CMS Is Making Medicare Advantage Risk Adjustment Changes
Wednesday, September 23rd, 2020

CMS recently proposed changes to Medicare Advantage and Part D payments for 2022, finalizing a multi-year phase-in of a novel, controversial payment method where plan risk scores are based entirely on encounter data.

In the past, to complement encounter information in calculating payment, CMS has relied on reports submitted through its Risk Adjustment Processing System (RAPS) method but stated that policy would cease in 2022.

Risk scores reflect a beneficiary’s estimated medical expenses and are utilized in tailoring Medicare Advantage plan federal payments. In general, the more ill an individual is, the greater the risk score and, therefore, the greater the payment earned by an MA plan. CMS began collecting encounter data, or data based on claims data generated by a provider, supplier, physician in a practice or hospital setting, in 2012. According to insurers, this data can often be incomplete or inconsistent, so depending entirely on that data for risk scores could potentially lower federal plan payments.

As mandated by the 21st Century Cures Act, CMS will completely transition to this risk adjustment calculation model that has been slowly increasing since 2016, when encounter data made up 10% of a risk score. In 2019, 25% of risk adjustment scores were based on encounter data, and that number increased to 75% in 2021. In 2022, encounter data will be the sole determinant for calculating risk adjustment.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

Optimize Your Clinic With a Patient Tracking System
Monday, September 14th, 2020

Ambulatory care surgical centers and urgent care clinics often grapple with numerous patients and clinical activity that need consistent tracking. Failure to streamline the process may affect the efficiency of the clinic or healthcare practice which, in turn, can lead to serious consequences. Greater wait times mean more disgruntled patients and stressed staff and providers. Increased wait times may also endanger a patient’s condition, requiring emergent care.

CareOptimize has developed a solution. Our Patient Tracking System helps clinics and surgical centers keep track of all clinical activity in real-time, boosting operational efficiency and ensuring better patient and provider satisfaction.

The Patient Tracking display is designed to be user-friendly and can be displayed on screens of various sizes. With this tool, the clinical staff is always aware of the location of each patient and provider on your floor plan and the degree of acuity and clinical actions for each case. Furthermore, the tool shows the average and longest wait time, plus the number of patients waiting to be seen, providing the right data to allow concentration of efforts to reduce wait times while, at the same time, offering optimal care.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

Medicare MIPS Continues During the Pandemic
Friday, September 11th, 2020

The Centers for Medicare & Medicaid Services (CMS) recently announced that healthcare groups and physicians have until the 5th of October to contest their success score for their 2019 Merit-based Incentive Payment System (MIPS) if they disagree with the amount reported by the Centers for Medicare & Medicaid Services.

CMS recently posted success ratings on the website of the Quality Payment Program (QPP) for physicians and those involved in MIPS, which can be accessed through the portal. The score governs 2021 Medicare payments to doctors and healthcare organizations, who are given an adjustment that’s either positive, negative, or neutral.

MIPS-eligible physicians, associations, and virtual entities — including those who engage in an alternative payment model (APM)—can request a summary by visiting the QPP website.

It is necessary for physicians and groups to review their 2019 performance feedback reports and 2021 payment adjustment scores for accuracy. As a result of the pandemic, CMS introduced a policy aimed at keeping physicians harmless from payment changes if they did not apply 2019 MIPS data.

CMS has also announced the option of opting out of the 2020 MIPS program in full or in part. In order to do so, a request for hardship on the QPP website must be made before December 31, showing the hardship is tied to the pandemic.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

EHR Target Goals
Friday, September 4th, 2020

Electronic health records (EHR) assist in the process of collecting patient data and record keeping. However, an EHR has broader implications. Based on what the objectives are, an EHR has the power to alter your entire practice’s workflow, structure, and cultural process. That’s why choosing an EHR that complements and enhances your office operations is so vital.

If you feel your existing EHR isn’t adding value, it may be time to opt for another solution. Moving over to a new EHR is often an extended process. Once all the data has been entered into the new system, your staff must be trained on how to use the different functions and features. This training can take several weeks. Long term needs and goals should drive the process of switching to a new EHR. This lessens the odds of spending the time to transition to a new EHR only to realize that the new solution is ultimately not one that is adapting to the distinct needs of your practice.

Make sure to remain connected with your patients throughout the process as they become familiar with the new EHR, and provide feedback. Identify any problem areas quickly, and take the steps to rectify them, when possible. Patient feedback also shows while you are focused on creating an efficient and effective office, your system also has your patients in mind. You want an EHR solution that follows your new EHR targets for better productivity and delivers as much value to patients as it does to you.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.