Understanding Medicare Paperwork Requirements for Physicians
The Importance of Compliance
For healthcare providers participating in Medicare, adhering to paperwork requirements is essential and cannot be overlooked. This has become increasingly crucial for medical practices due to the Medicare Access and CHIP Reauthorization Act of 2015 and the associated MIPS (Merit-based Incentive Payment System) incentives. Compliance with these requirements is vital in the evolving value-based care model.
Financial Incentives for Compliance
Once physicians meet these requirements, they can qualify for a 5% incentive added to their 2020 Medicare payments. It is important to recognize that these adjustments can significantly impact your practice’s finances. While monetary benefits are important, the reputational enhancement that comes with compliance can elevate your status as a clinician, marking you as an authority in the healthcare field.
Upgrading EHR Systems
To align with MACRA guidelines, it is advisable for practices to upgrade to a 2015 certified EHR technology edition. This is especially relevant for practices still operating on outdated paper-based systems. When considering new technology, ensure that the vendor has a reliable history of compliance with government proposals. Additionally, staff training is crucial for the successful implementation of any new EHR systems.
Key Changes in MIPS for 2019
Change 1: Exemptions Under Extreme Conditions
CMS acknowledges that extreme conditions can hinder the collection and submission of patient data. In 2019, clinicians facing such challenges will receive more leniency. For instance, during the 2017 performance year, clinicians affected by natural disasters, like the California wildfires, were not penalized for lack of data. This trend of automatic exemptions is expected to continue, protecting MIPS-reporting physicians during unforeseen events. For assistance with quality measures and reporting, consider contacting P3 Healthcare Solutions at 1-844-557-3227 or via email at [email protected].
Change 2: Increased Weight for the Cost Category
As Medicare transitions to a value-based care model, the cost category in MIPS will gain more significance. It held a weight of 10% in 2018 and is projected to increase in 2019, with expectations of reaching 30% by 2022. Preparing early for this shift can help practices achieve favorable MIPS scores, aligning them with quality-based care. Consequently, a corresponding decrease in the weight of the Quality category is anticipated.
Change 3: Expansion of Low-Volume Thresholds (LVT)
The Low-Volume Threshold (LVT), which is determined by the number of eligible Medicare Part B charges and patients seen by clinicians, is set to increase in 2019. Currently, the LVT stands at 200 Medicare patients or $90,000 in allowed charges. This marks an increase from the 2017 requirements of 100 patients or $30,000. Practices that were previously ineligible may find themselves eligible for MIPS submissions in 2019. As soon as you meet the LVT, P3Care, a MIPS qualified registry, can assist in reporting on your behalf to maximize incentives.
Change 4: Boost in MIPS Cost Category Weight
The cost category weight will rise to 15% in 2019, emphasizing the need for careful reporting as CMS intensifies its focus on healthcare cost reductions. Adjustments in the Quality category will also occur, decreasing its weight from 50% to 45%. Staying informed about regulatory changes concerning Medicare reimbursements is crucial for successful quality reporting, which aims to enhance healthcare delivery and compensation for physicians.
Conclusion
P3 Healthcare Solutions provides valuable insights into the intersection of medicine and medical billing, focusing on efficient revenue cycle management and MIPS consulting. Staying updated with the latest Medicare MIPS reporting requirements is essential for offering quality billing services to clinicians.