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For years, medical professionals were profoundly unhappy with the Medicare reimbursement program. The Sustainable Growth Rate (SGR) program that proceeded QPP was based on the growth of the population eligible for Medicare and a small inflation increase. This system had serious flaws which had to be corrected by Congressional action each year, or providers would have received much less than they should have. Its replacement, the QPP, has been in place for several years and is still undergoing yearly changes. While this switch to QPP is widely seen as a positive for providers, the paperwork can still be daunting. Getting the right level of reimbursement often requires the help of skilled quality metrics consultants, such a TempDev.

QPP Basics

Before the change was made, providers needed to serve as many people as possible since quantity determined their reimbursement. Obviously, this approach had problems. The QPP, or Quality Payment Program, was designed to emphasize the quality of services rendered instead of the quantity in an attempt to better serve patients and providers. Excellence of care became the important standard. Established in 2017, the program also eased the paperwork load that had been crushing to many providers, in particular, smaller offices with limited staff. QPP involves two payment tracks: the MIPS - or Merit-based incentive Payment System - and APM - or Alternative Payment Model, both of which reward providers for giving their patients excellent care.

QPP Year Three

Overhauling the Medicare reimbursement plan is a huge job and not one that can be done quickly. The QPP change was gradually implemented during 2017 and 2018. The 2019 changes were based in part on feedback given by program participants during these first two years. Expanding the provider list was one of this year's major adjustments. The QPP program expanded to include the following:

  • Physical therapist

  • Occupational therapist

  • Qualified speech-language pathologist

  • Qualified audiologist

  • Clinical psychologist

  • Registered dietitian or nutrition professionals

In addition, medical groups or clinicians may opt-in to MIPS if they meet or exceed at least one of the low-volume criteria, which is especially good news for rural clinics.

Other changes include improving electronic health record access for providers and for patients as well while meeting the requirements of Medicare Promoting Interoperability Programs for hospitals. The emphasis is on simplification and ease of access without harming security.

In addition, clinicians saw their Medicare objectives and measures reduced and simplified, making record keeping and reimbursement easier and faster. Providers who are based in a facility are able to use facility-based measurement even when they are participating in QPP as individuals, greatly reducing their reporting duties and complications.

One major change includes the requirement for clinicians to utilize 2015 CEHRT by their reporting period. This means all MIPS users must be on the 5.9/8.4 NextGen EHR version.

Other changes include a reworking of the bonus point system and no-cost support for Small, Underserved and Rural Support, or SURS. Some of the terminology has changed as well, which certainly affects how providers report their data.

As a rule, these changes have been beneficial to providers and continue to reward quality of service over quantity. Still, they can be confusing, making it easy to overlook some regulations that can benefit a practice. In the three years since the program came into existence, providers have had to adjust to a completely different Medicare reimbursement system. While this new system should benefit them, it requires a high level of expertise to successfully navigate.

2020 Changes

Medical providers are still working to adjust to the 2019 changes while the Centers for Medicare and Medicaid Services is preparing to roll out 2020 adjustments, including a revision to the physician fee schedule. The plan is to increase the conversion factor by a nickle. They are also considering increasing payment for transitional care management as well as creating new codes for chronic care management and principal care management. All of these proposed changes should benefit providers as long as they understand how to take advantage of them.

Other possible changes include raising the number of points a physician must accrue to avoid a negative payment adjustment - going from 30 points in 2019 to 45 in 2020 - a significant jump. They are also recommending that the exceptional performance threshold be raised to 80 points next year. Providers may see the quality performance weight lowered to 40% while the cost performance weight be raised to 20%. These new rules could cause a significant change in a practice's, reimbursement.

TempDev Expertise

While many providers see the QPP as a positive change for Medicare reimbursement, the continual introduction of changes can be quite confusing to any size practice. Mistakes in submitting data and following the new rules can cost a practitioner a huge amount of money, in some cases placing strain on an entire medical facility. The pressure to get it right is immense.

TempDev offers a number of MIPS consulting services to help providers get their QPP submissions right the first time. Their team of experts stays current with all the changes, both big and small, to the system. They are also experts on proposed changes, so providers can prepare for what's coming next as well as getting this year's data submission correct.

TempDev not only helps you update provider billing practices; they are also experts on the latest clinical and technological breakthroughs in the industry including updates to NextGen that can benefit quality reporting. TempDev focuses on quality improvement, which leads to a higher level of remuneration from the CMS. Providers can then offer patients the best care possible while enjoying a greater degree of financial security.

For help navigating QPP this year, contact TempDev.


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