Joncé Smith

The new year is fast approaching, and practices must keep pace with evolving Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) policies. With the new final reporting rule, it is often difficult to balance optimizing the revenue cycle while monitoring impacts on performance scores and operational workflows. 

To combat these challenges, practices can apply the following four tips to enhance cash flow while being mindful of MACRA’s Merit-based Incentive Payment System (MIPS) reporting requirements: 

Prepare for major changes for MIPS Year 3. 

MIPS participation eligibility changes with MACRA’s Quality Payment Program (QPP) 

. The following providers have been added for eligibility in MIPS Year 3: physical therapists, occupational therapists, speech-language pathologists, audiologists, clinical psychologists, and registered dietitians or nutrition professionals. 

To be exempt from MIPS Year 3 participation, clinicians or groups must meet one of the following three criteria: 

Have $90,000 or less in Part B allowed charges for covered professional services,

Provide care to 200 or fewer Part B beneficiaries, or 

Provide 200 or fewer covered professional services under the Physician Fee Schedule (PFS). 

The third exemption option is new in MIPS Year 3. In addition, clinicians or groups who meet these exemption criteria can now voluntarily participate if they meet one or two low-volume threshold MIPS exemptions. For exempted clinicians, the opt-in option was not available in past years, which prevented them from reaping MIPS reimbursement through properly documented and submitted category measures.CMS also offers the option for clinicians who are based at a healthcare facility to use facility-based scoring instead of reporting separately.

In terms of overall performance category changes, the transition from MIPS Year 2 to Year 3 brings slight category weight shifts. The Quality category will account for 45 percent, Cost for 15 percent, Promoting Interoperability (PI) for 25 percent and Improvement Activities (IA) for 15 percent. This places a higher focus on the Cost category in 2019. 

Additionally, participating clinicians must adjust to the reallocation of the small practice bonus in 2019, available for practices with 15 or fewer eligible clinicians. Now, the small practice bonus offers up to six points rather than the five that were available in 2018. And unlike last year, the points will be added to the numerator of the Quality performance category score, rather than the overall MIPS final score. Still, in MIPS Year 3, CMS will continue to award small practices three points for submitted Quality measures that do not meet data completeness requirements. Finally, clinicians should look out for new MIPS terms throughout the Year 3 final rule, such as collection type, submitter type, and submission type. The terminology change better reflects how clinicians and vendors interact with MIPS. 

Strategize MIPS performance category submissions. 

Both the MIPS PI, formerly Advancing Care Information, and IA categories expanded in 2018 and adjusted reporting activity options to ease meaningful participation for more practices. Many practices do not realize they can submit IA measures for any continuous 90-day reporting period. In demonstrating improvement to existing activities for easy comparison and documentation, 2018 MIPS participants should thoroughly document IA starting points and activity measurement progress as well as take advantage of opportunities. 

 for Year 2, participating clinicians should report on all base measures. If they don’t, they lose the chance to score additional category points to reach the 100-point category max. In 2018, the total possible base and performance measures also depends on certified EHR technology (CEHRT). Utilizing 2015 CEHRT offered 10 bonus points in Year 2, but this elevated CEHRT requires more advanced functionality with five base measures and nine performance measures. 

in MIPS Year 3. It is no longer a bonus opportunity, and 2014 CEHRT will not be permitted in MIPS Year 3. The 2019 final rule eliminates the old PI bonus opportunity and scoring method to focus instead on performance-based scoring at the individual measure level.  

Ensure more conscientious registration processes. 

As administrative and business office staff juggle multiple roles, physician practices suffer from a high rate of denied claims. To improve claims processing without pulling significant time from MIPS and other value-based care reporting, require registration or appointment staff to collect accurate insurance data, including for Medicare and managed care plans. 

Have staff verify this information for all scheduled encounters at least one week prior to the appointment. At appointment check-in, ask staff to check for expired patient identification and insurance cards using a formalized basic registration checklist. Host training throughout the year for new hiresand conduct annual staff re-education with visual examples of checklists and workflows for proper registration data collection. Repeated attention to insurance data details can significantly impact claims processing success, which can free up more time for staff to focus on MIPS initiatives.  

Encourage patient portal participation. 

Clinicians often do not encourage patients to use patient portals for test results, secure communication, and payments. Yet increasing portal adoption is an easy way to score MIPS PI points, improve patient satisfaction, and free staff from answering calls. Automated portal notifications and consistent communications with patients around portal access, for example, touch PI measures in areas like secure messaging, patient-specific education, and patient access.

Patient portal adoption has also been shown to improve care plan adherence among patients with chronic conditions and save staff time. For private insurance collections, the ability to accept payment directly from the patient portal reduces staff follow-up efforts and days in accounts receivable. Therefore, practices should remind patients at check-in and again at check-out to utilize their portal access. Provide patients with private login credentials and short, clear instructions to promote adoption rates. Promote patient portal utilization with each patient visit and include material explaining its benefits in patient waiting rooms. 

Fully comprehending the evolving MACRA changes can be extremely difficult for already strained practice staff. By following these four recommendations, practices can improve their collections and documentation workflows, maximize reimbursement opportunities, and improve practice operations significantly. 

is vice president of revenue cycle management for 

Articles

Revenue cycle management tips to enhance cash flow under the 2019 Quality Payment Program Final Rule.

4 ways to prepare for MACRA in 2019  

Are you overwhelmed by the detailed requirements of the Medicare Access and CHIP Reauthorization Act (MACRA)? If yes, your practice is not alone.

According to Pa.-based Stoltenberg Consulting's fifth-annual Health IT Industry Outlook 

, 64 percent of providers say they feel "unprepared" or "very unprepared" for managing and executing MACRA initiatives.

MACRA holds major significance for these confused providers because its Quality Payment Program (QPP) centers on improved patient outcomes, activities for quality clinical care practices, efficient use of medical resources, and the meaningful utilization of EHRs. The QPP replaces the outdated Sustainable Growth Rate (SGR) formula, moving away from fee-for-service care.

Now practices are tasked with the job of thinking beyond claims data in the transition to value-based care and eliminating the data-silo mentality. This represents a major upheaval for many, and a challenge for all.

But while 68 percent of survey respondents said preparation for MACRA should be a combined effort with clinical, financial and IT departments working cohesively, pulling together the right mix of representatives is not always easy. In fact, 82 percent of survey respondents admitted that finding qualified health IT representation is an obstacle.

Considering the ongoing reporting burden, reimbursement impact, and industry significance tied into MACRA's QPP, lack of readiness is widespread across already stretched physician practices. Many still struggle to understand the program altogether, assumed it would be delayed or hindered by a repeal of the Affordable Care Act (ACA) or don't know how to jump-start reporting alignment. To overcome physician practices' already limited resources, consider the following four tips for making the most of MACRA:

 Establish a working MACRA governance committee with cross-departmental representation. Financial representation can take the lead in selecting reporting measures for the practice under the Merit-based Incentive Payment System (MIPS) that will be most operationally effective among the varied options laid out by CMS. For a solid foundation, the team needs to absorb a strong understanding of MACRA to effectively identify reporting gaps. Resources like this 

 cover program exemptions, participant expectations and guidelines.

Even within physician practices where there isn't a designated IT department, it's important to bring in the voice of the individual who best knows how to maintain, extract and analyze practice data. The go-to IT expert needs to work with financial and clinical representatives to help the practice achieve success under MACRA. If you can’t pinpoint that voice, it may be time to bring in a third-party IT advisor, who can assess and capture the whole picture of care by best maneuvering the EHR system.

 For smaller practices, the initial question is whether or not they have to report at all in the first year. All clinicians required to participate in MIPS should have received 

 by the end of May, according to CMS. Likewise, all physician practices will be given the status of each MIPS clinician associated with their Taxpayer Identification Number (TIN). Another helpful resource is CMS' recently released 

. MIPS-eligible clinicians-including physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified nurse practitioners-can look up their status with their National Provider Identifier (NPI) number.

•Accurately gather all pertinent data. 

To effectively select a reporting path, practices need to think beyond claims and reimbursement data, knowing that the transition to value-based care relies on the whole picture of patient health. Review helpful reports like your Quality and Resource Use Report (QRUR), which ties in the Physician Quality Reporting Program (PQRS) and Value-Based Payment Modifier to assess quality and cost performance. This historical data can shed light on which measures yield the highest potential for positive reimbursement adjustments.

Even if your practice is exempt from reporting this year, you should still consider reporting requirements for subsequent years. MACRA requirements become more stringent in the future, as the potential for reimbursement or penalty increases. Remember that participating in 2017 offers practices the chance to solidify footing for a long-term strategic plan to best utilize reporting measures for maximum operational effectiveness and reimbursement opportunity.

When planning for the future, consider how the practice's makeup will change. While some clinicians may be exempt now in their first year with Medicare Part B, they will likely be required to report next year (if they meet Medicare patient number and billing level minimums). How will that impact your practice's figures? Will new physicians be added to the practice or leave? Consider the impact since there is a two-year gap between financial reporting and reimbursement adjustments. Also think about what medical specialties are represented within the practice. Some QPP measures may correlate more easily to specific-focus care programs already in place for chronic disease groups.

Whether your practice is just beginning its MACRA journey or looking down the road for future path alignment, follow these tips to maximize QPP reimbursement potential.

With the value-based care evolution of healthcare well underway, practices can no longer blindly submit data. Instead, they must strategically utilize care information to display quality care, improved patient outcomes and efficient use of EHRs and resources.

 has more than 30 years of healthcare industry and management experience with work spanning the public, private, academic and governmental sectors for acute facilities and large physician practices. With a special focus on revenue cycle optimization and business office transformation, she serves as the vice president of revenue cycle management at 

Follow these tips to avoid feeling overwhelmed by MACRA requirements, while remaining prepared for the uncertain future.  