Setting Your Business Up for MIPS Success in 2019
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In this webinar, Sr. Training Specialist, Marina Verdara, will provide you with the information and tools you need to ensure that your business avoids receiving penalties related to MACRA. Marina will: -Provide an in-depth analysis of MACRA, including APM and MIPS -Review the four MIPS reporting categories and how your business can meet each of their individual requirements -Recommend industry best practices so both independent medical practices and billing companies can avoid penalties in 2019
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Setting Your Business Up for MIPS Success in 2019
- 1. webinar Setting Your Business Up for MIPS Success in 2019 Marina Verdara, MBA June 18, 2019
- 2. kareo.com Agenda 2 Agenda 2 ⢠Welcome & Introductions ⢠MACRA ⢠Payment Adjustments ⢠Recommendations ⢠Your Questions
- 3. kareo.com 33 How to Participate Today Type your questions Download todayâs resources View todayâs presentation
- 4. kareo.com 44 Connect via Social twitter.com@GoKareo facebook.com/GoKareo linkedin.com/company/kareo
- 5. kareo.com 55 Supporting Your Professional Development ⢠PAHCOM has approved 1 CEU credit ⢠Youâll 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 live webinar to receive credit ⢠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 live 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.
- 6. kareo.com 66 Speaker Marina is a Sr. Training Specialist guiding Kareo customers to higher levels of success with their CMS Incentive Program reporting. Marina has more than eight years of experience working directly with hundreds of small practice clinicians on a variety of projects. Her specialty is working with clients on CMS Incentive programs such as Meaningful Use, PQRS, and MACRA. Marina Verdara, MBA
- 7. MACRA Itâs easier than you think
- 8. kareo.com 88 What is MACRA? MACRA MIPS Quality 45% -Report up to 6 measures -Full year reporting Promoting Interoperability 25% -4 objectives -90 days up to a full year reporting Improvement Activities 15% - Submit 40 points to earn full credit Cost 15% -10 measures evaluated -Data submission not required APM ACOs Specialty Specific Programs State Specific Programs
- 9. kareo.com 99 2019 APMs 2019 Approved APMs ⢠Bundled Payments for Care Improvement Advanced Model (BPCI Advanced) ⢠Comprehensive ESRD Care (CEC) Model LDO Arrangement ⢠Comprehensive ESRD Care (CEC) Model non-LDO Two-Sided Risk Arrangement ⢠Comprehensive ESRD Care (CEC) âModel non-LDO one-Sided Risk Arrangement ⢠Comprehensive Primary Care Plus (CPC+) ⢠Medicare Accountable Care Organization (ACO) Track 1+ Model ⢠Next Generation ACO Model ⢠Shared Savings Program - Track 2 ⢠Shared Savings Program - Track 3 ⢠Oncology Care Model (OCM) - Two-Sided Risk ⢠Oncology Care Model (OCM) - One-Sided Risk ⢠Vermont Medicare ACO Initiative ⢠Maryland Primary Care Program ⢠Independence at Home Demonstration
- 10. kareo.com 1010 Alternative Payment Models (APMs) Important facts to know about APMs: ⢠These are Medicare Incentive programs ⢠They are managed by local medical entities such as hospitals, medical groups, or IPAs ⢠Most are known ACOs ⢠The APM/ACO administrator assigns quality measures to clinicians ⢠Clinicians might also be required to submit data for MIPS ⢠Every kind of APM has itâs own requirements and thresholds. *The best thing a clinician can do is to partner up with the medical entity who invited them to join the APM
- 11. kareo.com 1111 Merit-based Incentive Payment Systems (MIPS) Quality ⢠6 Measures or a Full Specialty Set ⢠1 Outcome Measure or 1 High Priority Measure â˘Improvement Activities ⢠10 Measures Evaluated ⢠Based on Part B Claims Submitted All Year Long ⢠No Additional Data Submission is Required Promoting Interoperability ⢠ePrescribing ⢠HIE (Health Information Exchange) ⢠Provider to Patient Exchange ⢠Public Health & Clinical Data Exchange ⢠Protect Patient Health information â˘Cost ⢠Submit 40 Points ⢠Medium= 10 Points ⢠High= 20 points ⢠Points Double for Clinicians with a Special Status Clinicians will be scored based on performance submitted in four categories:
- 12. kareo.com 1212 Quality ⢠Report 6 measures; or a complete specialty set ⢠Include 1 outcome or a high-priority measure ⢠Bonus points awarded if more than 2 outcome or high-priority measures are submitted ⢠Full year reporting (Jan-Dec) ⢠Must report at least 20 cases for each measure to be fully scored ⢠Must meet the data completeness requirement standard of 60% ⢠Small practices earn up to 6 bonus points in the quality category ⢠Multiple collection types (submission methods) include claims and registry submission
- 13. kareo.com 1313 Promoting Interoperability Eligible clinicians will be scored on their performance on four objectives and one mandatory measure: Objective Measures Maximum Points ePrescribing ePrescribing 10 points Prescription Drug Monitoring Program Optional Verify Opioid Treatment Agreement Optional Health Information Exchange Send Health Information 20 points Receive & Incorporate Health Information 20 points Provider to Patient Exchange Provide Patients Electronic Access to their Health Information 40 points Public Health & Clinical Data Exchange Report to two different public health agencies or clinical data registries 10 points * Protect Patient Health Information A Security Risk Assessment is mandatory, but will not be Scored *Mandatory
- 14. kareo.com 1414 ⢠The goal is to submit 100 points ⢠Measures removed: ⢠Patient Education ⢠Secure Messaging ⢠View, Download or Transmit (VDT) ⢠Patient-Generated Health Information ⢠Exclusions available for some measures ⢠Submission options include registry and manual submission via the attestation website Promoting Interoperability
- 15. kareo.com 1515 Improvement Activities To earn full credit (15%) in this category, clinicians must submit a combination of activities that add up to 40 points: ⢠Medium= 10 points ⢠High= 20 points ⢠2 high-weighted activities ⢠1 high-weighted activity and 2 medium- weighted activities ⢠4 medium- weighted activities ⢠Clinicians with a special status will earn double points for each activity. A special status is ⢠Small practice ⢠Non-patient facing ⢠Rural ⢠Health Professional Shortage Area (HPSA)
- 18. kareo.com 1818 ⢠Supporting documentation: ⢠Screenshots: EHR and/or PM/Billing ⢠Create policies and procedures ⢠Write a statement to explain how you believe you met your selected activity, date and sign it ⢠Reports ⢠Screenshots of a website such as a drug monitoring website ⢠Save supporting documentation for a minimum of six years ⢠Save supporting documentation in a MIPS audit binder ⢠Submission types include registry and manually via the attestation website Improvement Activities
- 19. kareo.com 1919 Cost ⢠10 cost measures will be evaluated ⢠If there are not enough attributed beneficiaries for any of the 10 measures to be scored, the Cost performance category percentage will be redistributed to the Quality performance category. ⢠No additional data submission is required ⢠Full year evaluation ⢠You can learn more about it at: https://qpp.cms.gov/about/resource-library
- 20. Kareo Confidential 2020 Who is Eligible for the QPP? Clinicians are eligible if they meet or exceed the low-volume threshold: 1. Bill Medicare over $90,000 in Part B allowed charges a year, and 2. Provide care to more than 200 Medicare Part B patients, and 3. Provide 200 or more covered professional services to Part B patients Clinician Types: ⢠Physician ⢠Physician Assistant ⢠Nurse Practitioner ⢠Clinical Nurse Specialist ⢠Certified Registered Nurse Anesthetist ⢠Physical Therapist ⢠Occupational Therapist ⢠Clinical Psychologist ⢠Qualified Speech-Language Pathologist ⢠Qualified Audiologists ⢠Registered dietitians or Nutrition Professionals
- 21. kareo.com 2121 Eligibility Determination Eligible Opt-In Option Voluntary Participation Meets or Exceeds ALL Low-Volume Threshold Criteria Meets or Exceeds One or Two Low-Volume Threshold Criteria Does NOT Meet or Exceed ANY Low-Volume Threshold Criteria ⼠90k in Part B Charges, and ⼠200 Part B Beneficiaries and ⼠200 Professional Services ⼠90k in Part B Charges, or ⼠200 Part B Beneficiaries, or ⼠200 Professional Services < 90k in Part B Charges < 200 Part B Beneficiaries < 200 Professional Services Will Receive Feedback Will Receive Feedback Will Receive Feedback Eligible for a Payment Adjustment Eligible for a Payment Adjustment NOT Eligible for a Payment Adjustment The Review Periods to determine a clinicianâs eligibility is: ⢠October 1, 2017 â September 30, 2018 ⢠October 1, 2018 â September 30, 2019 There are three participation options:
- 22. Payment Adjustments Which side of the scale are you on?
- 23. kareo.com 2323 Payment Adjustments According to the CMSâs 2017 QPP Experience Report: 0 - 2 4 - 74 75 - 100 2017 Group Size Negative Payment Adjustment Count # Individual (1) 2,225 Small Group (2 - 15) 20,014 Total 22,239 3 Group Size Neutral Payment Adjustment Count # Positive Payment Adjustment Count # Individual (1) 20,137 55,240 Small Group (2 - 15) 670 23,539 Total 20,807 78,779
- 24. kareo.com 2424 Payment Adjustments Starting January 2019, Medicare Administrative Contractors (MAC) will use the three code types listed below to identify payment adjustments for the 2017 reporting year: ⢠Claim Adjustment Reason Code (CARC): 144 for a positive payment adjustment and 237 for a regulatory penalty ⢠Remittance Advice Remark Codes (RARCs): N807 âMIPS based payment adjustment ⢠Group Code: CO for a regulatory requirement that resulted in an adjustment Clinicians will also receive a Medicare Summary Notice (MSN) every three months. If a payment adjustment was made, the MSN will indicate the following message: âThis claim shows a quality reporting program adjustmentâ
- 25. kareo.com 2525 Payment Adjustments Important facts about payment adjustments for 2017: ⢠93% of clinicians received a positive payment adjustment. Code used is CARC 144 ⢠5% received a negative payment adjustment. Code used is CARC 237 ⢠ONLY 2% of clinicians received a neutral status ⢠The national mean MIPS score was 74.01 ⢠Clinicians in small practices received an average score of 43.46 points ⢠The national mean APM score was 87.64 93% 5% 2% 2017 PAYMENT ADJUSTMENTS Positive Payment Adjustment Negative Payment Adjustment Neutral
- 26. kareo.com 2626 Payment Adjustments ⢠The minimum positive payment adjustment is 0.28% ⢠The maximum positive payment adjustment for clinicians who submitted 70 to 100 points is ⢠The negative 4% payment adjustment taken away from providers who ignored MIPS or submitted less than 3 points in 2017, is being used to pay the winners 1.88% This Photo by Unknown Author is licensed under CC BY Which side of the scale are you on?
- 27. Recommendations What can you do?
- 28. kareo.com 2828 MIPS 2019 Point Scoring System Up to -7% Payment Adjustment Neutral Neutral or a small Positive Payment Adjustment Neutral or up to a +7% Payment Adjustment 0 - 29 30 - 74 75 - 100 Quality 45% PI 25% IA 15% Cost 15% 100% Submit 60 points to earn full credit Submit 100 points to earn full credit Submit 40 points to Earn full credit Earn 100 points to earn full credit 30
- 29. kareo.com 2929 What Can You Do? Understand MACRA ďź Confirm your MIPS/APM eligibility status ďź Sign up for training ďź Take advantage of resources available to you Take Action ďź Create a team: include clinicians, staff and billers ďź Refine your teamâs knowledge on MIPS ďź Select your measures and submission options ⢠Claims, registry, manual attestation ďź Set goals and expectations and meet regularly ⢠Find ways to incentivize team members for their good work. Create contests. Make it fun! ďź Track your progress. Run reports twice per month
- 30. kareo.com 3030 What Can You Do? Attest Run your final reports in January 2020: ďź Full Year for the Quality category ďź 90 days up to a full year for the Promoting Interoperability Category ďź Gather and save any supporting documentation for your selected improvement activities ďź Submit your data prior to March 31, 2020 Number of Clinicians Total Part B claims paid per Year Negative 7% Assuming the national maximum positive payment adjustment is 2% 1 150,000 $10,500 $3,000 2 220,000 $15,400 $4,400
- 31. kareo.com 3131 Recommendations Clinicians Calculate your possible financial gains or losses and ask yourself: ďź Can I afford to leave money on the table? ďź Am I willing to modify my workflow to improve my scores? ďź Create a customized MIPS plan for your team Billing companies Calculate your clinicianâs possible financial losses and how those financial losses could impact you ďź Partner up with clinicians to help them earn a positive payment adjustment ďź Should you incentive clinicians for meeting MIPS? ďź Should you setup recurring meetings? ďź Should you be involved in the attestation process?
- 33. kareo.com 3333 Awards and Rankings Growth Awards The speed at which medical practices are moving to Kareo and referring it to other providers. Software Reviews and Rankings 3rd party recognition, driven by direct customer feedback, equals trust and credibility.
- 35. kareo.com 3535 Kareo Platform Extensions
- 36. kareo.com 3636 How to Participate Today⌠Type your questions -- Questions After the Webinar -- 888.775.2736 x1 sales@kareo.com
- 37. kareo.com 3737 Connect with Kareo Stop by and say hi! Kareo @GoKareo GoKareo 3353 Michelson Drive, Suite 400 Irvine, CA 92612 (888) 775-2736