Embed Size (px)
Citation preview
MIPS Made Easy with TheraOffice
Nick Austin, Director of Product Management
A Tale of Two Webinars
Today’s Webinar What is MIPS?
Do I need to participate?
What are the incentives to participating?
What options do I have?
How do I get started?
The Next Webinar Which measures do I need to report
on?
What improvement activities should I use?
How are these measures scored?
11/20/2018 @ 1:00 PM CST
What is MIPS?
• In 2015, the Medicare Access and CHIP Reauthorization Act, or MACRA, was passed.
• Permanently repealed the SGR cut.
• Started us down a path where all healthcare providers would have two options:
• Participate in an Advanced Payment Model• Participate in the MIPS Program, a consolidation of
PQRS, Meaningful Use, and Value Based Modifier.• Program started in 2017. PTs, OTs, and SLPs are starting
the program in 2019.
Who has to participate?
Exempt Participation Optional Participation Required Participation
• Speech Language Pathologists.• Providers that submit
Institutional claims to Medicare.
• New providers that are enrolling into Medicare for the first time in 2019.
• Providers who participate in an Advanced Payment Model.
• PTs and OTs that do not meet any of the Determination Period thresholds.
• PTs and OTs that meet one or two of the Determination Period thresholds.
• PTs and OTs that meet all three of the Determination Period thresholds.
Determination Period
• 10/1/2017 – 9/30/2018• 10/1/2018 – 9/30/2019
For the 2019 Reporting Year, there are two
determination periods.
• Greater than 200 Professional Services (Units)• Greater than 200 Distinct Patients• Greater than $90,000.00 in Allowable Amounts
The thresholds are as follows:
What are the MIPS
Incentives?
• Similar to PQRS
• Performance Year (Reporting Year) 2 Year Gap Payment Year
• For participating in the 2019 Performance Year, you will not see any payment until 2021.
• Providers are scored 0-100 based on their actual performance with each measure
• Payments are budget neutral• How much successful reporters receive is directly
related to how many providers unsuccessfully report.
• … except for an Exceptional Performance Bonus that is allotted each year to be paid out despite what is done on the lower end.
The Impact of Budget Neutrality
• For the 2017 Reporting / 2019 Payment Year, the maximum payment adjustment fell short by about 53%.
• For the 2019 Reporting / 2021 Payment Year, the maximum incentive / penalty is 7%.
Advisory.com: How Much Incentive Do You Get For The Max MIPS Score of 100?
Advisory.com: How Much Incentive Do You Get For The Max MIPS Score of 100?
The MIPS Categories
Cost
Promoting Interoperability
Quality
Improvement Activities
Cost
• Previously known as Value Based Modifier• Cost is a program that requires no additional
work to be involved in.• Based on the CPT codes you submit to
Medicare, they will determine how cost-effective your treatments are.
• PTs, OTs, and SLPs will not be participating in the Cost category in 2019. The impact of this category will be weighted to zero in your final MIPS score.
Promoting Interoperability
• Previously known as Advancing Care Information or Meaningful Use.
• Requires the use of a certified EHR for objectives like e-prescribing and patients having access to documentation.
• When you hear that you need to use a CEHRT (Certified EHR Technology), it is for this category.
• PTs, OTs, and SLPs will not be participating in the Promoting Interoperability category in 2019. The impact of this category will be weighted to zero in your final MIPS score.
Quality
• Previously known as PQRS or PQRI.• The Quality category is required and will make
up the bulk of your MIPS participation.• List of various measures you can participate in
to improve the quality of your patient care. These measures are very similar to what you did in PQRS.
PT/OT Specialty SetQuality # Measure Title Measure Type
128 Preventative Care and Screening: BMI Screening and Follow-Up Plan Process
130 Documentation of Current Medications in the Medical Record Process
131 Pain Assessment and Follow-Up Process
182 Functional Outcome Assessment Process
217 Functional Status Change for Patients with Knee Impairments Outcome
218 Functional Status Change for Patients with Hip Impairments Outcome
219 Functional Status Change for Patients with Lower Leg, Foot or Ankle Impairments Outcome
220 Functional Status Change for Patients with Low Back Impairments Outcome
221 Functional Status Change for Patients with Shoulder Impairments Outcome
222 Functional Status Change for Patients with Elbow, Wrist or Hand Impairments Outcome
223 Functional Status Change for Patients with General Orthopedic Impairments Outcome
*The Next Webinar Will Go Into Detail On All These Measures
Improvement Activities
• New Category for MIPS, no tie to a previous program.
• The Improvement Activities category is required in 2019, and while carrying a less weight than Quality, is still important to do if you are looking to get the exceptional performance bonus.
• Least rigid structure of all of the categories. • Perform an activity over a 90 day period and
then attest to CMS that you performed it.
APTA Suggested Improvement Activities
Activity Name Weight
Promote use of patient-reported outcome tools High
Use of QCDR for feedback reports that incorporate population health High
Collection and follow-up on patient experience and satisfaction data on beneficiary engagement High
Improved practices that disseminate appropriate self-management materials Medium
Regular training in care coordination Medium
Regularly assess the patient experience of care through surveys, advisory councils and/or other mechanisms.
Medium
Use group visits for common chronic conditions (eg. Diabetes) Medium
Implementation of fall screening and assessment programs Medium
Implementation of practices/processes for developing regular individual care plans Medium
Use of tools to assist patient self-management Medium
*The Next Webinar Will Go Into Detail On All These Activities
Submission Options
• Three decisions to make:• Am I participating?• Am I submitting through claims
or registry?• Am I submitting individually or as
a group?
Claims vs Registry
Claims ONLY available to Small Practices (15
or less providers)
Requires that you perform the Quality measures on only Medicare patients.
No cost to submitting this way
Outcome measures not available
Registry Requires that you perform the Quality
measures on ALL patients. Requires an annual fee All measures are available
Why Should I Use a Registry?
• Registries will offer quarterly status reports and work with you on ensuring your success in the program.
• No need to adjust off the charges on claims or audit your own providers for compliance.
• No surprise payment adjustments years later.• CMS is slowly making the full transition to electronic
submission. In previous years of PQRS, it was available to anyone. Now, only for small practices. This option could eventually be fully phased out.
TheraOffice Registry
• Happy to announce that we have been approved to be a Qualified Registry for the 2019 reporting year.
• Additional details will be announced when they become available.
• If you would like more information on the registry, please respond to the poll in the webinar interface and we will make sure to follow-up with additional details.
Individual vs Group
Individual Payment Adjustments are made to
each individual NPI/TIN combination.
Good option for companies that are looking to test the water with MIPS instead of full participation.
Group Payment Adjustments are made to
the full TIN based on an aggregate score of all NPIs submitted under that TIN.
Good option for companies looking for full participation.
TheraOffice
• In addition to becoming a registry, TheraOffice will be releasing the .11 update before the end of the year. This update will include MIPS-specific changes that should make for participation being greatly simplified.
MIPS Timeline
By December 31st, 2018•TheraOffice .11
Release•TheraOffice
Registry Sign-Up
January 1st, 2019•FLR Phases Out•Start Collecting
Data on Quality Measures
April 1st, 2019•First Status
Update from TheraOffice Registry
December 31st, 2019•Reporting
Period Ends
Q1 2020•Registry submits
data on behalf of clinics for 2019 Reporting Year
Questions
Thank you for attending today’s webinar! If your question is not answered during the Q&A portion, we will be following up with you over the next week. For any additional questions that come up later, please contact our
support department.
TheraOffice Support866.562.8413 x2
MIPS Measures & Scoring Summary November 20th @ 1:00 PM – 2:00 PM CST
2019 Preview & TheraOffice .11 Release November 29th @ 1:00 PM - 2:00 PM CST
Keep up with TheraOffice on Twitter, Facebook, & LinkedIn for
more updates!
