2022 is the sixth year of the CMS Incentive Program, MACRA /MIPS, and as a practice or billing company, you have seen payment adjustments that have affected your business in more than one way. The biggest impact is payment adjustments, where we see up to a negative 9% of claims paid. So what can you do about it, and how can we minimize those adjustments?
Marina Verdara, CMS Incentive Program SME and Sr. Training Specialist at Kareo will explore what you need to know about MACRA/MIPS and how you can improve your bottom line. She will walk you through:
-The overview of MACRA
-MIPS eligibility, training, and tracking progress for providers
-Billing companies & the claims submission process
-Supporting documentation & attestation
2. Safe
Harbor
The information in this presentation is confidential and proprietary to Kareo® and may not
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agreement or any other service or subscription agreement with Kareo. Kareo has no obligation
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develop or release any functionality mentioned therein.
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and may be changed by Kareo at any time for any reason without notice. The information on
this document is not a commitment, promise, or legal obligation to deliver any material, code,
or functionality. This document is for informational purposes and may not be incorporated into
a contract. Kareo assumes no responsibility for errors or omissions in this document.
3. Agenda
• MACRA/MIPS Overview
• Claims Submission Process
• 5 Easy Steps for Compliance
• What’s New in 2022
• What You Should Do Now
• Q&A
5. Kareo and PAHCOM
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 webinar
to receive credit
6. Kareo and AAPC
Supporting Your
Professional Development
• 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 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.
7. Marina Verdara
Regulatory SME- Customer Education
• 10+ years experience with hundreds of small practice
clinicians
• CMS Incentive Programs SME
• Trains clinicians on meeting MIPS requirements using tools
in Kareo Clinical EHR
9. The Quality Payment Program (QPP)
● QPP: MIPS & APMs
● Goal is better care for patients
● Help reduce healthcare cost
● Motivate clinicians to provide better
quality care
● Improve patient communications
● Increase security in Data Exchange
between providers
QPP
MIPS APMs
11. MIPS-Important Facts
• Bill $90K+ in Medicare Part B charges per year
• Have 200+ Medicare Part B patients
• Render 200+ covered professional services
Eligibility Criteria
• Quality 30%
• Promoting Interoperability 25%
• Improvement Activities 15%
• Cost 30%
Four Categories
• Between -9% and +9%
Payment Adjustments
12. MIPS-Important Facts (cont.)
• Minimum Performance Threshold = 75 Points
• Exceptional Performance Threshold = 89 points
Thresholds
• Individual or group
• Quality: full year submission
• Promoting Interoperability: 90- 365 days
• Improvement Activities: 90 - 365 days
• Cost: full year evaluation of Medicare Part B claims
Submission Options
13. APM Basics
• Most are known Accountable Care Organizations
(ACOs)
• Managed by local hospitals, medical groups, IPAs
• Administrator assigns quality measures to clinicians
• Clinicians may or may not be required to submit
data for MIPS
• Each APM has its own requirements and thresholds
• Providers can earn more incentive dollars than in
traditional MIPS
• MIPS Category scores are different for APM
participants
15. Claims Submission Process
• Go to QPP.CMS.gov
• From MIPS, select Quality Requirements
• Scroll down & click on Explore Measures
• Scroll down to the filters & select
• Your Specialty
• Medicare Part B claims measures
16. Claims Submission Process (cont.)
• Select Quality Measures from list
• Find Collection Type and Documentation
• Select Medicare Part B Claims measures
Specifications (PDF)
• Measure Specification opens in PDF format
• Identify if a measure is classified as a High
Priority Measure, Outcome measure or
both as in this example.
17. Claims Submission Process (cont.)
• Review Description and Instructions
• Understand how Denominator is calculated
• Find required codes in Numerator section
• Submit via Claims as they apply to your patients
• Quality Measures must be submitted for full year
19. Practice & Biller Partnership
1. Confirm MIPS eligibility
2. Learn the Program
3. Track progress
4. Gather supporting documentation
5. Attest
20. Step 1: Confirm Eligibility
• Are you eligible?
• MIPS
• APM
• Both
• Define your goal
• Avoid Negative Payment Adjustment (60 pts)
• Earn Positive Payment Adjustment (85 pts)
• Create a team
• Provider
• Clinical Assistant
• Office Manager
• Biller
21. Step 2: Learn the Program
Prepare Your Team Kareo University Support
• Select measures and set goals
• Share responsibilities
• Identify team trainer
• Set recurring reminders to run reports
• Find the MACRA/MIPS course
• Complete all 4 sessions (live or recorded)
• Attend attestation webinars provided
yearly from January through March
• https://helpme.kareo.com/CMS_Incentive
_Programs
• Step-by-step guides
• Short videos
22. Step 3: Track Progress
• Run Quality Measures Report
• Run Promoting Interoperability Report
• Identify measures needing improvement and review guides for each
• Verify that scores align with goals
• Repeat every two weeks
23. Create MIPS Audit Folders
• Hard copy saved in the practice
• Electronic backup version
Store in folders:
1. Security risk assessment
2. Supporting docs for improvement activities
3. Copies of final reports
• Quality Measures Report (QRDA /xml)
• Promoting Interoperability (PDF)
4. Kareo Certification ID Number
Step 4: Gather Supporting
Documentation
24. Step 5: Attest
• Attend Kareo’s free Attestation Webinars
(mid-January through end of March)
• Find EIDM/HARP login credentials at QPP.CMS.gov
• Have MIPS audit binder accessible
• Log into attestation webinar and submit MIPS data
• Check preliminary score
• Receive final score after attestation deadline
25. Readiness Checklist
• Free training (live and recorded) for
Clinicians and Billing Companies
• Step-by-step guides
• One-on-one support via professional
services
• Free attestation webinar
• Kareo University Training Modules
27. ● Group-level scores only for group submissions
● No more bonus points for:
○ Reporting additional outcomes
○ Patient experience
○ High-priority measures beyond the one required
○ Measures meeting end-to-end electronic reporting
criteria
Note:
● The Eligible Measure Applicability (EMA) process is
applied to providers who submit fewer than 6 measures
or submit more than 6 measures, but no Outcome or High
Priority measures.
● EMA applies to providers who report quality measures
through Medicare Part B claims or submit MIPS CQMs.
Quality Measure Performance Category Changes
You can help:
● Go to:
https://qpp.cms.gov/resources/resource-
library
● Use the following filters:
28. Exceptions:
● Small practices automatically reweighted to 0%
● No need to report data for reweighting
● No need to submit hardship exception
application for reweighting
Participants:
● New SAFER Guides attestation measure
● Immunization Registry & Electronic Case
Reporting now required:
https://www.healthit.gov/topic/safety/safer-
guides
● Bonus points for optional measures
● 21st Century Cures Act: Information Blocking
○ Direct Message
○ Patient Portal
Promoting Interoperability Performance Category Changes
You can help:
● Go to:
https://qpp.cms.gov/resources/resource-
library
● Use the following filters:
29. New episode-based measures for:
● 2 Procedural Measures
● 1 Acute inpatient medical measure
● 2 Chronic Condition Measures:
○ Diabetes
○ Asthma/COPD
Medicare Part B Claims
● Medicare Part B claims are reviewed for
the full calendar year
Cost Performance Category Changes
You can help:
● Go to:
https://qpp.cms.gov/resources/resource-
library
● Use the following filters:
31. ● Monitor reports every 2 weeks
● Use Kareo resources such as:
○ https://helpme.kareo.com/CMS_Incentive_Programs
○ https://helpme.kareo.com/CMS_Incentive_Programs/Dashboards_and_Supporting_
Documentation/Create_Quality_Measures_Report
○ https://helpme.kareo.com/CMS_Incentive_Programs/01MACRA/MIPS_Action_Plan
Helping your customers now, will help prevent possible negative adjustments
Stay On Top of MIPS