Home Forums Discussions MACRA/MIPS If you read nothing else about MIPS/MACRA please read this

It is easy to be turned-off by the entire MIPS/MACRA program, and to decide not to participate. You can not only skip all of the hoops of participation, but you also don't need to waste time learning how the program works or any of the minutiae of the program requirements. I think that would be a mistake though because you can very easily avoid a cut to your Medicare income in 2019 with a minimal amount of effort.

First, a brief explanation. MIPS/MACRA is designed to simplify the CMS incentive/punishment programs. Beginning in 2017, there is no more MU, PQRS, eRx, or value based modifiers... they are all combined into MIPS. The program, its components, and the program requirements are still voluminous and complex. A key point for 2017 is that our activities this year determine a pay cut or raise between -4% and +4% on our Medicare payments for 2019. Without going into detail here, getting any bonus will be difficult. Even if you participate for all 365 days of 2017, in all the components of the program, there is NO guarantee that you will get a 4% bonus. Even with year-long, perfect participation, a much smaller bonus is likely. Medicare states this very clearly. What IS guaranteed is that if you do NOTHING, then you will have a 4% cut in 2019.

The good news is that you can break even and avoid that 4% cut with a minimal amount of work. CMS has decided to offer a "test" path for 2017. Participation in the test path will not get you any bonus but it will avoid any cut. Participation involves a minimal amount of work. Theoretically, submitting a single Medicare claim with the appropriate added codes will be regarded as successful test participation, and you avoid the 4% penalty. For safety, you may choose to do more than one claim, but the requirements are minimal. How do you know what codes to pick? I will be happy to discuss that in future posts, but there are many easy choices.

AC is doing an excellent job of trying to organize this information and you will be hearing more about this as the year goes on. That is especially important if you plan to participate more fully than what I describe here.

For more details on the test path and how to navigate it, AC has prepared an excellent summary which you will find here. It contains a large amount of information condensed into a small space, but I would suggest that you focus on the "Quality Measures" section, which they mark as the "easiest option" and then use the "claims" method of submission (which is quick, easy and free).

So for now, you need do absolutely nothing. Simply resolve that before the end of the year, you will spend a few minutes reading here which codes will save you the 4% cut, and then submit a few claims with the added codes. If you object to this program on moral or political grounds, then that of course is your choice. To lose 4% because it is "too much work" or "too hard to figure out"... that, I think, would be a mistake.

Jon thanks for this 'Pep Talk' post on MIPS

So just to clarify if we are doing the test path and do a quality measure we don't have to pay for the security risk analysis to be done?

That is correct.
You can avoid the 4% cut with a quality measure which has no security analysis requirement.

An alternative is the "advancing care information" path which has 4 requirements; three of them are pretty easy, but the fourth is the security risk analysis which is either a hassle or an expense. That is why I think the quality measure is the easiest way to go.

Good Morning Amazing Charts Users!
I was wondering if anyone had any advice on which registries to use?
I have used PQRS Wizard in the past, and found it very user friendly.
Please help w/ this! I am at a loss as to which to use.
I have looked into MDInteractive, but it seems very complex.
Any help would be appreciated!
MGulledge, CMA, CPC
South GA Internal Medicine, PC

Hi MGulledge,

If your having trouble selecting a registry, you can contact a service called Elixir. Elixir is a matching service that takes your practice and matches you to the appropriate registry. Its kind of like a dating service between practices and registries.

For more information, you can email info@amazingcharts.elixirmd.com. Please note that it takes about 6 weeks to get up and running with a registry, so I would recommend contacting them ASAP.

I hope that helps.

The old MU system has been discontinued with no real admission from the responsible parties concerning its abject failure and the waste of not only billions of dollars of taxpayer money, but the meaningless disruption in the lives of thousands of doctors and others involved in healthcare.

If you ever want the madness to end, you have to stand up and choose that you are not going to participate with any more similar schemes. If enough of us did this, they would realize they could not manipulate us in this way.

I told PQRS this year to stick it in the same hole as a colonoscope....

We are having problems with the counting of mammograms in AC. Our results are faxed over so there is no LINC code as you would have with a lab result that is imported.
Honestly, we haven't spent a lot of time on this until recently when we are working on Care Gaps and decided to use this measure for MIPS.
We have the order entered for Mammogram.
We have the faxed Mammogram result reconciled,reviewed by physician and in imported items.
Is there a way to have this show up on MU/MIPS reports when we run?
Is there another way to collect these numbers with available reports in AC?
We can't be the only Practice having this issue.
Is there something that we are missing?
I would appreciate any guidance available on how to acheive the counts needed.

MU/MIPS automated reports are only going to show those types of measures if there is a place in AC to store and "check" that it was done.

I know that coming releases are supposed to be responsive to new requirements - time will tell.

On the other hand, if you can attest manually, or without using EHR output, you have other options.

I got their nifty little letter saying I have to participate in the program or lose up to 9% by 2022. It also said if I had less than 100 Medicare patients or less than 30,000 per year in billing I'm exempt. That is supposed to be relief for small practices, but it's a pretty small number. I spent 45 minutes on the phone with them asking how I can inform them if I drop below 100 patients, but they could not answer the question. I told the strongly that I'm not playing any more of their games. Please tell me you are not all going to try MU round 2?

There is a webinar arranged for the knowledge and implementation of MACRA

https://sybridmd.com/WebinarDetail...._MACRA_by_Sybrid_MD&utm_medium=email

one way to do this is might be to use the PRIME registry
I have half of my mammograms faxed over and the others are imported with EDI codes
they have mapped my practice so that when the word " mammogram" or " mamm" appears in the name of the imported item, it picks it up
also they have mapped my electronically imported files so that
" tomosynthesis screen with CAD and "b/l scrn Mammo"
are picked up by the registry

unfortunately I cannot tell you how well it is working since I have hit a glitch over the past month and the registry is inoperable

I do fully expect it to work and my mammogram rate should shoot up to the 76% that it is by hand, as opposed to the 3% which it is counting now

I'll let you know when the system becomes operational again.

We were in the same boat as many others and thought of taking the cut. Then we saw the postings by Chris C. and Chris T., read the recorded the webinars and decided to participate. Our position on participating changed very dramatically from test participation to partial to full.

Prime Registry delivered everything it was billed for. The integration was real easy and the dashboard shows where quality measure performance one can track and make use of. Recently it added the CMS average performance as well. On top of that we would want to thank AC product management team for appropriately evangelizing MIPS/MACARA for many AC users.

We do not know what the future holds since CMS is always changing the requirements. But for 2017, we shall be participating in Full.

We strongly believe anyone can in MIPS/MACRA for 2017 with a little bit of effort and using the guideposts AC folks have developed.

Regards
aramiz
Houston TX

Any suggestions on who to hire for security risk analysis? Last year is cost us $2500+ for small office with one provider.

aramiz,
Thanks for posting this. Would you be willing to share more? Can you tell us how much Prime Registry cost and how many hours of extra effort you would estimate you expended? And what is your expectation of a return on that investment?

I signed up w/ Prime registry in May but they are yet to provide me with any data - anyone having these issues - very frustrating . My AC does not seem to spit out accurate data for me to report- Its October already and not sure how to resolve this in time for reporting.
Any suggestions?
Priya
CT

Hi Priya,

Can you please reach out to me via email about the Prime registry. I can contact them directly and have been able to get a speedy response to issues. My email is mdabeck@amazingcharts.com

I am having issues with PRIME too. Most of their data is wrong, and they can't seem to distinguish the difference between pts seen by me and those by my PA. I haven't heard from my PRIME rep (they're in India) for a month despite e-mails, sending them screenshots, etc.

Yes they are in India and not seem to know what time zone we exist in so call at odd hours!

Just sent you the email and thanks!

Just a quick reminder and update on my original post seven months ago...

Medicare providers will be hit with a 4% payment cut in 2019 if they pay no attention to MIPS in 2017.
On the other hand, you can break even and avoid that 4% cut with a minimal amount of work but participating in the "test path".
Last week I confirmed that submitting a single Medicare claim with the appropriate added codes will be regarded as successful test participation, and you avoid the 4% penalty.
That is one G-code on one Medicare claim to save 4% on a year's billings.

More specifics on how to choose and submit a code coming....

I will try to answer multiple questions my comments on 10/02/17 has generated.

As for Security Risk Analysis, we use REC ( regional extension center for the gulf coast). These RECs are formed when MU was started. Cost us $1800 for one clinician.

As for Prime Registry, the cost is $360/year. We had about 3 sessions each about an hour long. Once the data was captured, we are already performing on par with the average. Then when we started digging into it, we realized data was there in AC but not properly captured by Prime. So we those two follow-on sessions were on refinement.

We strongly believe the effort was worth it. The data was already there in AC as part, all Prime did it was extract it correctly and will own submitting it to CMS.

The folks have been extremely helpful and responsive. Once you sign up, they will assign an account rep who in our case was always responsive.

Once again it was worth our effort and strongly believe will be yours as well.


Thanks
Aramiz

CMS has an iOS app for doing it yourself...

We are doing the test path this year and I'm wondering if anyone can give me some codes to add to a claim that will qualify. I have done a couple but I would like to do a few different ones just to make sure.

diabetes: A1C > 9.0 3046F; A1C <7.0 3044F: A1C 7.0-9.0 3045F
HTN must report systolic and diastolic: SYS <140 G8752; SYS >= 140 G8753; DIAS <90 G8754; DIAS >=90 G8755

Here is my favorite:

One of the measures is documenting current medications (including doses, frequency and routes; and herbals) on patients. If you document this on a patient -even if they are on NO medications, and you say that - add on your CMS 1500 billing form in box 24D the code "G8427" and in the charge box, 24F, $0.01.
You could probably do that on every single patient that you see.

Boom. Done.

Does anyone have a definitive answer to the following question?

Must the use of administrative codes such as G8427 as recommended by Jon above be appended to an ACTUAL patient visit?

Or can you create a DUMMY visit for a date when the patient was not here ("Patient is here for MIPS. Has a very large MACRA on exam"), and put the G8427 CPT code for the purpose of MIPS test (or any other) path on the bill with the appropriate ICD 10 code?

Thanks,

Norm
Internal Medicine
Vail

Norm I imagine the patient has to be in the database of Medicare for the data input to 'stick' and count.

Following up on my PRIME experience, things are now going well. It took a couple hours on the phone with the tech folks plus I had to change some templates and the way things are labeled in AC. I also had to send some screenshots to PRIME. Basically you have to have things structured in AC so that PRIME is able to recognize and pull out the data.

I'm anticipating being able to participate in MIPS in full, which was actually not my intent going in. The hard part is getting things set up then after that most things seem to be on cruise control.

So is it worth it - still hard to say. I think there will be a small improvement in quality of care though it's a ponderous and inefficient way to achieve it. Financially it probably is worth it as we see a lot of Medicare patients. Theoretically I could get a bonus though my experience with these government bonuses is they hold them out then you never see them.

What is the yearly fee for the PRIME registry?

$360

And you will have direct one-on-one interaction with Prime account rep till all the kinks are worked out and data are captured successfully.


Our experience with Prime was far better than that with PQRSWizrad .

Aramiz
Houston

You don't have to take a cut, and you don't have to participate. You can just say "no" to it. Participating promotes further govt experimentation and disruption in our lives. We are professionals: we should dictate our prices.

Hello,
Do you know if AC will be able to make a QRDA3 file for us to submit for quality measures for next year. My ACO reported data this year for us but I am told won't be next year.
(and please don't think I really know what I am talking about, I was just told this is what I would need;-)
Avery

MIPs submission window officially closed on 4/3/18.

Preliminary performance data is now available on https://qpp.cms.gov with final performance data available by summer 2018.

2018 measures are expected to be published shortly.

Thanks
aramiz
Houston