However, depending on the level of sophistication of EHR systems, this may not be as easy as it sounds. The switch to value-based analytics reporting increases the challenges and potential headaches.

Here are some reporting suggestions that may help your practice save time, money and aggravation while improving your rates of payer reimbursement:

Financial Reports: Information Every Medical Practice Should Acquire

⇒  Denied Claims Report

As any physician knows too well, denied claims cost money in lost revenues as well as staff time spent finding the cause of denials, followed by re-billing. Be sure to pay attention to each payer’s EOB to determine not only the reasons but their codes and explanations line up with how you bill claims.

According to a recent survey from the following are trends in denied claims:

• Demographic, as well as technical denials, have risen over 100 percent since the last survey, resulting in increased write-offs.
• The success rate of appeals on denials was only between 50-56 percent.
• Commercial payer denials had risen by over 26 percent of total denied claims.

Having a good revenue analytics program can help practices and other organizations detect denial patterns as well as the amount of recoverable revenue.

A denial analysis report can also be broken down further into two separate denial categories based on:

• The payers who were the source of most denied claims
• Top CPT codes over which claims were denied

⇒  Profit and Loss statement (P&L)

This report shows how profitable practice is by tracking income (revenues) and expenses. It can help identify key performance indicators (covered further below) including total patient encounters, procedures, charges as well as any collected monies. Any drop in revenue (collections) is a warning before taking action.

An example could be a decrease in the prior month’s billing would likely result in a drop in this month’s collections.

⇒  Key Performance / Provider Productivity Indicators

Your provider productivity and performance report should show how each physician is contributing to how to increase revenue-producing with quality measures while keeping costs under control, making it one of the practice’s most important reports.

In addition, having efficient systems software now enables you to do in a matter of minutes what used to take days: track total charges, collections, procedures, encounters, A/R outstanding and adjustments.

⇒  Accounts Receivable (AR) Aging

Whether fee-for-service or value-based, this report is essential to determine which claims are outstanding and why. As with denials, unpaid claims are a drain on revenue, so use your analytics to track any claims over a month old. If still unpaid after 45 days, you need to check to see whether it was paid and possibly posted to the wrong account or whether it was denied or still unpaid.

⇒  Clearinghouse Rejections and Benchmark Metrics

Early in the switch to ICD-10, a number of payers added set-specific coding in front-end translations, resulting in entire groups of claims rejected, usually at the claim-acknowledgment stage with a 999 designation. Use analytics to determine which denied claims are due to erroneously using both ICD-9 and ICD-10 coding as well as codes with wrong qualifiers.

⇒   Value-based Reporting

This may be one of the most important considerations as you run reports:  moving into value-based reimbursement, the practice’s quality measures should have been captured for the Merit-based Incentive Payment System (MIPS) along with others. Using clinical registries and other sources, providers should be able to compare physician and practice-quality scores against their peers. Quality measures can also reveal areas needing improvement along with gaps in care.

⇒   Removing Obstacles to Reporting

Issues with interoperability between providers’ systems as well as the quality and quantity of data collected can all make sharing data, analyzing and reporting a logistical nightmare.  The result could be missing key metrics and critical financial information which can lead to bad business decisions that could cost you your practice.

We can help eliminate risks of above mentioned miscoded claims as well as identify other areas where you may losing revenue and to track and identify unpaid claims so your practice is reimbursed in a timely manner.

Contact us or Schedule a free demo http://localhost/main-site-update/live-demo/

It doesn’t seem that long ago when MACRA was first announced and the final rule was released last October. But now, providers are anticipating what’s ahead for the program in its second year, especially for the Quality Payment Program. The healthcare industry received its first glance at what’s in store for 2018 as CMS released the QPP proposed rule earlier this week.

What changes mean for Providers?

More solo practitioners and small groups will be excluded from the Merit-based Incentive Payment system (MIPS) in 2018; those remaining in the program will need to prepare for increased reporting requirements. Simultaneously, many healthcare organizations will need to begin defining a broader value-driven care strategy, and considering how to structure contracts with non-Medicare payers.

CMS will accept comments on the proposed rule until August 18, 2017, and the Final Rule will be published in the fall.

MIPS Transition Reporting and Scoring Thresholds

CMS proposes a continuation too many of its initial transition year policies in 2018 and to moderately increase the thresholds for MIPS eligible clinicians from the 2017 performance year. This includes:

• Increasing the performance threshold from three points to 15 points in 2018 and maintaining the additional performance threshold at 70 points.

• Slightly increasing data completeness thresholds for most reporting mechanisms within the Quality category from 50 percent in 2017 to 60 percent in 2019 and continuing to implement scoring floors.
• Increasing the performance period to a full calendar year for the quality category in 2018, while keeping the performance periods for Improvement Activities and Advancing Care Information at 90 days.

Highlights from the QPP Proposed Rule

• 2018 will feature continuation of “pick your pace” for the new payment system’s data reporting and expands exemption of physicians from mandatory participation.
• Physicians will be able to participate in MIPS through Virtual Groups working with other small practices to combine their administrative costs.
• Physicians in small practices will receive extra “bonus” points within the Composite Performance Score for MIPS to recognise their value to communities where they practice.

MIPS Cost Performance Category Delay

The cost performance category has been a significant concern for clinicians and provider groups of all sizes and as a result, CMS proposed to eliminate the domain for an additional year.

Changes to the Cost category proposed by CMS include:

• Measuring clinicians on Medicare Spending per Beneficiary (MSPB) and total per capita cost measures. However clinicians will not be scored on these in 2018.
• Eliminating the previously finalized 10 episode-based measures and continuing to work with stakeholders on replacing these measures.

Virtual Groups in 2018

Beginning in 2018, solo practitioners and groups of 10 or fewer will be able to partner virtually with other solo practitioners or groups of 10 or fewer, regardless of location or specialties. They will generally be treated as any other group in the QPP. This could be an attractive option for clinicians who may not have the resources to perform well in the QPP independently.

All-Payer Combination Advanced APM Option

Alternative Payment Model (Advanced APM) track by participating in a combination of Medicare and other payer models. In its 2018 proposed rule, CMS provides the first details of the All-Payer Combination methodology which will be used to shape contracts with non-Medicare payers over the next several years. Key provisions include:

• Determining Qualifying Participants under the All-Payer Combination Option at the individual clinician level only.
• Allowing clinicians to self-submit other payer data to CMS without requiring that payers attest to this data.
• Implementing an eight percent revenue-based threshold in addition to the existing benchmark-based total risk threshold, similar to the finalized Medicare nominal amount standard

For more information or to discuss implications for your organization, please contact us.

CMS will be sending letters to physician practices throughout the month of May with important, practice-specific information regarding eligibility to participate in the Merit-Based Incentive Payment System (MIPS) at the group/individual level for the performance year 2017.

Everyone Taxpayer Identification Number (TIN) should enrolled to participate in the Medicare program will be receiving a letter that includes a summary of the Quality Payment Program (QPP),

The Following steps towards participation and reporting, and the exemption eligibility guidelines:

1. Being a less volume clinician: Identified by using historical Medicare claims data and defined by having less than $30,000 in annual Medicare Allowable charges or by treating fewer than 100 Medicare patients.
2. First-year Medicare enrolled clinicians.
3. Not being one among the categories of clinicians included in the program’s first year, i.e. therapists, audiologists, and others.
4. Participants in certain Advanced Alternative Payment Models (APM), if participation is sufficient to meet certain thresholds.

If you find that your questions regarding MIPS are still left unanswered, Please give us a call or send an email at +1(302) 613-1356 or support@wonderw.com

MIPS Participation Attachments:

The true value of the letter is found in its two attachments which contain information specific to you and your practice.

Attachment A: It contains the Eligibility /Exemption status for the TIN and each individual provider enrolled under the TIN. This can be used to help you determine whether your group will be required to participate in MIPS for performance year 2017 and if you should report as a group or as individual clinicians.

NOTE:  If your group chooses to report as a group, MIPS assessment will be based on All Individuals in the group. This will not take into consideration any providers who would be individually exempt from participation.

Attachment B: It contains CMS’s best effort to answer some of the many questions you may have about the Quality Payment Program, its two tracks: MIPS and APM, and how you should prepare for participation.

If you have not received your letter from CMS, you can also look up your MIPS eligibility on the QPP website at: http://qpp.cms.gov/learn/eligibility

More information on MACRA, MIPS can be found on our blog at http://localhost/main-site-update/among-uninformed-macra-mips/