MACRA & MIPS - Top 10 to know for 2017 forward and who will be impacted

Industry experts Kim Dues and Holly Cassano share useful information and shed the much needed light on MACRA and MIPs. To understand what your providers and practice's role will now be and how they can either win and earn positive payment adjustments and significant bonuses watch this webinar now
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Printed materials for the MACRA webinar, featuring relevant information and resources.

MACRA Webinar Transcript

0:16 Kim Dues: Good morning.
0:22 Holly Cassano: Good morning Kim; how are you?
0:39 Kim Dues: I’m excellent; how are you?
0:48 Holly Cassano: Good; thank you.
0:51 Kim Dues: Okay.
0:52 So first I would like to thank all of you for attending our Facebook live today
0:57 and introduce myself.
0:58 My name is Kim Dues, I am CPC, CRC, ICD-10, AAPC certified; a coder
1:08 and auditor and have been in the healthcare
1:10 industry for over 22 years.
1:12 I am a regional director
1:14 for Billing Paradise in Texas and the central US territory.
1:18 I provide client services and revenue
1:20 cycle management system to my respective client base.
1:26 Our MACRA MIPS subject today, I have personally worked with numerous providers over the
1:32 past several years on PQRS extrapolation and successfully submitted through a registered
1:39 portal
1:40 for all of them.
1:41 The name of the portal I have used in the past is called New Jersey Innovation
1:47 Institute.
1:49 It’s
1:51 They’re excellent and they are very helpful to help you review your
1:58 measures before they are submitted so you understand what the results will be.
2:05 I’m here today to discuss with my co host Holly Cassano who is a CPC, CRC, ICD-10 certified
2:13 with AAPC also since 2006.
2:17 She has also worked in the healthcare industry for well over 20
2:21 years.
2:22 Along with that she is also a regional director for Billing Paradise in Florida and the
2:29 Northeast US providing client services and revenue cycle management system to her respective
2:34 client base.
2:39 She is here to help me discuss today’s Facebook – she is here to discuss the Facebook live
2:52 broadcast regarding the current changes to healthcare, the landscape for MACRA and MIPS.
3:07 Together we will be conversing on the various nuances that provider must be aware of to
3:11 avoid
3:12 negative payment adjustments going forward.
3:15 That will impact not just their CMS contracts but
3:18 all payer contracts across the board that you participate with and how you can prepare
3:25 your
3:26 practice.
3:28 All right.
3:30 So –
3:31 Holly Cassano: Thank you Kim.
3:33 Kim Dues: I’d like to say on behalf of Billing Paradise, they are pleased to offer the following
3:39 tools and services; some are free and some are at cost to existing and new clients.
3:46 Billing
3:47 Paradise is a billing company, they offer coding, auditing, revenue cycle management
3:54 – so we
3:57 have a MIPS eligibility status verification, we have a quality payment program, it’s
4:03 called the
4:05 QPP measuring.
4:07 We have a MIPS calculator.
4:09 We can help you with your provider specific
4:12 PQRS codes which is what you submit, either through your EHR or on paper.
4:19 Those are
4:21 provider specific.
4:22 So we can help you zero in on your provider specialty.
4:26 We have the MIPS
4:27 checklist and we also have a free loss recovery revenue, we call that our LRRA.
4:34 This is a value
4:35 pack report that will assist practices in discovering their monetary deficiencies within
4:40 their
4:41 revenue cycle process.
4:43 And we offer solutions to the missing dollars.
4:46 We also have a free 60 minute MACRA consultation post webinar; you can sign up for it and
4:54 it’ll be on first come first serve basis.
5:01 So Holly, we’re just going to dive into it.
5:03 We’re going to go into what clinicians and elements of
5:06 Medicare payments are impacted by the QPP.
5:09 So do you want to speak a little on that?
5:11 Holly Cassano: Yeah.
5:12 That sounds great Kim and thank you for the very welcoming
5:15 introduction.
5:16 Kim Dues: You’re welcome.
5:17 Holly Cassano: Yeah.
5:19 So basically CMS estimate that over 710,000 providers will be affected
5:25 by the Quality Payment Program which is also called QPP and those changes which are this
5:31 this year
5:32 2017.
5:33 And this actually launches the first performance year for the QPP.
5:36 Of note, not all
5:38 providers will be subject to the coming changes; close to half of US physicians are not familiar
5:43 with MACRA and MIPS initiatives and per initiatives. [0:05:44] recent survey of about 600
5:48 doctors; additionally almost eight out of 10 physicians stated that their preference
5:54 for fee for
5:55 service is definitely over the various risk sharing value based programs under MACRA and
6:01 MIPS.
6:02 But what they are forgetting is that MACRA and MIPS is here for the duration.
6:06 Kim Dues: It most definitely is here for the duration.
6:09 Kim Dues: Yeah Definitely, for the duration
6:10 Holly Cassano: [0:06:07] some staggering numbers when you think about 710,000
6:12 providers and the –
6:15 Kim Dues: I think though, eight out of 10.
6:17 Holly Cassano: Yeah.
6:18 Eight out of 10 and I’ve been familiar and would prefer fee for service
6:20 but that’s because they really don’t understand MACRA and MIPS so that’s what we’re here
6:25 to
6:26 hopefully assist people with.
6:32 Of note providers and payments that are included, any services billed under the Medicare
6:37 Physician Fee Schedule MPFS will be impacted.
6:39 Specifically, the adjustments will apply to the
6:43 work, practice expense and physician liability insurance malpractice and the relative value
6:48 units
6:49 which are also known as RVUs.
6:50 Physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered
6:54 registered nurse anesthetists [0:06:55] and groups that include any of these clinicians are included.
7:02 And
7:03 then the providers and payments that will be excluded are the Inpatient Prospective
7:06 Payment
7:07 System IPPS, Outpatient Prospective Payment System OPPS and Ambulatory Surgical Center
7:11 Payments System ASCPS.
7:12 Physician groups that fall below the low value threshold
7:16 of 30,000 or less in Medicare billing charges or 100 or less in Medicare patients and then
7:25 also
7:26 providers in their first year of billing Medicare will be excluded.
7:28 Kim Dues: Let me add to this Holly that Medicare has been very busy sending out letters to
7:35 providers, letting them know their eligibility.
7:39 We have – yeah, they’re sending them out and
7:42 doctors are receiving them and so if they get a letter from Medicare stating that they
7:48 are eligible
7:50 for the MIPS program, they need to give that to their revenue cycle department and let
7:55 them
7:56 know so that they put a plan together.
7:59 And so that’s what this webinar is about, is to help you
8:01 put a plan together, to make you aware how just very important this is.
8:07 So everything you just said, what does that mean Holly?
8:10 Holly Cassano: What it really means is that a physician’s MIPS score represents his
8:14 or her
8:15 comparative performance in four categories.
8:18 And the four starts with 50% being in quality
8:21 measures, 25% in meaningful use of their EHR, 15% goes to clinical quality improvement
8:27 activities and 10% goes to products basically, yeah.
8:31 Kim Dues: Right.
8:32 So that’s their breakdown.
8:34 So that gives you 100% of the breakdown.
8:36 Holly Cassano: Yeah 50% is fitting in that clinical quality measure program.
8:42 So that’s why
8:43 those PQRS measures that were resubmitted prior really need to be looked at by specialties
8:50 going
8:51 forward.
8:52 Kim Dues: Well absolutely; and some of the PQRS measures have just dropped off, some
8:57 of the
8:58 ones that we have used in 2016, they got rid of them and so now they, you need to review
9:04 the
9:05 PQRS measures and make sure.
9:06 And furthermore, Medicare is going to tell you, if you are using
9:10 PQRS measures and you are closely monitoring your EOBs which you have to monitor your
9:15 EOBs for Medicare, there’s a treasure trove of information on there.
9:20 You can also – what’s the
9:21 website you go out to find the meetings for the – it’s the Washington – anyway,
9:28 you have to
9:29 really read your dunning messages on the bottom of your EOB.
9:33 Holly Cassano: Yeah, I mean funny.
9:36 You can just – we can provide that post meeting but you
9:40 can go to your MIPS [0:09:40] website, you can go to your local Medicare intermediary
9:45 like for Florida we have –
9:47 Kim Dues: Sure.
9:49 Right.
9:50 And if you don’t understand one of those messages then you go to your
9:55 local Mac and then you’ll be able to read up on it.
9:59 But monitor those EOBs and the letter that
10:03 you get from Medicare, put a plan together and because we’re already going into the
10:07 month of
10:08 June.
10:09 Okay, so let's talk about transitioning from PQRS to the MIPS program.
10:17 So three small –
10:18 Holly Cassano: Well we have – go ahead sorry.
10:22 Kim Dues: Go ahead.
10:23 Holly Cassano: I was going to say that we have just a couple of tips for small practice
10:26 providers
10:27 that we want to share.
10:30 Everyone is to review and understand your 2015 quality and resource use
10:35 report, your QRUR which you should already have and if you don’t have that, then again
10:38 you
10:39 can go to your local Mac website and they can instruct you on how to download that.
10:44 Determine
10:45 your MIPS eligibility and document all future encounters in your EHR.
10:49 For providers that have
10:52 participated in the physician quality reporting system program in the past years and even
10:56 for
10:57 those that did not accomplish requirements created by the standards for Medicare and
11:00 Medicaid
11:01 services for the merit based incentive payment system MIPS can be daunting.
11:05 So below, what
11:06 we have done is we have decided to outrun few things that you can do as a small practice
11:11 provider and set yourself up for MIPS success going forward.
11:15 Kim Dues: So let's talk a little bit about that EHR; in that EHR, if there is not one
11:20 person that’s
11:21 watching that EHR for the company, there really should be.
11:25 You need to have somebody
11:26 monitoring the EHR, monitoring your PQRS measures and how they are collecting.
11:31 Make sure
11:32 they are collecting all the PQRS measures for your specialty.
11:36 If they’re not, then you have to
11:37 jump on it and what I mean by jumping on it is you get on the phone with that practice
11:44 management company and you start talking to them about how can I fix this; what are the
11:50 steps
11:51 for me to fix this?
11:52 If you have to buy I.T time in order to get it fixed then do it because it will be worth
11:59 it.
12:00 Holly Cassano: I agree and just additionally, for MIPS eligibility, 2017 is the year to
12:07 determine
12:08 your MIPS eligibility as we said.
12:10 And CMS has designated 2017 as a transition year which will
12:14 allow the small practice providers to be exempt from the MIPS payment adjustments, that will
12:16 be
12:17 applied in 2019.
12:18 This is the year to review the requirements for MIPS eligible providers and the
12:23 exemption criteria in order to be able to determine if the practice should take action
12:27 this year in
12:28 order to bypass a 4% negative payment adjustment in 2019.
12:33 And that’s pretty significant.
12:35 Kim Dues: For the MIPS eligibility?
12:38 Holly Cassano: Mm-hmm.
12:41 The other thing we want to drive home is that you really need to
12:43 document all your patient encounters.
12:44 So in order to meet with compliance for MIPS, all patient
12:48 encounters must be documented in whatever EHR your practice uses.
12:52 This is really the only way
12:53 that the MIPS program can quantify the data as it moves Medicare providers to a performance
12:59 based payment system.
13:01 The system actually rewards use of health I.T and high quality care and
13:05 the program applies to all patients for all payers not just patients that use Medicare
13:10 for
13:11 Part-B [0:13:07].
13:12 It’s pretty much mission critical just to really document all patient
13:15 encounters using your EHR in order to ready yourself to extract a report for comprehensive
13:20 data
13:21 to CMS which requires best practices in overall patient care.
13:25 What are your thoughts on that?
13:27 Kim Dues: I think that there needs to be an echo through the canyon that says documentation,
13:34 documentation.
13:35 That’s the echo, that’s really what this is all about.
13:39 Everything is going to loop
13:41 back around to provider documentation.
13:44 So not only for coding but it’s also going to be for your
13:48 MIPS measures.
13:49 Holly Cassano: Yeah, for your MIPS measures.
13:52 Yeah I mean, I’d like to expand from that –
13:59 Kim Dues: Because this is about quality, it’s about quality.
14:00 Holly Cassano: Oh yeah.
14:01 Quality of care.
14:02 Kim Dues: And so the only way you can tell them about quality is documentation.
14:06 Holly Cassano: Absolutely.
14:08 I like to always say because you know that I do a lot of government
14:12 auditing, working with providers that have had issues with Medicare, I have been doing
14:17 that for a
14:18 long time.
14:19 And also I worked with risk adjustment for many, many years and actually –
14:25 Kim Dues: Absolutely.
14:26 Because you and I have worked on a few projects.
14:28 Holly Cassano: Oh yeah, we’ve worked on quite a few.
14:33 And so one of the things – just to kind
14:34 of share a little bit of insight is with the documentation, how important it is.
14:39 The AAPC had
14:41 asked me to assist them in developing their risk adjustment credential and the national
14:46 credential [0:14:44] years ago.
14:48 So I was on a team with about seven other folks with the AAPC
14:52 and we worked on that.
14:54 And let me tell you something, it was a four month process and one of
14:57 the biggest hurdles that we had to conquer was really discussing what components of that
15:04 exam
15:05 that we want to make, circle around documentation and how important it is.
15:10 And it was very
15:11 interesting to kind of get that perspective because there was people from health plans,
15:15 big health
15:16 plans on that committee as well as there was a doctor, other folks like myself amongst
15:21 the eight
15:22 of us in total.
15:23 And one of the things I always like to say is you’ve got to bulletproof your documentation.
15:28 So in
15:29 order to bulletproof your documentation, you first must have to know what you need to
15:33 document.
15:34 Wouldn’t you agree?
15:36 Kim Dues: Absolutely.
15:38 Absolutely you do.
15:39 You absolutely do.
15:40 Holly Cassano: And unfortunately, as we both know, and through no fault of the providers,
15:45 because they build a school really, to be able to service their patients and to treat
15:51 their patients.
15:52 Kim Dues: That’s right, to take care of them.
15:54 To take care of them; that’s right.
15:55 Holly Cassano: Right.
15:56 They don't [15:53] go to school to understand all the different
15:58 elements of a note that they need to document.
16:01 So it can be a bit of a challenge.
16:04 Kim Dues: Right.
16:05 So it boils down to collaboration.
16:06 It boils down to collaboration on the
16:08 clinical side and it boils down to that collaboration between the clinical and the billing.
16:13 There
16:14 has to be a bridge that they meet in the middle and then they start talking about documentation.
16:21 And it’s not about the revenue side, you know what I’m going to say, it’s not about
16:29 the – it’s
16:30 about the revenue side, explaining to the providers, what the elements are of that particular
16:36 code
16:38 and how we meet the specific elements of that code so that the documentation proves it.
16:46 Holly Cassano: Correct.
16:48 Kim Dues: So hypothetically, a doctor – let's just say an urgent care center, they have
16:58 impacted
16:59 ear wax.
17:00 They can't just say in the documentation that it was impacted ear wax and here’s
17:05 the
17:06 code.
17:07 You have to describe the way that wax was removed in order for us to choose the right
17:12 code.
17:13 So that is the documentation part of it and that’s just a very simple example but I
17:19 was just
17:20 reading an article from our buddy Barbra Kabazie last night and that’s a big shout out to
17:25 Barbara
17:26 because we love her and I was reading an article with one of the team leads last night and
17:32 we
17:33 were discussing the fact that that is what the documentation was missing, it was missing
17:37 that
17:39 explanation on how you actually – we see in the documentation that you did a procedure
17:46 but you
17:47 have to tell us how you did it so that we can choose the right code.
17:50 So that’s what the billing side brings to the provider.
17:52 Of course the provider is the expert,
17:54 obviously he is the medical trained doctor and he brings that to the table.
18:02 And so it’s those two
18:05 departments meeting in the middle in regards to documentation.
18:09 Holly Cassano: Yes.
18:11 No I completely agree.
18:13 It’s funny you know.
18:15 With the use if these EHRs
18:17 it’s so easy to do what I like to call the point and click mentality.
18:23 Because sometimes providers
18:25 on their busy day, as they’re seeing people, they’re just pointing and clicking, pointing
18:27 and
18:28 clicking and they are like, okay.
18:29 And then, and sometimes at the end, they go through it so fast,
18:30 you can really literally point and click your way into a level five like on any given day
18:37 all day
18:38 long.
18:39 A lot of these EHRs allow that.
18:41 So with that being said, you have to be cognizant not only
18:45 of what it is that you are pointing and clicking and when you recheck [0:18:46] but also
18:49 with
18:50 these measures to make sure that they are appropriate for the type of service that you
18:53 are
18:54 providing to those patients and is it within your specialty.
18:59 I often times have to – I can recall many conversations with many different types of
19:06 providers in
19:07 different settings trying to explain to them that this is not a level five, it will never
19:13 be a level five
19:15 and this is why.
19:16 Because it’s really based on medical necessity as we all know.
19:19 And CMS will
19:21 tell you right on their website that medical necessity is the overall confectionary for
19:26 any level of
19:27 servic, up or down.
19:28 It’s how they look at it.
19:30 Under coding is not good and over coding as we
19:32 know is not good.
19:33 So you just have to make sure that your documentation is bullet proof as I like
19:37 to say because then it will stand and hold up in the event of any type of audit.
19:42 You just have to
19:43 understand from the documentation –
19:44 Kim Dues: Right.
19:45 And that’s why getting an outside audit is a smart thing to do, to use
19:49 internally for your own purposes.
19:52 You can see – you can have a bellgraph [0:19:53] given as to
19:57 how many 99 – between 99211 and 99215 and the 99201s all the way to the 99205s, you
20:06 can see
20:07 a bellgraph [0:20:05] of what your – and so that’s really powerful information for
20:13 a doctor’s
20:14 office to have to help them zero down and drill into their documentation through that
20:21 audit.
20:22 It’s
20:23 really powerful to allow that to take place in your practice.
20:28 And Holly and I also know, it’s a little scary, we also know that it’s scary to make
20:33 a decision like
20:34 that, to let somebody else in, to take a look but it’s necessary.
20:38 And then you use that information
20:40 to empower your documentation.
20:41 Holly Cassano: You don’t know what you don’t know until you get audited.
20:47 And then that is a
20:49 real eye opener for many people in practice today.
20:52 And it also has been the cause of many
20:54 practices shutting down unfortunately.
20:56 Not because they intentionally did anything wrong but
20:59 the –
21:00 Kim Dues: No they didn’t wake up in the morning.
21:04 No.
21:05 Holly Cassano: Yeah.
21:06 The intent generally is not there.
21:07 I would say in all the cases that I’ve
21:08 ever been on to review, I was in maybe like 2%or 3%, wasn’t any even like maybe and
21:15 inkling of
21:16 intent or possibly.
21:18 I couldn’t have – most of it is matters of don’t understand or billing steps
21:26 don’t understand and that’s – these are things that we can help you while we’re
21:30 talking about
21:31 Billing Paradise, the company that we represent, this is what we’re trying to say, is that
21:36 doing a
21:37 baseline audit, letting us maybe do a baseline audit for your practice doesn’t mean you
21:41 have to
21:42 sign up for services with us, we can just do a baseline audit for you.
21:45 We can do an LRR8 for
21:47 you; we can do the MACRA 60 minute consult for you.
21:51 You don’t know what you don’t know
21:53 until you get audited.
21:55 And that’s something that you really need to consider in your practice.
22:01 So we could definitely talk to you more about that after the presentation but getting back
22:07 on –
22:08 yeah getting back on track you–
22:09 Kim Dues: Right so let's –
22:10 Holly Cassano: There are a variety of options; I’m going to hand that one off to you for
22:12 MIPS
22:13 okay?
22:14 Kim Dues: Okay.
22:17 So MIPS does present some challenges, one is simply that there are multiple
22:22 options to choose from as an eligible provider who wants to participate in MIPS.
22:27 The
22:28 requirements for MIPS participation vary depending upon what option a provider chooses.
22:33 Of
22:34 note, MIPS eligible providers need not select on a final participation option this year.
22:43 CMS is
22:45 not requiring registration for the program for 2017 so providers can take all of 2017
22:52 to decide the
22:53 MIPS participation going forward.
23:00 The current and the future forecast.
23:05 So 2017 –
23:07 Holly Cassano: Yeah.
23:08 There’s a timeline.
23:09 Kim Dues: Yeah.
23:10 This is a timeline but basically MIPS reporting begins in 2017.
23:15 And then that
23:16 reflects in 2019 payments.
23:18 Holly Cassano: Yeah.
23:20 It does.
23:22 Basically the way MACRA started, it was approved back in
23:28 2015 by CMS and in 2016 the QPP quality payment programs proposed the finals rules were
23:34 released.
23:35 And then as of 2017 this year, this is the MIPS inaugural performance year that begins.
23:42 There are multiple reporting options for providers that allows them to select an option which
23:48 will
23:49 work best for the practice.
23:51 And there are several options which can be selected in order to avoid
23:54 a negative payment adjustment.
23:56 One is reporting some data which means maybe a month of
24:00 data, two months of data, something like that.
24:04 Then you can go to a 90 day data reporting period
24:06 and then you can do a full year of data reporting for this year.
24:09 It’s really up to you.
24:10 Kim Dues: Right.
24:11 And I mean of course – right, the full year is optimal but some may not be
24:17 ready and we’re not talking about just Medicare, we’re talking about all your payers.
24:24 All your
24:25 payers across the board, all your patients.
24:27 That is the data that you are collecting all your MIPS,
24:34 all of it.
24:35 And then that information is going to be sent through a portal to CMS.
24:39 A registered
24:41 portal with CMS.
24:42 Holly Cassano: Absolutely.
24:44 Yeah.
24:45 Kim Dues: And then the adjustments will show up in 2019.
24:48 Holly Cassano: Correct.
24:49 And providers can – as I said, providers can even begin collecting
24:54 performance data as of January one of this year or they can select any continuous period
25:02 ending
25:03 no later than October second of 2017.
25:04 Kim Dues: Yeah.
25:05 Holly Cassano: So continuing with the timeline as of 1/1/2017 providers who were ready to
25:11 begin participating in the programs were able to start collecting performance data and could
25:16 result in a positive payment adjustment.
25:19 MIPS payment adjustments for 2019 will be based on
25:22 that performance this year of 2017.
25:26 Then October second of this year, providers who are not yet
25:29 prepared to participate have until October second of this year to begin collecting performance
25:35 data and still could qualify for a nominal positive payment adjustment if they start
25:41 in October.
25:42 MIPS payment adjustments again in 2019 will be based on performance of this year 2017.
25:46 And
25:47 then lastly as of 12/31/2018, a meaningful use physician quality reporting system PQRS
25:53 and the
25:54 value based modifier VBM payment adjustments.
25:58 Finally and I’m sure with many people clapping, well sunset for Medicare providers at the
26:03 end of
26:04 2018.
26:05 All of it has been very challenging for providers that we’ve interacted with and Kim I’m
26:11 sure you have quite a few that you’ve interacted with.
26:13 Kim Dues: Right.
26:14 I mean honestly at minimum, my recommendation is to get 90 days at
26:19 minimum.
26:20 That’s just my recommendation.
26:21 Holly Cassano: Yeah.
26:22 I would at least go for 90 days; I wouldn’t want to go for less than that.
26:26 Kim Dues: Right.
26:27 And so this is why I said in the beginning, we’re already turning the corner,
26:31 tomorrow is the first of June so if you’re going to collect 90 days, that’s June, July,
26:37 August.
26:38 If
26:39 you’re going to – so I’m just saying there’s really only – there’s only six
26:42 months left to really
26:44 grab that data.
26:45 And 90 days is – that’s just my suggestion.
26:49 So –
26:51 Holly Cassano: I want to ask you a question about PQRS.
26:55 Because I remember you were
26:57 talking to me about it.
26:58 I have worked with some providers who are on the PQRS program but I
27:04 know you’ve done a lot of extensive work with providers and PQRS.
27:07 So can you maybe share
27:09 one of your as I like to call it, horror stories about a provider and how you straightened
27:15 it out and
27:16 what you did?
27:17 Kim Dues: Oh yeah.
27:22 Well, I’ll just take a – all right I’ll just take a little practice that I worked
27:27 with.
27:28 This little practice, they were basically started from the ground floor up.
27:33 They had a pretty
27:36 decent practice management system EHR combination under one umbrella.
27:42 Not too bad but one
27:44 of the problems we ran into is once the provider’s wife who was the office manager, once we had
27:53 our meeting and laid out a ground plan for submitting her PQRS data, then what we were
28:01 doing
28:02 is we were talking about the collection of that data.
28:04 So we dove into the EHR, we found like
28:07 98% of the measure but there were two really big measures and it was a paying management
28:13 practice.
28:14 There were two really big measures that the EHR was not collecting.
28:18 So we went
28:20 round and round and round with the practice management system and they basically said
28:25 that
28:26 they weren’t going to make a change to the EHR specifically for that.
28:30 So what we did is we basically found a back door process so that the EHR will collect
28:39 those two
28:40 measures.
28:41 And so this is what I’m saying to the group of viewers, is that in the event you have
28:46 an EHR that is not collecting all your measures and you need them to collect all your measures,
28:53 then you have to be proactive enough to look at your EHR, find a back door so that it will
29:04 collect
29:05 those measures and that they will show up on a report.
29:08 Because it’s the report that you’re going
29:09 to be submitting.
29:12 So what you do is you find that back avenue and you work with your revenue cycle team
29:17 also.
29:18 And if you don’t have a revenue cycle team, here we are, Billing Paradise, we can help
29:22 you with
29:23 that.
29:24 So we can find the backdoor for you to make sure those measures are collective so that
29:29 they
29:30 show up on the report.
29:31 So that when you submit them to a portal – now I do know that some of
29:35 the EHRs, they do have a method where they will submit them for you but what they are
29:44 not
29:45 doing is they are not scrubbing your PQRS measures, they are not telling you where you’re
29:50 deficient, they are not giving you advice.
29:52 And so I really, I really recommend using a registered
29:57 portal and this is what they do.
30:00 Yes you pay them a fee but what they give you for that fee is
30:04 they let you know ahead of time that basically your measures will pass because they’ve
30:10 scrubbed
30:11 them, they know what the – they know what is expected of that particular specialty and
30:15 those
30:16 measures and that’s what you want.
30:18 You want a registry that’s going to help you.
30:20 And so in the beginning, I mentioned a company called New Jersey Institute and it’s
30:29 They are excellent, their staff is very knowledgeable, they help you out, they’ve worked with
30:36 hundreds and hundreds of practice management systems.
30:39 They’ve reviewed hundreds of reports,
30:41 hundreds of specialties and they are just very, very good.
30:45 So that is the company that I have used
30:48 and I have leaned on to make sure that those measures are correct and to make sure that
30:53 everything is the way it’s supposed to be before they are submitted through the portal.
30:58 And then
30:59 once they are submitted they are gone; you can't reach back in and take –
31:02 Holly Cassano: That’s good
31:03 Kim Dues: So I do recommend that portal.
31:05 It is very important.
31:06 Yes I understand that it’s free
31:09 to use an EMR portal and yes they will submit them for you, but they’re not going to scrub
31:15 them
31:16 for you.
31:17 Holly Cassano: No they won’t.
31:18 Kim Dues: That’ going to be something you pay for.
31:19 Holly Cassano: Also on that website, correct me if I’m wrong, don’t they have an area
31:25 you can
31:26 go to where they list all of the specialty measures?
31:28 Kim Dues: They do and it’s just – yeah the website is super user friendly.
31:35 They have all the
31:36 measures out there, you just have to find your specialty, click on it, drill down into
31:41 them and then
31:42 you start the hard work of going into your EMR to make sure that your EMR is capturing
31:49 those
31:50 measures that you see there.
31:51 Holly Cassano: Yeah.
31:52 If I’m –
31:53 Kim Dues: They have an excellent website.
31:54 Holly Cassano: So for those providers that possibly may not have done any type of PQRS
31:59 or are
32:00 very limited with it, they’ll be able to land and they can download the measures for
32:06 their
32:07 specialty which will help them with MACRA and MIPS going forward to identify that.
32:11 Kim Dues: Yeah.
32:13 Honestly, this is going to be the easiest year to get involved, it has been really
32:18 a nail biter since 11 honestly it has been.
32:22 And it’s, this is really the easiest year to get involved
32:24 and so I really encourage all those watching and anybody that will see this little podcast
32:34 later on
32:35 to really take that to heart because this really is the year to get involved.
32:40 And these measures are
32:41 not going to go away, the quality payment system is, it’s coming down the pike, right
32:47 Holly?
32:48 Things are going to change a little bit yeah?
32:50 Holly Cassano: Absolutely.
32:51 Yes.
32:52 Outcome might be going away or coming back in some
32:55 regurgitated format.
32:56 However these measures are not going away.
32:59 Because really what’s
33:00 happening is the government is gearing up with all the other payers, kind of come together
33:07 under
33:08 this one umbrella and under a risk type of environment as I like to call it.
33:14 Everyone’s heard of
33:15 Medicare advantage, risk adjustments all these kind of stuff.
33:16 This is kind of what it’s all heading
33:18 towards.
33:19 And so it’s going to be – it’s not going to be exactly like a Medicare advantage plan,
33:26 it’s not going to be exactly like that.
33:28 Because there are a lot of problems within that system that
33:30 I’m sure people have read in recent headlines over the past week or so with large payers.
33:37 But it is really, what it’s all about is trying to gain control of the chronic disease
33:43 issues within our
33:44 country.
33:45 We are one of the sickest countries in the world with chronic disease unfortunately.
33:51 But that’s what this is; trying to get healthcare under control, trying to get cost under control.
33:57 Trying to make sure that we have more preventative care with well women visits, well child
34:03 visits, well man visits.
34:05 All this kind of stuff is where it’s –
34:08 Kim Dues: Going on [0:34:05]
34:09 Holly Cassano: Yeah.
34:10 Because the cost–
34:11 Kim Dues: Yeah.
34:12 Your annual visit, it’s very important.
34:13 Holly Cassano: Absolutely.
34:14 These annual visits[0:34:12] all of it; well visits, all of it.
34:18 And they
34:19 are trying really to get not just the primary care docs involved as the gate keepers but
34:22 they are
34:23 really trying to get the specialists involved.
34:25 That’s what all this five star ratings that you’ve
34:29 heard about too not to get sidetracked but just to kind of expand a little bit, that’s
34:34 really where
34:35 this is coming from because it used to be just health plans were under a five star rating
34:40 plan.
34:41 Well now they’re not.
34:42 It’s also hospitals, it’s practices, it’s providers.
34:44 This is one of the first
34:45 years that providers are being looked at.
34:49 So when Medicare says, okay with MIPS, with the MIPS program, they’re basically saying
34:55 that
34:56 we’re giving you a free pass if you get on board.
34:58 Kim Dues: They are?
35:00 Holly Cassano: All right.
35:01 So when Medicare does that, you need to sit up and listen and kind of
35:06 see what it’s all about.
35:07 You may not like it, you may not want to have to do it, you may have to
35:11 expand resources to help you join in but you really need to sit up and listen and take
35:19 notice or
35:21 Medicare gives you a free pass as I like to say.
35:25 What do you think Kim?
35:27 Kim Dues: I agree.
35:28 It’s this whole risk adjustment umbrella with all the payers.
35:33 That’s another
35:34 thing that’s not going away.
35:37 That’s why this is just another program because it’s a program that
35:43 is expanding.
35:45 So in the past, we submitted our measures strictly for the Medicare patients.
35:50 So
35:51 this is a good example.
35:52 It is now expanding to all your payers; they want to see it on all your
35:56 payers
35:57 Holly Cassano: Absolutely.
36:00 So and I think – go ahead.
36:04 Kim Dues: I was just going to say it’s not going anywhere, it’s just going to continue
36:08 to expand
36:09 and so it’s really about just jumping on that train and getting involved and stay involved.
36:16 Holly Cassano: Exactly.
36:18 Really all it is, is they’re trying to get providers to document better on
36:24 these parentheses[0:36:22] processes.
36:26 No matter whether it’s MIPS, risk adjustments, all these
36:29 different things; PQRS.
36:30 They are trying to really gain the knowledge that they are lacking on
36:38 where is our [0:36:36] country with healthcare.
36:41 Kim Dues: Right.
36:42 And ICD-10 is helping that correct?
36:44 Holly Cassano: I say it’s definitely helping that.
36:49 But now what’s happening is they kind of give
36:51 everyone a free pass for the first year of ICD-10 about getting it right, making sure
36:57 you’re
36:58 submitting very clear diagnosis codes that are accurate.
37:01 Making sure everything is specific,
37:04 documenting it properly.
37:05 But now what’s happening is now they are going back and they’re
37:09 auditing the ICD-10 codes.
37:11 They didn’t do it for a little bit but now the start to go back and they
37:15 are auditing providers on their ICD-10s.
37:17 So with Medicare business free pass, there’s always a give and take with that.
37:21 So this year, just
37:22 kind of give me your free pass of MIPS, so guarantee, the [Inaudible] [0:37:24] comes
37:28 with 4%
37:29 and other elevated payment adjustment rates that will continue, forward through this.
37:31 You can
37:32 see this is going to be audits and things of that nature just to make sure that this
37:38 is what is really
37:39 happening, this is what you’re recording and you need some documenting appropriately.
37:44 So look
37:45 at that, I strongly suggest everyone to devote the resources that will be necessary and these
37:51 are
37:52 things that we can help you with going forward.
37:54 Kim Dues: Absolutely we can help you with.
37:56 Absolutely.
37:57 Holly Cassano: Yeah.
37:58 Billing Paradise, Kim and I are definitely set up to help providers
38:03 strategize and get themselves in line for MIPS as it come forward.
38:08 Go ahead Kim; sorry.
38:09 Kim Dues: Absolutely.
38:10 No that’s fine.
38:11 So we went over the MIPS performance period, did we
38:14 go –
38:15 Holly Cassano: Yeah.
38:16 There’s still – for 1/1/2018 it really is the first full reporting performance
38:21 period for MIPS in a full calendar year being from January one through December 31 st which
38:27 is
38:28 two years prior to the payment adjustment year.
38:30 And with that, the payment adjustments for
38:32 2020 will be solely based on performance in 2019.
38:35 The 2018 requirements are still subject to
38:38 change as CMS releases more Information during the course of 2017.
38:45 And as of 3/31/2018 all
38:47 participating providers must submit all data to CMS for 2017 regardless of when the actual
38:53 data
38:54 collection began in 2017 no later than March 31 st .
38:58 Kim Dues: Right.
38:59 So march 31 st , that’s the day when everybody submits their MIPS for 2017,
39:03 that’s the day you’re going to turn in that information.
39:07 Holly Cassano: Mm-hmm.
39:09 Kim Dues: So the payment adjustments, the 2019 MIPS payment adjustments will either
39:16 be a
39:17 positive or a negative of up to 4% plus providers can earn up to a 12% bonus for achieving the
39:26 25 th percentile or qualifying alternative payment model a.k.a APM of 5% participant
39:37 incentive
39:38 payment.
39:39 So this is just another incentive.
39:44 So in 2020, MIPS payment adjustment will either be
39:47 a positive or a negative of up to 5% plus providers and earn up to a 50% bonus for achieving
39:55 the
39:56 25 th percentile qualifying APM; 5% participant incentive.
40:02 So it’s going up.
40:03 So it starts its ride in
40:04 2019 and then it goes up to 15% for that dangling –
40:12 Holly Cassano: It actually goes all the way up.
40:15 In 2021 it goes up to 7% and then you get –
40:17 positive or negative.
40:18 And then you can gain up to a 21% bonus.
40:22 Kim Dues: Right.
40:23 Plus the 21% bonus.
40:24 Holly Cassano: And then in 2022, that –
40:27 Kim Dues: So in 2022 MIPS payment adjustment for 9% plus up to a 27% bonus for achieving
40:41 25 th percentile.
40:43 Go ahead.
40:45 Holly Cassano: Now Kim, you want to kind of discuss a little bit about the messages on
40:52 the
40:53 Medicare EOBs that people will see?
40:55 Kim Dues: Yeah.
40:56 So just like I was saying before, when it comes to those EOB messages, you
41:00 have got to read those messages.
41:02 You need to take a look – I know that everybody is posting
41:06 electronically, fine.
41:09 We know that Medicare requires that everybody take their payment
41:13 electronically and do the bank account, but someone on the revenue team has got to sit
41:18 back and
41:19 they’ve got to read those messages; especially the negative messages.
41:23 So the messages as it
41:25 relates to – there was a message for a sequestration, it was a reduction and that’s CO-253.
41:33 So
41:34 that’s its own message.
41:35 But as it pertains to the MIPS adjustment messages, there is one that’s
41:41 going to be an N-701 that’s payment adjusted based on value based payment modifier.
41:47 There’s an N-699 payment adjusted based on the PQRS incentive program and then there’s
41:55 a
41:56 CO-237 legislative regulatory penalty to designate when a negative or downward payment
42:02 adjustment will be applied.
42:04 So you got to watch for these but just my point of bringing this up
42:10 and just throwing this out there today is, these negative adjustments will not be the
42:17 same
42:18 adjustment that sequestration was; sequestration is its own baby.
42:23 It’s not going to be the same.
42:27 So and you still may see that CO-253; I’m sure some of them, we are all seeing the sequestration
42:37 percentage reduction on our payments but just know that the MIPS negative adjustments will
42:43 come on a different message.
42:44 That’s my point on that one.
42:46 Holly Cassano: Yeah.
42:47 Sequestration I think really threw a lot of people for a loop, they thought
42:50 they were getting penalized when other people weren’t but that was across the board basically
42:53 because of the reduction –
42:54 Kim Dues: Yeah it was cross board to everybody.
42:58 Sure.
43:00 So that’s why I’m saying that either a
43:04 practice manager or the billing manager or whoever it is that’s leading that billing
43:09 team,
43:10 somebody’s got to be reading those dunning messages on the bottom of the EOB.
43:14 Holly Cassano: Absolutely.
43:16 So I think we’re coming to the end of our presentation today
43:21 correct?
43:22 Kim Dues: We are coming to the end of our little chat.
43:25 Holly Cassano: So.
43:26 Kim Dues: It’s MACRA.
43:28 Holly Cassano: Yeah.
43:30 So I’d like to thank everybody but I think were – are we going to open it
43:33 up for Q and A or are they going to email us?
43:35 Kim Dues: I think we can take some questions and we can try to answer some of those questions
43:43 here.
43:44 So if any of you watching, if you have any question, just go ahead and send them along
43:50 and we’ll try to answer them and if not I know that we’re going to want your email
43:56 address to
43:58 follow up with you or to – if you decide to take advantage of our –
44:06 Holly Cassano: MACRA forums.
44:08 Kim Dues: Our free 60 minute MACRA course [0:44:11] of course we said that’s first
44:16 come first serve and then the other one is the LRRA, the Lost Revenue Recovery Audit,
44:21 we can
44:22 do that for you and talk to you about what’s happening with your revenue cycle and where
44:28 some
44:29 of your – what’s happening with some of your payments.
44:33 And of course, again we’ll be reading
44:36 those denials and digging down into those.
44:39 So if anybody has anything, that’s fine, they can just
44:42 send it along.
44:44 Holly Cassano: What email should they be sending it to Kim?
44:50 Kim Dues: They can send it to mine or yours and mine is or you
44:57 can
44:58 send it to Holly, really simple.
45:02 We’ll get those emails right away.
45:06 Holly Cassano: Sounds good.
45:08 Kim Dues: Yeah.
45:09 Holly Cassano: I enjoyed our chat; we’re going to be doing this –
45:12 Kim Dues: I enjoyed our chat too.
45:14 Holly Cassano: Yeah.
45:15 We’re going to be doing this going forward on a variety of different
45:20 topics.
45:21 We’re still determining if we want to do it on a monthly basis, maybe by weekly or
45:25 something like that but we’ll let you know on our Facebook.
45:29 And please go ahead and check out
45:30 Billing Paradise’s Facebook page and hit like and share.
45:34 We appreciate that.
45:35 And I guess we
45:37 want to thank everyone for joining us today and hope it was informative for you and please
45:41 give
45:42 us feedback.
45:44 Kim Dues: Yes.
45:45 Thank you.
45:46 Thank you.
45:47 Holly Cassano: Have a wonderful day.
45:48 Kim Dues: Have a wonderful day everybody and thanks so much again.
45:49 Holly Cassano: Thank you.
45:50 Kim Dues: See you soon.
45:51 Bye Holly; thank you.
45:53 Holly Cassano: Bye.
45:54 Bye Kim
45:55 Kim Dues: Bye-bye.
45:56 [0:45:52] [Video Ends]

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