MIPS Manual 2020: A Comprehensive Guide to MACRA and the Merit-Based Incentive Payment System

Joy Rios

Procedure Press

This practical, action-oriented guidebook by Joy Rios, MBA, CHTS-PW will help healthcare professionals navigate the new industry landscape, where providers are paid for reporting quality measures and will receive payment adjustments based on their performance rates. Healthcare is moving from a pay-for-service model to a pay-for-performance model. Many in fact, arguably most healthcare professionals do not understand how this will happen. It's being introduced gradually through the Physician Quality Reporting System (PQRS) and the Value-based Modifier Program. Neither program is very well understood in the industry, yet if providers choose not to participate, they will start to see significant penalties up to 9% reductions in Medicare reimbursements, depending on the size of the provider's organization and their participation in other incentive programs. What's more is that each provider's quality results whether good or bad will be publicly available online as part of the Physician Compare program. ABC's of PQRS gives you a full spectrum of content: Discussion of how the program came to be, to put PQRS in context Providing explicit examples of penalty scenarios Addressing the various ways to report (Registry, EHR, QCDR, Web Interface, Claims, and CAHPS) Examines how other quality programs are interrelated with PQRS specifically the Value-based Modifier Program (VM) If you are unclear about the program requirements, confused about how to start, are having difficulty knowing which measures to report, or you don't understand how PQRS reporting will affect your future reimbursements, this book is for you. Read this book to gain clarity, confidence and comprehension to PQRS Reporting. Acquire the tools so you feel more capable and bring a more strategic mindset to your quality reporting. Chapter 1: Understanding PQRS Context Present Past Future How the Government Plans to Get There Financial Impacts of CMS Quality Programs PQRS Basics Avoiding Payment Adjustments Eligibility Requirements Eligible but Not Able to Participate Naming Conventions Reporting Periods Individual versus Group Reporting Group Practices Defined Why Choose One or the Other PQRS Measures Where Measures Come From Defining Quality Measures Calculating Quality Measures Determining a Quality Measure s Reporting Frequency Performance Timeframes Types of Measures Availability of Measures Measure Selection Strategy Individual Measures Measures Groups Specialty Measure Sets Chapter 2: PQRS Reporting Methods Claims (I) Registry (I) (G) Electronic Health Record (EHR) EHR-Direct versus DSV Qualified Clinical Data Registry (I) Group Practice Reporting Option (GPRO) Web Interface (G) Web Interface Quality Measures Certified Survey Vendors (CAHPS for PQRS) Chapter 3: Understanding the Value-based Payment Modifier (VM) Program Calculating a VM Score 38 Quality Composite Cost Composite Quality Tiering Downward VM Payment Adjustment in 2017 Quality Resource and Use Reports (QRURs) Performance Highlights Page of the QRUR Informal Review How to Request an Informal Review Informal Review Decision Chapter 4: Public Reporting of Quality Physician Compare Chapter 5: Physician Quality Reporting System (PQRS) Best Practices Getting Help Frequently Asked Questions (FAQs) Acronymns Appendix Claims-based Reporting Coding Measure Applicability Validation (MAV) Clinical Relation Test Measure Applicability Validation (MAV) Minimum Threshold Test Cross-Cutting Measures

ABC's of PQRS: Your 2015 Guide to Successfully Participating in the Physician Quality Reporting System

Greenbranch Publishing

<p>Healthcare professionals across the country are tasked with collecting more and more data to essentially prove to the government how well doctors do their jobs. Several complex quality programs must now be reported on annually or providers will pay a hefty price. ABC's of PQRS gives you a full spectrum of content: Examining how several health IT programs are interconnected, including PQRS, Value based Modifier and the Merit-based Incentive Payment System Providing explicit examples of penalty scenarios based on the size of a doctor s practice Addressing the various ways to report quality to the government If you are unclear about the program requirements, confused about how to start, are having difficulty knowing which measures to report, or you don t understand how PQRS reporting will affect your future reimbursements, this book is for you. Table of Contents: Chapter 1: Understanding Quality Reporting Context The Path for 2016 Looking Back The Road Ahead Financial Impacts of CMS Quality Programs PQRS Basics Avoiding Payment Adjustments Eligibility Requirements Eligible but Not Able to Participate Scenario 1: Does not bill services payable under the MPFS Scenario 2: Does not submit individual rendering National Provider Identifier (NPI) Naming Conventions Reporting Periods Individual versus Group Reporting Group Practices Defined Why Choose One or the Other PQRS Measures Where Measures Come From Defining Quality Measures Calculating Quality Measures Determining a Quality Measure s Reporting Frequency Performance Timeframes Types of Measures Availability of Measures Measure Selection Strategy Individual Measures Measures Groups Specialty Measure Sets Cross-Cutting Measures PQRS Reporting for Pathologists Chapter 2: PQRS Reporting Methods Claims (I) Registry (I) (G) Electronic Health Record (EHR) (I) (G) EHR-Direct versus DSV Qualified Clinical Data Registry (I) Group Practice Reporting Option (GPRO) Web Interface (G) Web Interface Quality Measures Certified Survey Vendors (CAHPS for PQRS) (G) Chapter 3: Understanding the Value-based Payment Modifier (VM)Program Calculating a VM Score Quality Composite Cost Composite Risk Factors of a Practices Attributed Beneficiaries How Does CMS Determine National Benchmarks? Quality Tiering Quality Resource and Use Reports (QRURs) Performance Highlights Page of the QRUR Informal Review How to Request an Informal Review Informal Review Decision Chapter 4: Public Reporting of Quality Physician Compare Chapter 5: Physician Quality Reporting System (PQRS) Best Practices Getting Help Frequently Asked Questions (FAQs) Acronymns Appendix: Claims-based Reporting Coding Measure Applicability Validation Clinical Relation Test Minimum Threshold Test</p>

ABC's of Quality Reporting: Your 2016 Roadmap to Navigating Health IT Initiatives, Including PQRS, Value-Based Modifier, and the Merit-Based Incentive Payment System

CHTS-PW

Medical Books

<p>CMS has a way of giving you 1000 puzzle pieces, without giving the clear big picture. This book helps put all the pieces together. Finally! A decoded, organized, easy-to-read, concise, and detailed reference and teaching tool for MIPS with everything you need to be successful for all physician practices! A must read for practice managers, administrators, executives, or clinicians navigating MIPS, Health IT Consultants and anyone interested in the details of the CMS, Merit Based Incentive Payment System (MIPS). This practical, action-oriented book by Joy Rios, MBA, CHTS-PW (in print or eBook) is a comprehensive guide to all MIPS program categories. This book will help stakeholders navigate the MIPS program and its nuances in easy to understand terms to help achieve MIPS program success. In the current landscape, it is up to the practice employee to do the research and understand the program. Rather than aggregating all of the information that is available online, let Joy Rios and this book do it for you using this guide will take the pressure off you and your staff members! You will enjoy a sense of empowerment in being able to take the information in the book and apply it directly to your practice to have more meaningful conversations with EHR vendors, billers/coders, etc. Healthcare is moving from a pay-for-service model to a pay-for-performance model. Many in fact, arguably most healthcare professionals do not understand how this will happen. Your Ultimate Guide to MIPS, 2018 Edition gives you a full spectrum of content. Table of Contents Chapter 1: Welcoming a New Healthcare Paradigm Getting to Know MACRA Making the Transition Chapter 2: MIPS Overview Eligibility Reporting Options Changes to Scoring by Year MIPS APMs Lessons Learned from the Field Chapter 3: Getting to 100 Quality Where Measures Come From Measure Selection Strategy Submission Methods Available CMS-Calculated Population-Based Measures Benchmarking Providers Topped Out Measures Quality Performance Category Scoring Bonus Score Improvement Scoring Calculation of Final Quality Performance Score Scoring Example When Clinicians Don t Have Enough Measures to Report Publicly Reported Quality Measures Keys to Success Resources Lessons Learned from the Field Advancing Care Information (ACI) EHR Certification Edition Option 1 2014 Edition EHR Option 2 2015 Edition Option 3 2014/2015 Combo Edition Understanding ACI Scoring Base Score Performance Score Bonus Points Composite Score 2014 Edition Scoring Example Table 3-20 2014 Edition certified EHR technology Scoring Example Keys to Success Resources Lessons Learned from the Field Cost Attribution for MSPB Measure Total Per Capita Cost for All Attributed Beneficiaries A Little More About Primary Care Services A Little More About Attribution Scoring Get to Know Your QRUR Episode-Based Cost Measures Coming in Future Years Hierarchical Condition Categories (HCC) and Risk Adjustment Factor s (RAF) Role Keys to Success Resources Lessons Learned from the Field Improvement Activities List of Improvement Activities Score Keys to Success Resources Lessons Learned from the Field Calculating the Composite Performance Score Chapter 4: Reporting Your Data Enterprise Identity Data Management Account Quality A Little More About QRDA-3 Submissions Resources Chapter 5: Public Reporting Glossary of Terms</p>

Your Ultimate Guide to MIPS, 2018 Edition

Administration & Medicine Economics

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Books by Joy Rios