Quality Payment Program Articles and Resources

News and Important Information

Quality Payment Program (QPP) Measures, Modifiers... 

The Money in MIPS

The Quality Payment Program is Medicare's performance-based payment system for Medicare Part B services. Providers may participate by choosing one of the following two tracks:

  1. The Merit-based Incentive Payment System (MIPS)
  2. Advanced Alternative Payment Models (APMs)

CLICK HERE to check your participation status, research applicable measures, and to review guidance on MIPS, APMs, etc.

CLICK HERE to go to CMS' new QPP Resource Library.

Additional information regarding this program can be found in a specialty-specific Reimbursement Guide available in the online store.

 

Resources

Select the title to see a summary and a link to the full article.  some articles require a subscription to view.

Calendar Year 2023 Medicare Physician Fee Schedule Proposed Rule

by  Amanda Ballif

The Centers for Medicare and Medicaid Services (CMS) is soliciting public comments on proposed changes for Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B issues effective on January 1, 2023 and thereafter. The Calendar Year (CY) 2023 PFS proposed rule is one of several proposed rules aimed at increasing equity in health care.

COVID-19 Clinical Trial Participation Helps Providers Earn MIPS Credit

by  Wyn Staheli, Director of Content - innoviHealth

All healthcare providers who are currently participating in the MIPS portion of Medicare’s Quality Payment Program may want to participate in the new COVID-19 Clinical Trials improvement activity. Read more about it here.

CMS Report on QPP Shows Increasing Involvement

by  Wyn Staheli, Director of Content - innoviHealth

MIPS 2018 participation increased according to the final report issued by CMS on January 6, 2020.

Q/A: Is G8730 Still Required? Are G Codes Required at all?

by  Wyn Staheli, Director of Content - innoviHealth

G8730, when is it required. Many G codes are still active and are required for non-quality reporting.

Quality Measures Finalized for 2019

by  Wyn Staheli, Director of Content - innoviHealth

CMS recently announced that the quality measures for 2019 have been finalized. There are new eligible clinicians so be aware of how that may affect your organization. New ECs are: Physical therapists Occupational therapists Qualified speech-language pathologists Qualified audiologists Clinical psychologists Registered dietitian or nutrition professionals The following are changes to Electronic Clinical Quality Measures (eCQMs) available ...

Are you Ready for CMS' 2019 Medicare Physician Fee Schedule Final Rule?

by  Wyn Staheli, Director of Content - innoviHealth

The waiting is over, the Final Rule for CMS' 2019 Medicare Physician Fee Schedule (MPFS) is available - all 2,379 pages for those looking for a little light reading. As anticipated, there are some pretty significant changes. Most of us were carefully watching the proposed changes to the Evaluation and ...

How Does the Physician Compare Website Affect You?

by  Wyn Staheli, Director of Content - innoviHealth

The physician compare website may not be working quite the way you think it is. Not all providers will have rankings showing up for them. Physician compare lists basic information, but quality measure information was not added until this year (2018) and not all quality measures are included in the ...

Small Practices are Affected by MIPS Increased Thresholds

by  Wyn Staheli, Director of Content - innoviHealth

We recently heard about a small practice that had been faithfully submitting all the required “G” codes for the Quality Payment Program (QPP) only to discover that for 2018 they are excluded from MIPS because the low volume threshold increased from $30,000 in Part B allowed charges or 100 Part ...

Patient Relationship Codes

by  Wyn Staheli, Director of Content - innoviHealth

Section 1848(r)(4) of MACRA requires that claims submitted for items and services furnished by a physician or applicable practitioner on or after January 1, 2018, include codes for the following: care episode groups patient condition groups patient relationship categories Previously, CMS decided to use procedure code modifiers to report patient relationship codes on Medicare ...

New MIPS Reporting Option for 2017 Data

by  Wyn Staheli, Director of Content - innoviHealth

On January 2, 2018, CMS announced a new data submission system for eligible clinicians to report quality measures for the Quality Payment Program. Data may be submitted through the new platform on the qpp.cms.gov website. The announcement stated: Data can be submitted and updated any time from January 2, 2018 to March ...

CMS Launches Data Submission System for Clinicians in the Quality Payment Program

by  Find-A-Code™

Today, the Centers for Medicare & Medicaid Services (CMS) announced that doctors and other eligible clinicians participating in the Quality Payment Program can begin submitting their 2017 performance data using a new system on the Quality Payment Program website (qpp.cms.gov). The data submission system is an improvement from the former...

Quality Payment Program in 2018

by  Wyn Staheli, Director of Content - innoviHealth

I checked the government website to see if I am an eligible clinician and it says that I am not. I just don't want to get blindsided with a letter saying I will be penalized. Is there anything you would suggest or recommend that I do now to protect myself from future penalties. Thank you

Appropriate Use Criteria for Advanced Diagnostic Imaging Services - 2018 Final Rule

by  Jared Staheli, MPP

What is the AUC program? From the CMS website: Section 218(b) of the Protecting Access to Medicare Act of 2014 amended Title XVIII of the Social Security Act to add section 1834(q) directing CMS to establish a program to promote the use of appropriate use criteria (AUC) for advanced diagnostic imaging ...

Why You Should Stop Using ROM as an Outcome Measure

by  Ron Feise, DC

We received this email from a chiropractic colleague: “I recently attended a continuing education seminar accredited by a chiropractic college. The presenter was talking about outcome measures and highly recommended cervical and lumbar range of motion (ROM) as a good outcome measure for patients with spinal conditions. But I am hesitant to use ROM, because it seems to be inconsistent with a patient’s status.” What does the current research demonstrate?

Four Final Rules Affecting CMS Payments for 2018

by  Wyn Staheli, Director of Content - innoviHealth

It’s a season for changes. CMS just finalized four rules which directly impact the following payment systems: Physician Fee Schedule Final Policy, Payment, and Quality Provisions for CY 2018 Hospital OPPS and ASC Payment System and Quality Reporting Programs Changes for 2018 HHAs: Payment Changes for 2018 Quality Payment Program Rule for Year 2 This ...

Payment Rulings and Small Provider Practices

by  Wyn Staheli, Director of Content - innoviHealth

Fall has always been the season for CMS fee changes and on November 2, 2017, CMS announced the finalization of four rules which directly impact the following payment systems: Physician Fee Schedule Final Policy, Payment, and Quality Provisions for CY 2018 Hospital OPPS and ASC Payment System and Quality Reporting Programs Changes ...

Importance of Outcomes Measurements

by  Wyn Staheli, Director of Content - innoviHealth

One important component of health care reporting is the utilization of quality measures which are typically classified into one of three broad categories: structure, process, or outcome. Structural measures define the healthcare provider’s capacity, systems, and processes (e.g., EHR use, ratio of providers to patients) Process measures indicate what providers do to ...

American Chiropractic Association Comments on MACRA 2018 Proposed Rule

by  ChiroCode™

Arlington, Va. - The American Chiropractic Association (ACA) recently submitted comments to the Centers for Medicare and Medicaid Services (CMS) in response to the federal agency's proposed rule changes to the Quality Payment Program (QPP) for 2018. QPP is a new payment model for physicians, including chiropractors, created by the Medicare Access and CHIP ...

Quality Measures for Chiropractic - 2017

by  Wyn Staheli, Director of Content - innoviHealth

Performance Measurement Codes for Chiropractic: Although there are hundreds of Performance Measurement (PM) services and events, only two may be reported for chiropractors for the 2017 reporting year. Pain Assessment and Follow-Up 131 ENCOUNTER: 90791, 90792, 92002, 92004, 92012, 92014, 92507, 92508, 92526, 96116, 96118, 96150, 96151, 97161, 97162, 97163, 97164, 97165, 97166, 97167, ...

Q/A: MIPS and G Codes

by  Brandy Brimhall, CPC CMCO CPCO CCCPC CPMA QCC

We have one doctor in our practice who qualifies under the MIPS guidelines so he is continuing to use the PQRS and G-codes. We are having the rest of our doctors do the same, just in case, and because it is good practice, but is that completely unnecessary and can it possibly do us more harm than good?

Select the title to see a summary and a link to the full webinar information.  some webinars require a subscription to view.

How to Report MIPS 

by  Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow

If eligible, you need to start reporting for MIPS by October 2th, 2017. Do you know who is exempt? Are you familiar with the quality measures that apply to chiropractors? Do you understand how to report on the Advancing Care Information or Improvement Activities? Don’t worry, Dr. Gwilliam has done all your homework and, in this presentation, you will get the crib notes containing just what you need to know. You don’t need to feel overwhelmed with Medicare regulations, you just need to know what to do.

Mighty MACRA! 

by  Find-A-Code™

Mighty MACRA!

The Future of Reimbursement - Medicare's Quality Payment Program 

by  Find-A-Code™

The Future of Reimbursement - Medicare's Quality Payment Program

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