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CMS to launch new MIPS Participation Framework in 2021 Performance Period

CMS is implementing a new participation framework for the Merit-based Incentive Payment System (MIPS), called the MIPS Value Pathways (MVPs), starting with the 2021 performance period. The goal of this new framework is to move away from siloed performance category measures and activities, and move toward an aligned set of measures and activities that are more meaningful to clinicians and patient care. With the MVPs framework, CMS is aiming to connect measures and activities across the Quality, Cost, Promoting Interoperability, and Improvement Activities performance categories of MIPS for different specialties and conditions. The new framework is designed to: Simplify MIPS and reduce clinician burden; Improve value and create a more cohesive and meaningful participation experience; and Better align with Alternative Payment Models (APMs) to help ease the transition from MIPS… . . . read more.

QUALITY PAYMENT PROGRAM

MIPS 2020 payment adjustments in effect based on 2018 performance

In July 2019, each Merit-based Incentive Payment System (MIPS) eligible clinician received a 2018 MIPS Final Score and associated payment adjustment factor(s) as part of their 2018 MIPS performance feedback, available on the Quality Payment Program website. 2020 MIPS payment adjustments, based on each MIPS eligible clinician’s 2018 MIPS final score, will now be applied to payments made for Part B covered professional services payable under the Physician Fee Schedule. Payment adjustments are determined by the final score associated with your Taxpayer Identification Number (TIN)/National Provider Identifier (NPI) combination. MIPS eligible clinicians, identified by TIN/NPI combination for the 2018 performance period, will receive a positive, neutral, or negative MIPS payment adjustment in 2020 if they: Were a clinician type that was included in MIPS; Enrolled in Medicare prior to Jan…. . . . read more.

ENFORCEMENT

Feds Take Down $2.1 Billion Medicare Genetic Test Fraud Scheme

You know that a branch of lab testing has gone from fad to mainstream when it becomes the subject of a major federal enforcement takedown. Accordingly, the newly announced breakup of a $2.1 billion genetic billing fraud scam, one of the largest Medicare frauds ever undertaken, signifies that genetic testing has officially arrived. Operation Double Helix Known as Operation Double Helix, this landmark investigation and prosecution was a joint HHS, DOJ and FBI crackdown carried out in five federal districts against 35 defendants associated with genetic testing labs (CGx) and telemedicine companies, including doctors, CFOs and CEOs that allegedly “capitalized on the fears of elderly Americans to induce them to sign up for unnecessary or non-existent cancer screening tests,” according to one of the U.S. Attorneys involved. Old Wine in… . . . read more.

COMPLIANCE

Hiring and firing risk factor: careless words

Today’s administrators need to be aware of the casual – albeit well meant – words that are bringing on claims of discrimination. Legal risks of both hiring and firing include careless words, says employment law attorney Donald W. Benson, a partner with Hall Booth Smith in Atlanta. The friendly hiring remark The dangers start with the interview, where a wrong comment can generate a claim no employer ever expects, says Benson. Everybody knows not to ask the obvious questions of “are you married?” or “do you have children?” or “are you planning to have a family in the future?” Yet many an interviewer brings up a discriminatory topic obliquely and unwittingly in an effort to build rapport with a candidate, never thinking about the danger. Remarks such as “we have a… . . . read more.

ERGONOMICS

Better productivity and a happier staff happen as ergonomics steps in

Ergonomics is good economics. When the work areas are in sync with the people spending their days in them, there’s no time lost to sick days and no money lost to low productivity, says Hayley Kaye, a certified professional ergonomist with HLK Consulting in New York City. Achieving that calls for attention to the desks, the telephones, and the chairs. But it also calls for teaching people how to set them up correctly. It’s of zero value to have thousands of dollars of ergonomically correct furniture that nobody has adjusted. The elbow-wrenching desktop A good place to start is with the hands and elbows. For typing, they need to be level, Kaye says. Yet most desks are too high to the point that anybody shorter than 6’2″ has to sit with… . . . read more.

INFORMATION SECURITY

HIPAA enforcement takes a dramatic new direction

Historically, HIPAA enforcement has focused predominantly on the failure of covered entities to keep protected health information (PHI) private and secure; but now the scope is broadening to encompass keeping PHI too private and too secure. The HHS Office for Civil Rights (OCR), the agency that enforces HIPAA rules, has broken new ground by fining a Florida hospital for failing to provide access to PHI to the individual it relates to. Here’s a look at the case and what it portends about the new direction in HIPAA enforcement. The HIPAA Right of Access When you hear the term “HIPAA Privacy Rule,” the first thing likely to jump into your mind is the obligation to keep PHI secure and refrain from disclosing it to third parties without appropriate authorization. But there’s… . . . read more.

MANAGING STAFF

The plain and practical side of medical office managing

Equally as important as regulations, revenue, coding, and Medicare are the day-to-day issues of running the office and managing the…


. . . read more

MEDICARE REIMBURSEMENT

MIPS bonuses are easy to earn—IF you can get into the program

The Centres for Medicare and Medicaid Services (CMS) has announced the results of…


. . . read more

INCREASING PROFITS

Deadline to submit a MIPS Targeted Review Request is this month

If you participated in the Merit-based Incentive Payment System (MIPS) in 2018, your performance feedback, which includes…


. . . read more

COLLECTIONS

Why you need an office policy on collecting fees

Most medical practices take time once a year to create new office goals or a business plan and, hopefully, to upgrade their policy manuals…


. . . read more


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