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MACRA and Hospitalists: Get Your Questions Answered
Presented By: Liz Morgan – Senior Solutions Engineer, Iatric Systems Cindy Paul – Senior Project Manager, Professional Service, Iatric Systems Technical Assistance: [email protected] This teleconference will be muted while we wait for all attendees to join. Thank you for your patience.
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Presented By: Liz Morgan – Senior Solutions Engineer, Iatric Systems Cindy Paul – Senior Project Manager, Professional Service, Iatric Systems Date: June 6, 2017
MACRA and Hospitalists: Get Your Questions Answered
Agenda
• MACRA/MIPS/QPP - Defined • Eligibility – Who needs to Participate • Timing – Pick Your Pace • Program Components MIPS • CMS Notifications • QPP and Groups • CMS Deadline • How to Get Help • Q&A
Poll question
Do you believe your hospitalists bill $30,000 AND see more than 100 patients for Medicare Part B or Observation? a) Yes b) No c) Don’t Know
Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)
• Passed by congress April 14,2015
• Removes Sustainable Growth Rate Methodology – SGR
• Revise the update in rates
• Establishes Quality Payment Program (QPP)
• Final Rule issued October 14, 2016
Eligible Clinicians (EC)
Hospitalists Anesthesiologist Radiologists
Pathologists Emergency Department Physician
Clinicians who have billed more than $30,000 in Medicare Part B allowable charges and have more
than 100 Part B-enrolled Medicare beneficiaries
Pick Your Pace
Payment Adjustment
Four Categories
2017
2017
2017
2018
Categories and Percentage
Quality
60% Need to report 6
Improvement Activities
15% Need to report 4
Advancing Care Information
25%
Cost
2018
85% 15%
CMS Notification • Letters went out to each Eligible Clinician • Mailed to TIN • Late April or Early May • Designated if they were eligible
Poll question
Have you received a letter from CMS stating that you are required to submit for MIPS? a) Yes b) No c) Don’t Know
QPP and Groups
Reporting as Individual
• Individual National Provider Identifier • Tied to single Tax Identification Number
(TIN) • Individual data for each MIPS Category • Payment adjustment based on YOUR
performance
Reporting as a Group
Group Defined: Set of eligible clinicians, identified by their National Provider Identifier (NPI) sharing a
common Tax Identification Number (TIN), no matter the specialty or practice site.
Group
• One TIN • Regardless of specialty or practice site • Aggregated group level data sent for each
MIPS Category • In-Hospital physicians in group – no need to
report on Advancing Care Information
Digesting CMS Information The hospital-based determination is done at the
individual national provider identifier (NPI) level. If an eligible clinician is determined to be hospital-based, that
status will apply to all NPI/ tax identification number (TIN) combinations for the clinician. If an individual
eligible clinician is hospital-based, we will automatically reweight the Advancing Care Information (ACI)
performance category. If the eligible clinician is part of a group, the group has the option to include or exclude
ACI data for the hospital-based clinician(s). If the entire group is hospital-based, the group's ACI category will be reweighted if the group does not submit any ACI data. The group, despite being entirely hospital-based, would have the option to include, or not include their data in
the group data that is submitted to CMS, but their payment will be adjusted based on the group's MIPS final
score.
If an eligible clinician is determined to be hospital-based, that status will apply to all NPI/ tax identification number
(TIN) combinations for the clinician. If an individual eligible clinician is hospital-based, we will automatically
reweight the Advancing Care Information (ACI) performance category. If the eligible clinician is part of a
group, the group has the option to include or exclude ACI data for the hospital-based clinician(s). If the entire group is hospital-based, the group's ACI category will be reweighted if the group does not submit any ACI data.
The group, despite being entirely hospital-based, would have the option to include, or not include their data in the
group data that is submitted to CMS, but their payment will be adjusted based on
the group's MIPS final score.
Groups, Quality, and the Physician Compare Conundrum
Groups and Physician Compare
• PQRS = MIPS Quality • Selected Measures apply to all physicians • Tax Identification Number • Data Aggregation
Questions for Your Consideration
• Do you have one TIN? • Does this structure have the ability to satisfy
all your physician types? • If not, how could your hospital benefit? • Does it really matter if a physician has no
data on Physician Compare?
Things to Think About
• This is a QUALITY program – how will the group fare?
• Hospital Contract? • What is your plan? October 2nd is the last day to
get 90 days of information
Deadline:
For groups to use the CMS Web Interface, you
must register by June 30, 2017
Get Help Defining Your Plan q Identify which providers or groups are MIPS eligible
within your organization
q Assist with Pick Your Pace
q Assist with identifying Quality Measures
q Assist with identifying Improvement Activities
q Gap Analysis q Action Plan
What Questions Do You Have?
We Can Help!
Liz Morgan Senior Solutions Engineer – Iatric Systems
Phone: (978) 674-8317 E-mail: [email protected]
Connect with me on LinkedIn: Liz Morgan
Cindy Paul Senior Project Manager, Iatric Systems
Phone: (978) 674-5927 Email: [email protected]
Connect with me on LinkedIn: Cindy Paul
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