we will begin at 12:30 pm est · 2. hipaa sra, project management & vulnerability scanning 3....
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We will begin at 12:30 PM ESTFollow us on Twitter: @KentuckyRECLike us on Facebook: facebook.com/KentuckyRECFollow us on LinkedIn: linkedin.com/company/kentucky-recCheck out our Website: www.kentuckyrec.comCall us: 859-323-3090Email us: [email protected]
Connect with Kentucky REC!
Quality Payment Program Y4: Planning for Success
The information contained in this presentation is for general information purposes only. The information is provided by UK HealthCare’s Kentucky Regional Extension Center and while we endeavor to keep the information up to date and correct, we make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability or availability with respect to content.
UK’s Kentucky REC is a trusted advisor and partner to healthcare organizations, supplying expert guidance to maximize quality, outcomes and financial performance.
To date, the Kentucky REC’s activities include:
• Assisting more than 5,000 individual providers across Kentucky, including primary care providers and specialists
• Helping more than 95% of the Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) within Kentucky
• Working with more than 1/2 of all Kentucky hospitals
• Supporting practices and health systems across the Commonwealth with practice transformation and preparation for value based payment
Physician Services
1. Promoting Interoperability (MU) & Mock Audit
2. HIPAA SRA, Project Management & Vulnerability Scanning
3. Patient Centered Medical Home (PCMH) Consulting
4. Patient Centered Specialty Practice (PCSP) Consulting
5. Value Based Payment & MACRA Support
6. Quality Improvement Support
7. Telehealth Services
Hospital Services
1. Promoting Interoperability (Meaningful Use)
2. HIPAA Security Analysis & Project Management
3. Hospital Quality Improvement Support
Kentucky REC Description
Kentucky Regional Extension Center Services
MIPS Y4 Program Essentials
MIPS Category Planning
Additional Reminders
Objectives
QPP Y4: QPP Clinician Eligibility
Merit-Based Incentive Payment System(MIPS)
$90KPart B
200 Medicare Patients
200 PFS
Advanced Alternative Payment Models(APMs)
Advanced APM
Participant 50%
Payment35%
Medicare Patients
QPP Track Eligibility Requirements
Eligible Clinician Types: Physician, PA, NP, CNS, CRNA, PT, OT, Qualified Speech-Language Pathologist, Qualified Audiologist, Clinical Psychologist, Registered Dietitian or Nutrition Professional
OR
QPP Y4: MIPS Thresholds
0 Points =Full 9% Penalty
45 Points Minimum
Threshold =No Penalty, No Reward
Between 46-84 Points =
No Penalty
85+ = Exceptional Performance
Split $500M Pool
Year 5 Minimum Threshold = 60 Points
QPP Y4: MIPS Overview
Program Year
Payment Year
Quality ImprovementActivities
Promoting Interoperability
CostAdjustment
Factor+ / -
2020(Y4) 2022 45% 15% 25% 15% 9%
Reporting Timeframes
365-Days
90-Day Minimum
90-Day Minimum
365-Days
Applied During
Payment Year
Must Submit by March 31st, 2021
QPP Y4: Reporting Options
Individual
Under an NPI number & TIN
where they reassign benefits
Group
> 2 clinicians (NPIs) who
have reassigned their billing rights to a single TIN
As an APM Entity
Virtual Group
Combination of > 2 TINs
assigned to > 1 individual MIPS ECs, or to > 1
groups consisting of <10 ECs with > 1
MIPS EC
Quality:6 Measures Required except for: CMS Web Interface report 10 quality measures
At least 1 Outcome measure
7th Measure based on claims for large groups
IA:40 points raw score required• Combination of
medium & highly weighted activities
• 50% ECs must participate in same activity
• 50% of the locations under the TIN are Certified PCMH/PCSP
Cost:Score is based on Medicare claims, including:Measure 1: Medicare Spending per Beneficiary (MSPB)
Measure 2: Total per capita costs (TPCC) for all attributed beneficiaries
18 Episode-Based Measures
QPP Y4: Reporting Categories: Basics
PI:100 points raw score required
• 4 Objectives, 5 Measures
Scoring:• Performance
Score• Bonus
2015 CEHRT Required
Year 4: Minimum Threshold = 45 Points; 9% Risk
QPP Y4: Quality Planning & Action Steps
Choose Submission Method(s)
Analyze 2019 Quality Performance
Review 2020 Decile Scoring
Pick Quality Measures & Study Measure Specifications
Validate Reporting
Integrate Improvement Methodology
QPP Y4: Quality Example
Analyze Previous Quality Performance Data
QPP Y4: Quality Example
Study Measure Specifications & Integrate Improvement Methodologies
QPP Y4: IA Planning & Action Steps
Determine Special Statuses
Decide 50% NPI Population (Group Only)
Select IAs
Choose Timeframe
Collect Evidence
QPP Y4: IA Example
Determine Special Status&
Select IAs
QPP Y4: PI Planning & Action Steps
Choose Submission Method(s)
Determine Special Status, Hardship & Bonus Possibilities
Study Measure Specifications
Validate Reporting
Clinician Documentation Training
QPP Y4: PI Example
Determine Special Status&
Study Measure Specs
QPP Y4: Cost Planning & Action Steps
Review Measure Specifications
Familiarize Measure Attribution Methodology
Analyze Past Cost Performance
Confirm Coding/Billing Practices
Consider Relevant QI Improvement Processes
QPP Y4: Cost Example
Review Specs & Attribution&
Confirm Coding Practices
QPP Y4: ResourcesPlanning• Y3 Performance Data – QPP Portal
• https://qpp.cms.gov/login• Eligibility & Special Status– QPP Website
• https://qpp.cms.gov/participation-lookup• Quality & Cost Measure Specs., Scoring, Imp. Activities, Data
Validation & Hardship Exceptions – QPP Resource Library• https://qpp.cms.gov/about/resource-library
Action• Kentucky Health Information Exchange (KHIE)
• https://khie.ky.gov/cwkhie/Pages/getstarted.aspx• QI Methodologies
• PDSA, Lean, Six Sigma, etc.
Additional Reminders
QPP Y4: CMS TimelineSn
apsh
ots CMS provides
a Minimum of Two Snapshots Throughout the Performance Year –1: April2: December
Legi
slat
ive
Upd
ates Notice for Proposed Rule Making(NPRM) – Late AugustQPP Final Rule – Early November Pe
rform
ance
Fee
dbac
k Typically Released in June – July Following Performance Period
QPP Y4: Planning for SuccessQ1
• Check Eligibility
• Determine Quality Measures • Map & Track
• Establish Submission Level & Method(s)
Q2
• Audit for Data Accuracy
• Plan Improvement Activities• Capture
Documentation
• Check Eligibility• Capture
Documentation from w/in QPP Portal
• Review Feedback Reports
Q3
• Review NPRM Proposals• Place Comments
• Check Quality & PI Reports
• Capture IA Documentation
• Review Feedback Reports
Q4
• Review QPP Final Rule Changes
• Final Eligibility Check
• Attestation Prep
• Documentation to Retain
QPP Y4: It’s that Time!
QPP Y4: Questions
Value-Based Payment Support Services
QPP SURS Technical Assistance:Free, high-level resources for organizations with 15 or fewer eligible clinicians as they navigate the Quality Payment Program. The Resource Center include: straightforward, self-directed resources and tools, up-to-date materials, and access to expert Quality Improvement Advisors. Sign up: www.qppresourcecenter.com
VBP Individualized Assistance: 12 months of planning and transformation support tailored to meet specific client needs and support success in value-based payment. This includes current state analysis, recommendations for action, collaborative goal setting and project planning, education, strategic decision support and ongoing advisory services.
Advanced APM Support:Ongoing support, research, work plan development and application support for transition to advanced alternative payment models (APM).
Like us on Facebook: facebook.com/KentuckyREC
Follow us on Twitter: @KentuckyREC
Follow us on LinkedIn: linkedin.com/company/kentucky-rec
Check out our Website: www.kentuckyrec.com• Call us: 859-323-3090• Email us: [email protected]
Connect with Kentucky REC!