CMS Issues Resources For Clinicians in the Merit-Based Incentive Payment System
CMS published three informative resources to guide eligible clinicians participating in Merit-based Incentive Payment System (MIPS) in 2017: a fact–sheet on MIPS participation, another on MIPS data reporting for clinical improvement activities, and a list of qualified registries available for reporting MIPS data.nnWith eligible clinicians transitioning to the federal program this year, these clarifying resources will answer many lingering questions regarding MIPS reporting for the Quality Payment Program under MACRA.nnThe MIPS participation fact–sheet offers a concise overview of who is expected to participate in MIPS, what participation entails, and the guidelines for voluntary participation. Additionally, the MIPS participation fact–sheet provides information on what is expected of clinicians practicing in rural areas (RHCs) or federally qualified health centers (FQHC).nnThe fact–sheet specifies RHCs and FQHCs are not required to participate in MIPS if they are billed as such, but clinicians practicing in critical access hospitals must participate. Further, the MIPS participation fact–sheet outlines who is exempt from MIPS and all special rules for certain MIPS eligible clinicians.nnThe MIPS improvement activities fact–sheet is designed to help clinicians understand the requirements of the MIPS clinical improvement activities performance category. Given these activities are an entirely new performance category, additional information is likely welcomed by clinicians.nnThis CMS fact–sheet lists which improvement activities eligible clinicians can choose from, how to submit information for this performance category, and what the reporting criteria are for receiving credit. The fact–sheet also lays out the scoring methodology for groups including the different weights of each activity and how these weighted activities translate on the point scale.nnFinally, CMS addresses scoring for alternative payment model (APM) participants and the procedure for submitting potential future improvement activities to add to the list of existing CMS-approved improvement activities eligible clinicians can choose in the coming yearsn
nThis article was originally posted on EHRIntelligence.com.
As part of the new coding format for our newsletter, Welter Healthcare Partners is excited to offer you a new surgery coding series in which we want to help you! The 2nd week of every month we will highlight a complicated surgical case. This week we are highlighting a general surgery case. We want to hear from you! If you have a complicated surgery case and need help with coding, please upload the operative note by clicking on the link below. Remember to remove ALL patient protected health information and organization identifiers. Welter Healthcare Partners will not use any medical records submitted in which PHI is not removed and protected. 
The Colorado Department of Health Care Policy & Financing recognizes some providers have had difficulties submitting claims during the transition to the new claims payment system (the Colorado interChange).nnIn an effort to ensure providers are appropriately paid for services to members, they are temporarily changing the limit for timely filing.nnEffective May 12, 2017, the timely filing limit will be extended to 240 calendar days.nnTherefore, they recommend providers hold claims with a DOS after December 1, 2016 (that are outside the 120 days timely filing limit) and do not submit those claims until after May 12, 2017. The system will automatically calculate the additional time and providers do not need to take action to receive the extension during claims submission.nnEffective November 1, 2017, the limit will be changed back to 120 calendar days.nnOn November 1, 2017, all claims with a DOS prior to July 4, 2017 will be outside the timely filing limit of 120 days, and providers will need to submit additional documentation to request a timely filing extension.nnExamples:n
Week 1 – Industry Hot Buttons!nnModifier 25: Modifier 25 landed itself on both private payer and the OIG hit lists again this year for overuse and blatant misuse leading to millions in overpayments – and everyone wants their money back! Applying Modifier 25 incorrectly can cost your practice tens of thousands of dollars! Understanding this modifier’s appropriate application can be very tricky.nnHere are a few questions to consider before sticking that modifier on your next claim:n
Republicans and the Trump administration are reported to be close to amending the health care proposal on overhauling Obamacare.nnThe Trump administration’s push to revive the moribund GOP health care proposal has apparently paid some dividends. The White House and key Republicans in the House of Representatives are reportedly close to an agreement to amend the bill so that states could opt out of two popular Affordable Care Act provisions, including one that requires individual insurance plans to cover 10 “essential health benefits.”nnThe other provision, known as “community rating,” bars insurers from varying premiums based on health status or medical history. It also requires insurers, under “guaranteed issue” rules, to offer coverage to all who want it. A proposal from Rep. Tom MacArthur, R-N.J., who leads the moderate GOP Tuesday Group, would allow individual insurers to charge plan members different rates based on their health status.nnThe proposal was negotiated with Rep. Mark Meadows, R-N.C., who heads the conservative House Freedom Caucus. The caucus announced their support for the deal on Wednesday. That could allow a House vote by Friday on the bill. House passage of the GOP bill would give President Donald Trump a key legislative success ahead of his 100-day mark this weekend. However, House Speaker Paul Ryan, R-Wis., wouldn’t speculate on timing for a possible vote.nnRep. Mark Sanford, R-S.C., who often sides with the Freedom Caucus, said he will support the revised proposal after “acceptance of the fact that we’re not going to repeal the Affordable Care Act.”nn“It’s not a repeal, lets be clear,” Sanford told reporters on Wednesday. “I think it’s very important to be clear with the American public and not to oversell this thing: ‘Oh we repealed it’. No we didn’t repeal the Affordable Care Act. We have trimmed back a couple of its key features…I think that, in short form, it’s the most you can get out of this conference. “nnMacArthur’s proposal addresses the Affordable Care Act’s community rating system, in which the entire pool of plan enrollees pays the same premium rates. That spreads the higher costs of sicker plan members among all who buy coverage. Both guaranteed issue and community rating helped cut the number of uninsured people with pre-existing conditions by 3.6 million, or 22 percent, from 2010 to 2014, according to federal estimates.n
Welter Healthcare Partners is excited to present our helpful career advancing tips and strategies to sharpen the skills prospective employers look for in a coder!nnPRACTICE: I’m sure you’ve all heard the old adage: Practice makes perfect! As simple as it sounds, most of us don’t make or take the time to adequately practice, especially when approaching a new project, subject or task. It takes an incredible amount of hours to master a subject…10,000 hours to be exact! Acknowledge the level of difficulty associated with any new task. Plan and prepare for mistakes. Pick your battles. Ensure enough time is set aside to complete the task at an exemplary level. Leverage all tools and resources. And Keep Practicing!!!