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Last June’s post was about new Medicare cards. At the time of the post, it seemed like a long time away and something that could be pushed off until a later time. Well, that time is upon us. Beginning next month, the federal government will begin issuing new Medicare cards. Gone are the days of using the patient’s Social Security numbers as their ID numbers. The new Medicare cards will have unique, randomly assigned numbers and letters that replace Social Security numbers. The new Medicare cards are being mailed in waves beginning April 1 and continuing through April 2019.
What the new Medicare cards mean to your practice
This is good news and bad news for all medical practices. The good news is that the old cards will work until December 31, 2019. The bad news is this means the front office staff has to wade through this transition for 21 months! Health care providers must use the new card numbers beginning January 2020. Some practices may think they can put this off but this time the patients are likely to force the transition.
This change will undoubtedly result in some of your patients having questions and concerns The Centers for Medicare & Medicaid Services is encouraging Medicare patients to bring their new card to their next visit. They are informing seniors that the change in cards is to protect them from medical identity theft. CMS is also informing patients that if they forget their card then their health care provider can look it up for them. If patients are also in a Medicare Advantage plan then the Medicare Advantage card is the main card for Medicare. However, it is better to be safe than sorry so make sure you add the new card to the patient’s record, as well.
Medicare is going to be mailing all Medicare patients a new Medicare number and your practice needs to update their records.
In June, we posted an article about Medicare’s decision to stop using Social Security numbers. Your patients likely call this their Medicare number. Since the transition date is looming ahead we thought an overview might be helpful.
- The effective date is April 2018.
- The new Medicare number will be called the Medicare Beneficiary Identifier (MBI).
- Your patients will get new cards with the MBI on the card.
- You will no longer be able to identify Railroad Retirement Board (RRB) members by their Medicare numbers. You will be able to identify them by the RRB logo on their card.
- The MBI will have 11 characters. It is unique to each person and will be clearly different from the HICN.
- The MBI is randomly generated so there is no link or hidden information related to the patient.
- MBIs will fit on forms the same way HICNs do. You don’t need spaces for dashes.
- Here is an example of the way the MBI will look: 1EG4-TE5-MK73.
- Your office must be ready to accept the MBI by April 2018 for transactions such as billing, claim status, eligibility status and interactions with MAC.
- There will be a transition period when you can use either the HICN or the MBI to exchange data and information with Medicare. The transition period will start April 1, 208 and run through December 31, 2019. However, your systems must be ready to accept the new MBI by April 1, 2018.
- It is especially important that you are ready for people who are new to Medicare because they will only have the new MBI.
- Verify your Medicare patients’ addresses because they won’t get a new card if their address isn’t correct.
- Starting in June 2018, you can look up your patients’ MBI through your Medicare Administrative Contractor’s (MAC) portal when the patients can’t or doesn’t give them to you.
- You can get more information by visiting Medicare’s Card Home and Provider webpages at www.cms.gov/Medicare/New-Medicare-Card.
Medicare has stated that they will “work closely with other payers, State Medicaid Agencies, and supplemental insurers to make sure the crossover claims process will still work”. Please note that they are not guaranteeing it will work.
As with all things related to payers, Ben Franklin had the right saying, “Distrust and caution are the parents of security”.
The Merit-based Incentive Payment System (MIPS) program is a key component of the MACRA Quality Payment Program (QPP) and is expected to be the more popular path for 2017, the first performance year. Under MIPS, the Meanighful Use (MU) Medicare incentive program, Physician Quality Reporting System (PQRS) and the Value-Based Modifier (VBM) program will be consolidated into one program.
We’ve consolidated the key highlights for the 2017 transition year and compiled them into this concise overview. It’s short and created for anyone in your practice wondering what to do next.
MIPS HIGHLIGHTS FOR THE 2017 TRANSITION YEAR
Is it too late to start?
- You can start anytime between January 1 and October 2, 2017
Pick your pace
- Test: submit a minimum amount of 2017 data to avoid downward payment adjustment.
- Partial: submit 90 days of 2017 data for a neutral or positive payment adjustment.
- Full: submit a full year of 2017 data and you may earn a positive payment adjustment
- If you don’t submit any 2017 data you will receive a negative 4% payment adjustment.
- The submission of data remains the same as in the past
- Quality Measures via claims based reporting or registry
- Advanced Care Information (ACI) and IA categories use the attestation process as you did with Meaningful Use
- ACI measures reduced from 11 measures to 5 measures
- Cost performance category (formerly VBM) – 0% weight in 2017
- Quality cross-cutting measures and domains removed to avoid a penalty and not earn an incentive, need only report on 1 patient.
MIPS eligible clinicians billing Medicare Part B listed as Physicians, Pas, NPs, Clinical Nurse Specialists, CRNAs.
Exempt eligible clinicians
- Physicians in their first year of Medicare Part B participation
- Membership in an advanced APM
- Physicians with less than $30,000 in annual Medicare revenue/or have less than 100 Medicare patients
MIPS Performance Categories for 2017
Quality (formerly PQRS) = 60%
- Submission: Claims Based, Qualified Registry or EHR
- Report: 6 measures
- Resource: https://qpp.cms.gov/measures/quality
Advanced Care Information (ACI) Formerly MU = 25%
- Submission: Attestation based on your health technology. Attest to 5 required measures for a minimum of 90 days.
- Security Risk Analysis
- Provide Patient Access
- Send Summary of Care
- Request/Accept Summary of Care (bonus credits available)
- Resource: https://qp.cms.gov/measures/aci
Improvement Activities – IA (aka from proposed rule CPIA) = 15%
- Submission: Attestation based on your health technology. Complete 2 – 4 improvement activities for a minimum of 90 days
- Resource: https://qpp.cms.gov/measures/ia
Congratulations on getting a patient portal for your practice! An August, 2015 study, published in Health Affairs, found that only 10.4 percent of practices met the meaningful use objectives of providing a patient portal.
This year, eligible providers who don’t meet the requirements for Meaningful Use, stage 2, will suffer the 1% Medicare penalty. While stage 2 has 20 core objectives, two of the most challenging will likely be: 1) 50% of your patients must be able to access their health information online in a timely manner, and 2) more than 5% of patients must actually use the providers’ patient portals. This means that not only do your patients need to be enrolled in your patient portal, at least 5% need to actually be using it.
Just having a patient portal is not a build it and they will come venture. You must be actively involved and your staff also has to be ready, willing and actively engaged in getting your patients to sign up.
Yes, patient portals can be great tools. They can be very beneficial to your patients. They can improved office workflow and save your staff time. But, before you can realize these benefits you must actually get patients and staff to use it. Here are some tried and true tips that other practices have used that will help maximize your patient portal in no time.
GET THE WHOLE OFFICE INVOLVED
Your staff has a real opportunity to promote the patient portal at every patient interaction. Educate the staff to see how the patient portal will improve their workflow. When patients can make appointments, pay bills, and message their provider it means less phone calls to the office. It also means that patients can complete the patient registration/check-in process faster.
A very busy orthopedic practice saw every patient interaction as a chance to promote the patient portal. In the end, 25% of their patients were actively using the portal. Here are some of the things this practice implemented.
- Every staff member had a script to ‘talk up’ the benefits of patient portal to patients;
- When patients called for an appointment, the staff reminded patients they could make their next appointment online;
- The practice utilized the appointment reminder feature to encourage patients to register for the patient portal;
- Staff reminded patients that they could pay their bills online;
- The practice engaged their billing company to help promote the patient portal both when talking to patients and by putting a message on the patient statements; and
- Before the physician left the exam room patients were reminded that they can access lab results, send secure messages or get other information relative to the practice.
MARKET THE PATIENT PORTAL
Are you promoting the patient portal the right way? Don’t tell patients about the features. Instead, tell them how it benefits them. Saying the portal has ‘secure messaging’ or an ‘appointment calendar’ isn’t enough. Tell them they can communicate directly with you when it is convenient for them. Or, you know their time is valuable too so now they don’t have to call the office, during office hours, or wait on the phone.
Every piece of marketing collateral must promote the patient portal. Create a non-page handout, explaining the benefits and how to register. It is important to give them clear instructions on how to register. Have your staff try out the instructions so that you know you have covered every ‘how to’ step. This will also ensure that staff knows how to explain it to patients.
Add it to your website; your automated appointment reminder; brochures, and Facebook page, if you have one. Also, the new patient packet offers a good opportunity to introduce the patient portal.
DON’T FORGET YOUR OLDER PATIENTS
Don’t assume that your older patients won’t or can’t sign up for the patient portal. Kaiser Permanente is the best example of effectively using their patient portal, My Health Manager, the largest private-sector patient portal in the United States. In the third quarter of 2015, Kaiser had more than 5.2 million or 70 percent of adult members registered and actively using their patient portal.
Kaiser reports that the older patient was actually eager to register. They appreciated the access to their healthcare providers, lab results, the ease of making their next appointment and make payments.
They may need a little extra help registering and navigating the patient portal but the time spent is well worth it. Remember, it will ultimately cut down on time spent by your office staff.
TRACK YOUR ENGAGEMENT NUMBERS
Tracking the number of patients who are actively engaged with your portal will tell you what you are doing right and where you might make improvements. They key to success is patient awareness. Make sure both your staff and your patients know how to use it and that they understand how the portal benefits them. Then watch your engagement numbers grow. You will find that your office is more efficient, patient payments are collected faster, patients appreciate the increased interaction and you will meet Meaningful Use. A win for all.