Taxonomy NJ

Greetings to all our customers in New Jersey. As you may already be aware, on April 1st, 2017, Horizon NJ Health is requiring all providers to include their taxonomy codes on claims for proper reimbursement. If you weren't already aware, you certainly will be when all your claims get cruelly rejected like your first screenplay. But that would be learning the hard way, now, wouldn't it? An easier way would be to read this post about how Rexpert can help you!

First, a little background explanation. All health care practices and providers must have a National Provider Identification number (NPI) assigned by the Center for Medicare and Medicaid Services (CMS). However, they also have a second number known as the Taxonomy Code which identifies the type and area of specialization. The change coming up in New Jersey is that both the NPI number and the Taxonomy Code must be included when submitting a claim to Horizon NJ Health.

If you are unsure about a Taxonomy Code, you can look it up on the CMS NPI registry website by using the practice or provider's NPI number. Scroll down, almost to the bottom of the screen, and when you see a section labeled "Taxonomy", there is your first clue that the epic quest for yon Taxonomy Code has been completed. 

You'll need to add taxonomy codes the practice and to each provider. Here are the steps:

Go to Settings > People and Places > Practice. Click on Billing Numbers on the upper right.

Click the new record icon (looks like a green plus-sign on the left task bar) to add a new number. Type in NPI#  for the Payor Group and select Special for the ID type. Type in your practice taxonomy code in Number/Code and check Electronic Claims and Participating. All other fields shall remain blank. Press the save button and exit.

 

Now, go to Settings > People and Places > Provider. Just like before, click on the Billing Numbers button located to the upper right and repeat the same steps as detailed in the preceding paragraph for each provider.

The last little step in this process is to activate the payor. Go to Settings > People and Places > Payor and find the payor needed for changes. Select Payor Options 1 tab, and press the Edit button. Check off the box on the left top corner labeled Taxonomy: Report all provider taxonomy EC boxes 24j, 33b. Save and exit and that's it, all finished!

MIPS, Part 2

"Today, we are going to talk about improvement activities", which sounds a lot like something my mother would have said back in my teenage years. I don't know what else she said after that opening line because that phrase was guaranteed to make me think of other things and generally tune her out. But we are all adults here, so I know I will have your full and undivided attention when I say "Today, we are going to talk about improvement activities" in the MIPS sense of the phrase.  And, just to add further interest, we'll cover Advancing Care Information as well.

Formally, Improvement Activities are designed to reward providers for care focused on care coordination, beneficiary engagement, and patient safety with your improvement activities score comprising 15% of your total MIPS score.

According to the MIPS website, there are only two things that need to be done. Access the  MIPS Improvement Activities page and select the activities that best fit your practice. Please note that activities are designated as high weight or medium weight. For practices consisting of less than 15 clinicians, 1 high weight or 2 medium weight activities need to be selected. Practices with 15 or more providers should select up to 4 activities equaling 40 points (medium weight is worth 10 points each and high weight is worth 20 points each). You will then attest to completion of the selected activities for a minimum of 90 days.

We recommend that you use

• Administration of the AHRQ Survey of Patient Safety Culture
• Collection and use of patient experience and satisfaction data on access

There are a grand total of  92 activities listed on the MIPS website from which you can make your selection.  Rather than read all 92, you can search by keyword, subcategory name, and activity weighing (medium and high weight are the two categories), See the picture below for an example of filter options.

In the above example, a search by keyword (Vitamin K), Subcategory Name (Population Management), and high Activity Weighing yields only one activity: Anticoagulant management improvements. Clicking on the activity will then display specific definitions and criteria for meeting the activity requirements.

And now, lets move on to Advancing Care Information. You will want to consult your EHR provider about this category. For our AuroraEHR users, you should be able to use Aurora just as you did for 2016.

The big change from years past is that the pass/fail scoring system no longer applies. Instead, a more rigorous grading system will be in effect; it's kind of like the difference between report cards from high school and kindergarten. For example, under the previous pass/fail system it was possible to pass with just 10% of patients getting Patient Education materials.  Now, if 11% of patients get the materials, you will get only 1out of 10 points, and if you hit 100%, you will get 10 out 10 points. We can foresee that this will cause some difficulties with certain measures, such as those involving the patient portal.  Fortunately, the scoring is set up so that many extra points are available.  So, the emphasis is now on complete usage, not merely getting a "pass" grade which again, sounds something like my mother used to say back when I was a teenager!

MIPS, part 1

MIPS came to stay with us January 1st,  which made the customarily cheery "Happy New Year" salutation ring a little hollow for our EHR clients.

However, not to worry. CMS has published a 962 page proposed rule with the rather unwieldy name "Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Models" or MBIPSAPMIUPFSCPFM for short.

If reading 962 pages of government-speak (a guaranteed cure for insomnia, by the way) seems daunting, never fear, Practice Alternatives is here. We are the lucky sods that had to read all 962 pages of the proposed rule and accordingly, will make the required software changes.

MIPS has several areas in the program: Quality, Improvement Activities, Advancing Care (replacing Meaningful Use), and Cost (will not be implemented in 2017). Today, we are going to talk about the Quality aspects of MIPS.

Before we get into the Quality stuff, let's cover a few basics about MIPS. The level of participation in MIPS is up to each practice but there are consequences to the level of participation or lack thereof:

1. Do nothing and receive a negative 4% adjustment in 2019
2. Submit some data and receive a minimum or zero payment in 2019
3. Participate for 90+ days and receive a small positive payment adjustment in 2019
4. Participate for a full calendar year with high scores (>= 70 points) to qualify as an "exceptional performer"; doing so could result in a significant payment bonus

The Quality Measures are very similar to PQRS, so this part of MIPS shouldn't be too daunting. Each practice should visit the CMS Quality Measures web page (Click on this link to access the page) and review the Specialty Measure Set list. See below for the screenshot:

Select the specialty that pertains to your practice and the website will display a list of applicable measures:

 Click on a measure, and the criteria for the measurement will be displayed:

You need to pick six measures or qualify for exceptions.

If you are a practice which uses AuroraEHR, contact us and let us know which measures you are planning on using. We will then customize your screens and implement the data tracking as required by the measurement criteria.

That's it for now, and Happy MIPSing!