MIPS 2019, 1 of 4

Well, it is mid-September 2019 and in three months, the year will come to an end. That means we should talk about MIPS, since the current reporting period closes at year's end. It would behoove us all to review the requirements, since the 2019 scores will determine the 2021 MIPS Payment Adjustment for each clinician/group/provider.

Let's start with some basics. Your total MIPS score is determined by the four performance categories listed below (along with the weight of each category in the final score):

• Quality Measures (45% of total score) 
• Promoting Interoperability (25%)
• Improvement Activities (15%)
• Cost (15%)

For today, we are just presenting a summary of all of the performance categories and their respective highlights. Each performance category will (very soon!) be covered in other blog posts.

Quality Measures (45% of total score)

• Quality Measures must be reported over the entire year, not 90 days.
• Reporting should be done on 6+ measures or a complete specialty measure set.
• You can mix and match four different types of quality measures, but one of the selected measures should be an outcome or priority measure. 
• There are ways to get bonus points which will be covered in part 4 of this series.
• Resources:
• https://qpp.cms.gov/mips/quality-measures for an overview
• https://qpp.cms.gov/mips/explore-measures/quality-measures?py=2019#measures for details, including all specifications, quality benchmarks, etc.)
• https://qpp.cms.gov/about/resource-library for even more resources

Promoting Interoperability (Reporting on EHR usage - 25%)

• The reporting period is for at least 90 continuous days in 2019. 
• Reporting is required on all measures except for two bonus e-prescribe measures.
• There are some attestation questions and four main objectives:
• e-Prescribing (10 points + 10 bonus points)
• Provider to Patient Exchange - essentially your patient portal (40 points)
• Health Information Exchange (40 points)
• Most AuroraEHR users will claim exclusions for e-Prescribing and Data Exchange, moving some points to this objective.
• This area will include the biggest differences from 2018, and will mean some changes in the way you use AuroraEHR to exchange structured clinical data with referring providers.
• Part 3 of this series will go into detail about exactly what you need to do to maximize your points.
• Reporting to registries (10 points)
• Details about the objectives and measures will be covered in part 2 of this series.
• Important: If you skip reporting on a single one of the required measures (without claiming exclusions), the entire score for Promoting Interoperability is 0!
• Four measures have been removed:
• Patient-specific education
• View, download, or transmit (VDT)
• Secure messaging
• Patient-generated health data
• Resources:
•  https://qpp.cms.gov/mips/promoting-interoperability
• Go to https://qpp-cm-prod-content.s3.amazonaws.com for measure specifications.

Improvement Activities (15%)

• Activities must be performed for 90+ continuous days in 2019.
• High-weighted activities receive 20 points and medium-weighted activities receive 10 points.
• You must report with one of these combinations of weighted activities:
• 2 high-weighted
• 1 high-weighted and 2 medium
• 4 medium
• Resources:
• https://qpp.cms.gov/mips/improvement-activities

Cost (15%)

• There are no reporting obligations for this objective, because the cost data is automatically calculated by CMS based on submitted Medicare claims.
• Resources at https://qpp.cms.gov/mips/cost 

We've covered a lot here and we will take an in-depth look at the areas relating to AuroraEHR over the next three blog posts. If there is anything we can do to help or if you have any questions, feel free to reach out to Client Services.

Blog posts in this series:

Part 1 (Overview of 2019 MIPS)
Part 2 (Promoting Interoperability)
Part 3 (Health Information Objective )
Part 4 (Quality Performance Category)

Online Eligibility

Beginning in April 2018, Medicare recipients will receive a new Medicare card that will have a randomly assigned 11-digit Medicare claim number (or policy number, to Rexpert users). This will replace the current policy number, which is based on the social security number. A year-long transitional period will follow, during which you can process Medicare claims using either the old or new Medicare number without any adverse effect on claim processing. However, beginning in April 2019, all claims will have to be processed using the new Medicare numbers.

CMS has put out out a list of things to do to get ready for the number change.  Rexpert will, of course, handle the new Medicare number format and will provide instructions for the April 2018 roll-out date.

One suggestion from CMS you can begin working on now is this:

Verify all of your Medicare patients’ addresses. If the addresses you have on file are different than the Medicare address you get on electronic eligibility transactions, ask your patients to contact Social Security and update their Medicare records.

As part Release 11.5, we are offering an Online Eligibility service which can be quite useful for checking addresses.  The report is fast and easy to use, and the patient's Medicare address shows up right on the summary:

Click on the image for full-size

You should compare the Online Eligibility address with the address in Account Registration. If the two addresses are different take one of these steps:

• If the Online Eligibility address is correct, update the address in Account Registration.
• If the Account Registration address is correct, advise the patient to contact Social Security to update his or her Medicare address. Otherwise, the patient may not receive his/her new Medicare card next year.

Well, that's it for now, and if you would like to know more about subscribing to the Online Eligibility service, please contact Client Services by using the feedback button in Rexpert.