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QPP

Deadline Oct. 5 to ask for MIPS targeted review

If you participated in the Merit-based Incentive Payment System (MIPS) in 2019, your performance feedback, including your MIPS final score and payment adjustment factor(s), is now available for review on the Quality Payment Program website. This final score determines the payment adjustment you will receive in 2021, with a positive, negative, or neutral payment adjustment being applied to the Medicare paid amount for covered professional services furnished by a MIPS eligible clinician in 2021. MIPS eligible clinicians, groups, and virtual groups (along with their designated support staff or authorized third-party intermediary), including APM participants, may request the Centers for Medicare & Medicaid Services (CMS) to review the calculation of their 2020 MIPS payment adjustment factor(s) through a process called targeted review. The deadline to submit your request is Oct. 5, 8 p.m…. . . . read more.

REIMBURSEMENT

Your office will be paid for counselling patients to self-isolate at time of COVID-19 testing

CMS and the Centers for Disease Control and Prevention (CDC) have announced that payment is available to physicians and health care providers to counsel patients at the time of COVID-19 testing about the importance of self-isolation after they are tested and prior to the onset of symptoms. The transmission of COVID-19 occurs from both symptomatic, pre-symptomatic, and asymptomatic individuals. Education on self-isolation is important as the spread of the virus can be reduced significantly by having patients isolated earlier while waiting for test results or symptom onset. The CDC models show that when individuals who are tested for the virus are separated from others and placed in quarantine there can be up to an 86 percent reduction in the transmission of the virus, compared to a 40 percent decrease in… . . . read more.

PANDEMIC

Protecting your medical practice during uncertain times

By John W. McDaniel bio Given the recent disruption and decreased demand for physician office services, coupled with the foreboding predictions associated with the COVID-19 pandemic, both hospital- affiliated and private medical practices are having to adjust their operations in order to provide billable patient care services while salvaging the cash flow/liquidity of the practice. Indeed, physicians have been slow to adopt telemedicine as an essential adjunct service; yet, the current external environment beyond our control has caused physicians to respond and explore ways to optimize operational changes in terms of modifying the traditional business model of physician practices in order to be financially viable now and in the future. The greatest change has resulted in realizing the benefits of telemedicine as physicians are discovering the benefits of performing patient assessments… . . . read more.

BILLING AND COLLECTIONS

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.

BILLING & COLLECTIONS

5 ways to break down bureaucracies to get payer contracts

By Steve Selbst bio It is important to remember that payers are large companies, with protocols, policies and business practices. As with any large company, there are bureaucracies, and they are necessary to maintain the order and success of these organizations. Therefore, the first tip is to understand that to get contracted you need to identify the right department and right person to send your request to get contracted. This is usually the payer contracting department and payer contracts’ manager. Generally, you will be sending your requests to the payer contracts’ manager in your state. A common mistake is to—instead—send these requests to provider relations or to another department. This brings us to our second tip. That is, figure out the approach the payer is using to establish its fee… . . . 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.

REVENUE CYCLE MANAGEMENT

Improving your revenue cycle efficiency

Modern medical practices are experiencing immense pressures as a result of increased regulatory scrutiny, changing reimbursement mechanisms, and a shift toward…


. . . read more

INCREASING PROFITS

How to make a collection call to a patient

A collection call to a patient should never be offensive. But it does need to be firm. Remember, the goal is to collect an…


. . . read more

READER TIPS

Getting that new patient info into EHR before appointment

Here are some reader tips for getting new patient information into the electronic health records prior to…


. . . read more


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