ACO ReportingPQRS ReportingValue-Based Payment Modifier
July 7, 2015

Anesthesiologists’ Best Practices: How to Succeed with Medicare PQRS and VBPM

Anesthesiologists across the country are coping with a unique PQRS challenge. Different procedures and settings may mean that some practices do not have the requisite number of measures to meet requirements. Other groups will have enough measures, but the choices may not be obvious. When you have up to 6 percent of your Medicare Part B revenues at risk, you cannot afford to take that chance. Read on to learn how to make the best reporting decisions for your anesthesiology group and avoid Medicare penalties. Like Orthopedists, your specialty focus inherently limits your relevant PQRS measures—except that for Anesthesia, the options are…
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ACO ReportingPQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
June 30, 2015

Orthopedists’ Survival Kit: How to Succeed with Medicare PQRS and VBPM

Pay for Performance success takes careful thought and management, particularly for specialty practices. Under Medicare’s PQRS and Value-Based Payment Modifier (VBPM), specialties have fewer measures available, which narrows reporting options—making it harder for you to meet PQRS and compare well against your peers. For Orthopedics, this is especially true. Nearly 200 PQRS measures have a Registry reporting option, but many orthopedic surgeons still have a difficult time finding nine measures across three National Quality Strategy (NQS) Domains (including one cross-cutting measure), where performance is good enough to report. All too often, orthopedic surgeons get trapped, reporting on measures where performance…
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ACO ReportingPopulation HealthQualified Clinical Data Registry ReportingValue-Based Payment Modifier
June 23, 2015

How to Get Paid for Your Population Health Program: Part 2

If you’ve written off population health initiatives as too expensive, think again. Pay for Performance means just what it says: you need to demonstrate better outcomes than your peers if you expect to reap benefits from Medicare. And, if you fall behind, you’ll risk ACO losses or Value-Based Payment Modifier (VBPM) penalties. As we discussed last week, by focusing on Medicare’s programs and reimbursable Medicare Wellness Visits, your organization can build a solid foundation for your population health program—and get paid for it. Medicare’s new Chronic Care Management Services offer another cost-effective way to build out your population health program.…
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ACO ReportingPopulation HealthQualified Clinical Data Registry ReportingValue-Based Payment Modifier
June 16, 2015

How to Get Paid for Your Population Health Program: Part 1

How can you succeed in Pay for Performance if you can’t risk revenues on a program that may not produce results? Especially if your competitors have made the investment and can prove better outcomes, raising the bar for everyone? It’s not enough simply to tighten existing procedures or to focus on maintaining high standards To stay competitive, you need to improve patients’ outcomes and reduce costs over your own history and against other organizations, even without a lot of cash on hand.  If you don’t, you’ll face even greater financial risks under ACO participation or independently through VBPM penalties. But…
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AttributionPQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
May 5, 2015

Who Else Cares for Your Patients? How the Wrong Patient Attribution Can Skew Your VBPM

So, exactly who are your patients? Sounds like a silly question. But when it comes to Medicare’s patient attribution methodology, the answer is not obvious. Medicare attributes patients to providers and practices in order to calculate components of the Value-Based Payment Modifier (VBPM). Like it or not, certain patients can be attributed to your practice, even if their conditions are not under your clinical management, skewing your VBPM. If you don’t understand the rules, you risk significant penalties. This is true for all providers, but most apparent in specialty groups. As a Qualified Registry and QCDR that reports all measures…
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Population HealthPQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
March 31, 2015

ACO v Group Practice P4P: How Medicare Costs and Quality Calculations Affect Your Bottom Line

Now that Value-Based Health Care defines the landscape, reporting for revenue is on its way out. Value-based quality is in. Medicare’s transition to Pay for Performance gives providers just three options—and no out—for participating in reimbursement models that reward for higher quality and lower cost: Build or participate in an Accountable Care Organization; Report PQRS and submit to the risk of the practice-based Value-Based Payment Modifier; Receive automatic financial penalties. Given that the last option is not really viable, which way should providers participate in Medicare’s Value-Based Health Care? An Accountable Care Organization (ACO) is a network-based model for managing…
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Population HealthPQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
February 10, 2015

Navigating the ACO Labyrinth to Success: How to Find Your Way to Quality and Shared Savings

Last year, less than one quarter of Medicare MSSP ACOs achieved success in generating shared savings. Not a good report card, given that Accountable Care Organizations form for the explicit purpose of delivering high quality, coordinated care, with shared savings as in incentive to avoid duplication of services. But ACOs are complex endeavors, both administratively and clinically. Better coordination of patient care does not guarantee success. Your efforts must be complemented by a solid understanding of Medicare’s basic rules for quality reporting and methods of attributing patients to the ACO, so that you can keep your patients within the network.…
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PQRS ReportingQualified Clinical Data Registry Reporting
December 16, 2014

Season’s Greetings from CMS: You Owe 1.5 Percent for a PQRS Reporting Failure

‘Tis the season to be jolly—unless your health care organization is one of many last week that received a letter from the Centers for Medicare and Medicaid Services (CMS) informing you that at least one of your providers was eligible to participate in PQRS in 2013, but failed to do so—and that a penalty is coming in 2015. Those who did not successfully report at least one PQRS measure in 2013 will only be reimbursed 98.5 percent on all allowable 2015 Medicare Part B charges—a 1.5 percent cut.   Ready or Not, the Penalties Were Based on 2013 PQRS Reporting…
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PQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
November 11, 2014

Specialists at Risk: How To Navigate Hazards in Medicare’s Value-Based Purchasing Programs

Heads up, specialty providers. The future of your practice may depend on three key components in Medicare’s Value-Based Purchasing program. Especially if you work in an independent practice with a higher proportion of Medicare patients than many primary care physicians, your income and practice survival are at risk if you don’t understand implications of the new Rule for 2015. This is certain: You must manage the new environment to avoid penalties and losses under these programs. Most important are PQRS 2015, Value-Based Payment Modifier (VBPM) and ACO Participation. That’s the foundation; with requirements getting tougher every year, you need to…
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Value-Based Payment Modifier
October 8, 2014

The “Avoidable Admissions” Pitfall: What Your Physicians Must Know to Avoid Medicare Penalties

Hospital and physician groups, take note: If you’re admitting patients to hospitals for complications that could have been prevented by better outpatient care, your Medicare revenues are in jeopardy. Under the 2014 Value Based Payment Modifier (VBPM) formula, groups that admit more patients for conditions classified as “avoidable” will risk penalties if their admissions are higher than similar sized groups, and reap rewards if admissions are lower. ACOs have similar reward structures associated with their hospital costs; in 2015, groups participating in ACOs will also bear risk under the VBPM. This is one of the ways that Medicare is instilling…
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