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QUALITY PAYMENT PROGRAM

2019 Performance Period Suppressed MIPS Quality Measures

In the 2019 Physician Fee Schedule Final Rule (83 FR 59847), the Centers for Medicare & Medicaid Services (CMS) established a policy that provides for the suppression of measures in certain circumstances. Starting with the 2019 performance period, for measures significantly impacted by clinical guideline changes or other changes where the CMS believes that adherence to guidelines in the existing measures could result in patient harm or otherwise cause misleading results as to what is measured as good quality of care, we will reduce the denominator of available measure achievement points for the quality performance category by 10 points for each impacted measure that is submitted by MIPS eligible clinicians and groups. Such policy will “hold harmless” any clinician or group submitting data on a suppressed measure. The measures identified… . . . read more.

CMS QPP

MIPS data submission deadline extended to April 30

The 2019 Merit-based Incentive Payment System (MIPS) data submission deadline has been extended by 30 days to April 30, 2020. In general, if you have already submitted MIPS data or if you submit MIPS data by April 30, 2020, you will be scored and receive a MIPS payment adjustment based on the data you submit. Many MIPS eligible clinicians have performed very well in the MIPS program in previous years, says the CMS. If you need to revise any data that has already been submitted you can still make changes by logging into qpp.cms.gov by the new deadline. 2019 MIPS Extreme and Uncontrollable Circumstances Policy Update MIPS eligible clinicians who have not submitted any MIPS data by April 30, 2020 do not need to take any additional action to qualify… . . . read more.

CORONAVIRUS

CMS to provide accelerated and advanced payments during patient surge

In response to the COVID-19 pandemic, CMS will provide accelerated payments to requesting providers and advance payments to requesting suppliers, including physicians and non-physician practitioners, who submit a request to the appropriate Medicare Administrative Contractor (MAC) and meet the criteria: CMS intends to provide assistance first to those providers and suppliers that experience increased demand and surge in patients. MACs responsible for processing accelerated/advance payment requests for different states, will prioritize those states that were hit the hardest (currently, these states are reported to be California, New York, and Washington). Most providers and suppliers will be able to request up to 100% of the Medicare payment amount for a three-month period. However, Inpatient acute care hospitals, children’s hospitals, and certain cancer hospitals are able to request up to 100% of… . . . 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.

BLOG

How to assess the overall health of your medical practice

By Nick Hernandez  bio
How do you know that your overall business is healthy? How do you know that the business processes you perform are…


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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…


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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…


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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…


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BILLING & COLLECTIONS

CMS releases 2020 Proposed Rule for the Quality Payment Program

The Centers for Medicare & Medicaid Services (CMS) has released its proposed policies for the 2020 performance year of…


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