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Is Your Practice Ready for MIPS?

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.

Reporting process

  • 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

Requirements reduced

  • 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.

Eligibility

MIPS eligible clinicians billing Medicare Part B listed as Physicians, Pas, NPs, Clinical Nurse Specialists, CRNAs.

Exempt eligible clinicians

  1. Physicians in their first year of Medicare Part B participation
  2. Membership in an advanced APM
  3. 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%

  1. Submission: Claims Based, Qualified Registry or EHR
  2. Report: 6 measures
  3. Resource: https://qpp.cms.gov/measures/quality

Advanced Care Information (ACI) Formerly MU = 25%

  1. Submission: Attestation based on your health technology.  Attest to 5 required measures for a minimum of 90 days.
    1. Security Risk Analysis
    2. ePrescribing
    3. Provide Patient Access
    4. Send Summary of Care
    5. Request/Accept Summary of Care (bonus credits available)
  2. Resourcehttps://qp.cms.gov/measures/aci

Improvement Activities – IA  (aka from proposed rule CPIA) = 15%

  1. Submission: Attestation based on your health technology.  Complete 2 – 4 improvement activities for a minimum of 90 days
  2. Resource: https://qpp.cms.gov/measures/ia

 

Flu Shots Given – Charges Denied

Flu ShotsNew codes for flu shots in 2017!

By:  Claire Ariyoshi, MBA, CPC

The flu season is underway and the Center for Disease Control (CDC) is recommending that people get their flu shots.  According to the CDC, only injectable flu shots are recommended this season.

Health care providers have been providing flu shots to their patients in record numbers.  However, some providers are now left wondering why their charges are being denied by various insurance carriers.  If this is happening to you, it may be because you are using the wrong codes.  Following is a summary of how providers must code in order to be paid.

Effective January 1, 2017, many influenza codes were revised to remove the age indicator and a dosage is now required. The table below illustrates these changes.

REVISED Influenza codes

2016 (age of patient) January 1, 2017 (Dosage)

90655, 90657, 9085,90687

6 – 35 months

0.25 mL dosage

90656, 90658, 90686, 90688 Older than 3 years

0.5 mL dosage

Providers who have followed these coding guidelines are being reimbursed in accordance with the carriers policies.Additionally, a new CPT 90674 has been added for a quadrivalent cell cultured influenza vaccine that is indicated for use in those 4 years of age or older.

Claire Ariyoshi is the Vice President of Finance for Onpoint Medical Solutions.  She has over 30 years experience managing medical billing and patient registration departments for private practices.  In addition to her MBA, she is a certified professional coder and is ICD-10 certified. 

(800) 594-8043 Email