIPS composite
performance score (CPS) of up to 100 points
9. Who is in the
Quality Payment Program?
You are a:
Physician
Physician Assistant
Nurse Practioner
Clinical Nurse Specialist
Certified Registered Nurse Anesthetist
you bill Medicare more than $30,000 a year
and
provide care for more than 100 Medicare patients a year
If 2017 is your first year participating in Medicare, then you are not
in the MIPS track of the Quality Payment Program.
11. Pick Your Pace
Don’t Participate
-4%
payment adjustment
Submit Something
0%
payment adjustment
Submit a partial year
+%
payment adjustment
Submit a full year
+%
payment
adjustment
12. You Have Choices
You can choose how you want to
participate based on your:
Practice size
Specialty
Location
Patient population
13. ** Potentially up to 3 times these rates
plus up to a 10% exceptional performance bonus **
Financial Impact Over Time
Performance
Year 2017
Medicare Part
B Payment
Adjustment
Year 2019
+4%
Incentive and
-4% Penalty
Performance
Year 2018
Medicare Part
B Payment
Adjustment
Year 2020
+5%
Incentive and
-5% Penalty
Performance
Year 2019
Medicare Part
B Payment
Adjustment
Year 2021
+7%
Incentive and
-7% Penalty
Performance
Year 2020
Medicare Part
B Payment
Adjustment
Year 2022
+9%
Incentive and
-9% Penalty
14. • CMS will set a threshold performance score each
year based on all eligible provider scores from a
prior period.
• Scores exactly equal to the performance threshold
= zero payment adjustment
• Scores progressively above the performance
threshold = progressively increasing incentives
• Scores progressively below the performance
threshold = progressively increasing penalties
Every Point Counts
15. How is it scored?
4
performance
categories
Cost
in 2017
0 points
Advancing
Care
Information
(formerly
Meaningful Use)
25 points
Clinical
Practice
Improvement
Activities
15 points
Quality
(PQRS/VBM)
60 points
16. Quality Points Example
If a PQRS measure has a 62% measure rate better than 60% of
peers reflected in the benchmark, then that measure would earn 7
out of 10 possible points.
Quality Points Example
18. What can I do now
to prepare for January 2017?
• Educate your organization as soon as possible
• Estimate your MIPS score using your current MU, PQRS
and VBM scores
• Optimize MU & PQRS/VBM Quality to maximize the
MIPS score
• Evaluate staff, resources and organizational structure
• Identify 2016 deadlines impacting 2017 MIPS, such as
the Medicare Shared Savings Program Track 2/3 ACO or
NCQA PCMH application deadlines to gain MIPS
exemptions or points
20. Mining
The Ability to Impact scale brings
in clinical, social, and
administrative factors to
determine which patients are
worth addressing
Visualizing
Package of preset graphs, heat
maps, plots, and diagrams eases
consumption of data
Reporting
Two Hour Guarantee -
Sometimes you need an answer
immediately
Actions
Key indicators automatically
create actions
Data Submission
Quality programs require
data submission -
HEDIS • GPRO • Other quality
measures
CareOptimize Population
Management Module
21. CareOptimize Care Management
Module
One Easy-to-Review Screen
The CareOptimize Care Management module collects all relevant clinical
information from disparate sources feeding the enterprise data
warehouse and displays it on a single screen.
• Automatically create evidence-based care plans specific to a patient’s
• diseases and social impacts in seconds using the integration with M*Modal.
• Review the evidenced-based literature included with the protocol, or simply
override it on a per patient, per provider, or per organization basis.
• Add your own protocols for your specific patient population.
Routine contact with a Care Manager can be the difference between a stable
patient or an expensive hospital stay. Medical assistants, health coaches,
nurses, and physicians can proactively reach out to these patients and stop
preventable expenses before they occur.
22. Identify. Assign. Engage. Measure.
After your high-risk, high-cost, high-ability-to-impact patients have
been identified, the cost improvements can have a dramatic increase
on your bottom line.
23. CareOptimize Coding Module
Make sure you are correctly reimbursed for the
additional costs unhealthier patients incur
• More precise diagnosis data
• Supported clinical documentation in case of an audit
• Greater efficiency, accuracy, and workflow management
• Correct reimbursement
• Discrete data from the EHR
• Claims data from payer feeds
• Scanned specialist notes
• (neatly) Hand written notes
Coding Accuracy Module
More than 1,000,000 disease concepts
developed over the past 15 years
24. Opportunities are identified overnight and available directly to physician at
point of care
Selected codes are automatically added to the encounter’s assessments
within the EHR workflow
Opportunities are reviewed and validated by coders before being sent on
to the physician
Rejected opportunities are continually reviewed
Coding Opportunities
25. The CareOptimize
Peer Benchmarking Module
Automates registration for MIPS, MACRA, MU, PQRS, and VBPM
Displays how peer organizations are scoring on
measures, including which are topped out
Recommends the best ways to
maximize scores against your
peers
Automates the attestation process
to CMS or Medicaid
Gives real-time progress on CMS
26. How Can CareOptimize Help?
• CareOptimize offers a State of the
Practice Evaluation. This is a free
evaluation that looks to see if your
practice is running efficiently,
checks to see if you are maximizing
your reimbursements, and reviews
the system to see if you are keeping
up with Meaningful Use and all of
the updated regulations. This
evaluation also answers the
question Are you ready for MIPS?
• A CareOptimize project specialist
will run your report, review it and go
over it in detail with you to discover
what you can be doing to make your
practice even better.
27. State of the Practice Report
• Top 20 Payers
• Denial Rate
• A/R Aging
• Bill Lag Time
• Charge Entry Lag Time
• Unapplied Credits
• Active Contracts
• BBP Jobs List
• Average Appointment per Day
by Provider
The State of the Practice Report captures information in these areas
• First Third Appointment by
Resource
• Meaningful Use
• CQM/PQRS by Provider
• CCM Coding
• All Users with Greater than 20 Tasks
• All Users with Tasks Over 7 Days
• All Templates in Use During the Last
2 Months
• All KBM Templates in Use During
the Last 2 Months
• Referrals Open
28. Contact Us
Please contact us to sign up for this free report
today!!
erica.badran@careoptimize.com
Jonathan Shivers:
770-595-3096
jonathan.shivers@careoptimize.com
Please follow http://www.ehrutilities.com/ to see
additional utilities provided by CareOptimize.
29. CMS Additional Resources
• CMS offers additional resources to help guide you
through this final rule. https://qpp.cms.gov/education
• Quality Payment Program Fact Sheet:
https://qpp.cms.gov/docs/Quality_Payment_Program_
Overview_Fact_Sheet.pdf
• Where to find Help:
https://qpp.cms.gov/docs/QPP_Where_to_Go_for_Hel
p.pdf
• Comprehensive list of APMs:
https://qpp.cms.gov/docs/QPP_Advanced_APMs_in_2
017.pdf
30. CMS Additional Resources (Continued)
• CMS also offers Videos as well as Webinars.
• The Quality Payment Program Service Center is also
available to help.
1-866-288-8292 Monday-Friday 8:00am-8:00pm EST
Questions can also be sent via email to
QPP@cms.hhs.gov
The new website CMS has created for this program
can be accessed at https://qpp.cms.gov/