Roji Intel Blog

Dave Halpert 0
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Alternative Payment Models (APM)AttributionMerit-Based Incentive Payment System (MIPS)Qualified Clinical Data Registry ReportingValue-Based Payment Modifier
September 1, 2015

Mastering MSPB: How “Episode” Care Calculations Make or Break Your Revenues

The whole may be greater than the sum of its parts—but how those parts each contribute to the whole is key to a new Medicare calculation of episode costs. If you aren’t paying attention to the total cost of an entire “episode” of care for your patients—including that rendered by others—your future revenues may take a hit. Enter Medicare Spending Per Beneficiary (MSPB), a component of CMS’s Value-Based Payment Modifier (VBPM) calculations that is crucial to your bottom line. MSPB is a measure of charges per episode of care that looks at costs immediately prior to, during and following a hospital…
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Dave Halpert 0
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PQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
August 11, 2015

Medicare’s 2016 Proposed Rule: What Do You Need to Know?

Is PQRS dead? That’s the question we’ve been hearing, in the wake of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which outlined a new program for merit-based payments. With the release of the 2016 Proposed Rule, the answer is a resounding “No.” The Proposed Rule is exactly that—proposed, rather than final. Nevertheless, historically speaking, there is little deviation between the Proposed Rule and the Final Rule, and so those with a stake in the matter (which presumably includes you, if you’re reading this), should begin digesting these 813 pages to see the direction the program will take…
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Theresa Hush 0
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ACO ReportingPQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
July 14, 2015

Will Medicare’s Published Physician Quality Data Push Your Patients Away?

CMS isn’t the only group scrutinizing your quality and cost data any more. As the next step toward value-based health care, Medicare has begun publishing provider performance data for PQRS under “Physician Compare.” Now patients and their families can make their own data-driven choices about health care providers with an online search. The website is a game-changer. Performance variation between providers is startling. There are 50 provider groups with performance at or lower than 65 percent for at least one published measure. By contrast, a handful of groups show all four measures over 95 percent. The 2013 data are limited and do…
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Dave Halpert 0
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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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Dave Halpert 0
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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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Dave Halpert 0
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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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Theresa Hush 0
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PQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
June 9, 2015

Does Your EMR Tell Medicare the Right Story About Your Patient Quality?

Reporting physician quality to Medicare through an EMR is an easy and affordable approach—at least on the surface. But be careful when using EHR Direct Reporting for PQRS 2015, so you don’t cost your organization as much as 4 percent in Medicare penalties or create an unappealing profile of your quality in Medicare’s public reporting. Navigating successfully through the maze of Medicare’s new Value-Based Purchasing requires a thorough understanding of how all the different reporting and performance programs interact. Unless you have a good grasp of how your EMR reports your quality data, you risk setting yourself up for costly…
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Dave Halpert 0
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PQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
June 2, 2015

GPRO Registration Ends June 30—Don’t Lose Your PQRS Reporting Advantage!

The clock is winding down—have you registered your practice for the Group Practice Reporting Option (GPRO) for PQRS?  To report as one collective unit, you must register with Medicare by June 30. If you don’t complete this step, you’ll still have to participate in PQRS, but your group’s providers will need to report on a person-by-person basis, which can be an administrative nightmare and make it much more challenging to succeed under the Value-Based Payment Modifier (VBPM). Tick-tock! GPRO registration is only the first administrative step. There’s a lot more to know in order to avoid penalties, either from failure…
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Dave Halpert 0
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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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Dave Halpert 0
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Population HealthPQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
April 21, 2015

Your VBPM Incentive Payment Could Be Higher Than You Expect—If You Act Now

Here’s a lesson in budget neutrality, Medicare style: If you are penalized under PQRS for non-reporting or under the Value-Based Payment Modifier (VBPM) for poor performance, your money will be paid out to providers earning a VBPM incentive. That’s right—to your competition. If you’re on the losing end of this equation, you could lose up to 4 percent of your Medicare Revenues.  But if you’re on the winning side, you may be rewarded with a much higher net gain than an additional 4 percent. The Basic Arithmetic of PQRS and the VBPM The law creating the VBPM requires it to…
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