– Provider productivity and availability
– Billing efficiencies, bottlenecks, and opportunities
– Payer strategy
– Untapped revenue streams
– System configuration
Many CareOptimize utilities, free and paid, are initially developed to help solve client issues. Others come about based on gaps in the market. As these products are released, they are placed on the website www.ehrutilities.com. The Insights webinar in April dealt with three of the free offerings.
The Clinical Operations Manager is used to manage a practice on an enterprise-wide level. It was designed to view data across the entire practice and can be filtered by type, user, and location, depending on the relevancy to any particular item. Tasks can also be reassigned. The template is easily installed; you do not have to be a developer. It easily opens from a system practice template and gives administrators a high-level view of any assigned or outstanding tasks and inefficiencies including:
Our most popular free utility is the Document Management/Care Guidelines Auto Complete Utility. Upon scanning an image into Document Management, the Care Guidelines or Open Orders for any particular item automatically complete, removing the need to manually go into Order Management or Care Guidelines section, saving time and increasing productivity. It comes in separate packages; you can install either one. Installation does require a bit of development knowledge. Instructions on how to set up triggers are included and can be used by your team developer. (If you don’t have a team developer, please contact us at email@example.com.) NOTE: If you have NextGen v. 5.9/8.4, we suggest you work with this utility in a test environment, since this latest version, developed to run with that update, is still in a beta state. If you have an earlier system, the utility will run fine.
Our State of the Practice Report is a proprietary report allowing you to evaluate your practice in more than 25 metric types created with data culled from many different parts of your system. Practices need to get in touch with CareOptimize to setup a webinar to run the SOP. Once the report has been installed and run, a follow-up meeting will be scheduled to go over metrics and make suggestions on any deficiencies. Both the running of the report and the consultation are free. This is a great way to identify ways to improve your practice. NOTE: To avoid slowing down your system, it is recommended this be run after hours. Metrics of the report include:
Please visit www.ehrutilities.com to see the complete line of utilities CareOptimize offers.
Healthcare technology has so many moving parts, it’s often difficult and always a challenge to keep up. CareOptimize is continually developing solutions to help alleviate the pain. Please join Director of Development and Head of Strategic Initiatives Kyle Quirk for a look into three of our most popular, valuable, and FREE utilities: Clinical Operations Manager, Document Management/Care Guidelines Auto Complete, and the State of the Practice Report.
CareOptimize works directly with CareMax Medical Centers, seven full-risk, full-service Medicare Advantage facilities in South Florida. All provide a full spectrum of medical services, including transportation (fleet of 50 vans) and home visits. Because these centers are full-risk, it is imperative CareOptimize monitor each center carefully to ensure CareMax centers remain successful value-based operations. To help do this, they have come up with a suite of templates for physicians and coders to work together at point-of-care not only to make the most beneficial coding decisions, but also to simplify the process.
Managing MA members in comparison to FFS
Medicare Advantage pays a capitated amount per beneficiary and focuses on proactive preventative care and early intervention. Care coordination and innovation are incentivized, and a risk adjustment model is used for patient differences. A comparison chart on cap rates per member per month illustrates how the MA contract rate fluctuates and how it might benefit practices.
Accurate HCC coding provides accurate RAF scores, and that accuracy reflects how well codes have been documented at point-of-care. Most CareMax members are joined with HealthSun, a large Medicare Advantage payer with a coveted 5-star rating from CMS. If HEDIS scores are managed well, HealthSun maintains their 5-star rating, which triggers a 5% bonus in addition to the base per patient per month payment.
By offering providers and payers accurate information, CareOptimize has been able to boost CareMax Medicare Advantage premiums. When Medicare Advantage is managed through accurate HCC coding, etc., even more funds can be generated.
To maximize our systems and take advantage of the Medicare Advantage model, we created a system at point-of-care for physicians to ascertain exactly what they need for accurate coding. This system tracks HCC drop-offs and suspected and overdue codes. The coding review process between provider and coder was streamlined, so coding opportunities would be caught before claim creation. We wanted to back all of this up with aligned workflows in the EHR, so we designed templates to do just that.
The pre-audit process lets providers know there is a set number of patients for the next day. A pre-audit review is generated, which includes suggested codes by coders based on holistic evidence. The physician can see and review the information at point-of-care, including codes, diagnosis descriptions, and status of patient (new or not) in their daily assessments. They can accept the code as is if they feel it’s valid or choose no evidence of disease right there, and go on with their notes. Simplifying the coding process benefits both provider and payer, giving crucial information at point-of-care to be generated, allowing for much more accurate results.
The MIPS program continues, with all of its trials and triumphs. While many of the parts of the program remain the same, there are some key pieces to keep in mind, so you won’t be left behind in the pursuit of a positive attestation. If you haven’t started on MIPS for 2018, there is still a possibility for reporting and meeting the minimum threshold for the reporting year, especially if you have less than 15 clinicians. It is also important to remember if you haven’t actively engaged in MIPS program and are always waiting to hit that neutral adjustment, scores are publicly available on the Physician Compare website for all to see.
The official attestation period for the 2018 reporting year began on January 2, 2019, and the deadline to send everything in is April 2, 2019. For groups submitting their practitioners as individuals (vs. group), consent does have to be given. A Practice Administrator may give consent on behalf of a group or virtual group, but not for a MIPS-eligible clinician reporting as an individual. MIPS data needs to include all payers for QCDR/Registry/EHR submissions. Medicare only applies exclusively to the Claims and Web interface submissions. The completeness of data must include all payers. For group submissions, data across the entire TIN, including data from non-Eligible Clinicians, must be included.
For 2018 the threshold for data completeness is 60%. Since it is supposed to be an accurate representation of data, you cannot select only the best performing patients. CMS has provided a lot of clarification about this in the last couple of months.
2018 is the first year practices are being graded on their cost performance. Although this information was provided in 2017, it wasn’t included as part of the overall score. In 2018, there are two measures: TPCC (Total Per Capita Cost – attribution plurality of primary care svcs – specialty-only groups will have patients who fall into this category) and MSPB (Medicare Spending Per Beneficiary – plurality of Part B services billed). Groups where the Eligible Clinician is not attributed any Cost measures will not be calculated a Cost performance score. In 2019, there will be eight new episode-based measures added.
Keep Good Records
It is very important for all to keep good documentation records, and CareOptimize highly recommends having an audit binder. CMS can audit practices up to 6 years after the program year in which you attested, so for PY 2017, you could be audited to 2023. Documentation that should be included in your audit binder includes proof from the registry stating your data was successfully submitted to CMS and a copy of your Security Risk Assessment report that was completed or reviewed, along with the date of completion. The same SRA report can be used and updated year to year. CMS has provided clear breakdowns per measure on what should be included in your audit binder on their website:
For 2018, you do need to be on a 2014 or 2015 certified EHR. If you are looking at an upgrade, such as moving from a 2014 to a 2015 certification, you do need to keep documentation supporting the time period in which you are attesting in your audit binder.
For all measures submitted in the Quality/PI categories, we highly recommend storing that year’s measure details in your audit binder as well as documented workflow used. Include screenshots within the EHR. It doesn’t have to be for specific patients, but you do need to be able to show how the providers are capturing the info. For PI measures, an ONC certified EHR is required to complete the report, which should be included, with numerator and denominator calculations, vendor logo, and timeframe in which you are attesting.
For additional measures within PI reporting, specifically specialized registry reporting and public health measures, it is critical to have documentation from state agencies including emails, screenshots, or receipts showing active engagement.
The CEHRT Bonus in Improvement Activities is a yes/no measure, and you need to include screenshots of the activity being completed for your attestation time period.
What 2019 looks like
The 2019 MIPS period has now started. MIPS 2019 includes two 12-month segments. The timeframe currently posted on the CMS website is October 1, 2017 to September 30, 2018. The second timeframe will be October 1, 2018 to September 30, 2019. Some changes:
We can learn a lot from previous years. CMS reported that 93% of MIPS Eligible Clinicians received a positive payment adjustment and 95% avoided a negative adjustment. They have been quite good at predicting trends for the future. For 2018, they predict only 74% of clinicians would earn a score higher than 70% qualifying for the exceptional performance threshold.
Minimum points are increasing from 3 to 15. Distribution of points is also different with the Cost category being implemented and Quality having a smaller percentage. The same trend is expected to continue in 2019, with a minimum point increase to 30 points.
There is an increase in Eligible Clinicians for 2019. The threshold is the same (>$90,000 billed to Medicare, >200 services to Medicare beneficiaries, and > 200 covered professional services), but if you meet one, but not all conditions, you can still opt in for 2019. (Keep in mind once you have opted in, you can’t change it for the applicable performance period.) This will help increase the number of organizations participating and working toward attestation and the possibility of potential positive adjustment.
If you are actively working on 2018 MIPS submission, you should still be looking toward 2019, since there are areas needing work now that will affect your scores down the line. Right now, you should be:
Ensuring you keep good records, staying up-to-date on CMS guidelines (www.cms.gov), and getting the help you need will all help you reach you attestation goals. For more information, please contact CareOptimize at firstname.lastname@example.org, call 855-937-8475, or visit our website www.careoptimize.com.
The MIPS program continues, with all of its trials and triumphs. This webinar arms you with the tools to make sure you know exactly what to concentrate upon and when you’ll need it, along with what to watch out for in 2019.
The Affordable Care Act requires health plans spend 80-85% of premiums on medical care, which has created a renewed shift towards capitation and risk contracts. This video provides an overview on how to leverage these new contracts and better align physician incentives to keep patients healthy – all while providing opportunities to increase your bottom line.
Medicaid MU3 is not going away. In this third iteration of the program, there are some significant changes and requirements to note. This 30-minute webinar takes you through the ins and outs of MU3, giving you tips on how you can actually be successful with the program including: