Contact Us: (800) 333-4176

Revolution Slider Error: Slider with alias Oct2016 not found.

Maybe you mean: 'slider1' or 'template1' or 'slider3'

Medicare Payment Reform: What is MACRA and MIPS?

If you’ve been staying up-to-date with Medicare payment reform, you know that a significant shift in quality reporting and payment programs is just over the horizon. January 1, 2017 will mark the first reporting period for the new MIPS program under MACRA. If you are not familiar with MACRA or MIPS, take a minute to read through the key points we’ve outlined below. As your EHR experts, we want to ensure that you understand how your practice will be impacted moving forward.

Please keep in mind as you read this that the final rule will not be issued until after November 1, 2016. The information below may change.

What is MACRA?

On April 16, President Obama signed the Medicare Access and CHIP Reauthorization Act (MACRA). MACRA made three important changes to how Medicare pays those who care for Medicare beneficiaries. These changes create a Quality Payment Program (QPP).

  1. It ends the Sustainable Growth Rate (SGR) formula for determining Medicare payments.
  2. It establishes a new system for rewarding healthcare providers for better care not just more care.
  3. It creates a more direct path to higher Medicare payments through the use of a consolidated reporting program.

MIPSWhat is MIPS?

MIPS stands for Merit-Based Incentive Payment System. It is one of two paths for the new Quality Payment Program (QPP) under MACRA. Not only is MIPS the path FoxFire clients will be using, but it is also the most common path for a majority of providers. MIPS will be taking the place of several current quality reporting mechanisms, combining elements of the Physician Quality Reporting System (PQRS), Value-Based Modifier (VBM) and Electronic Health Record Meaningful Use (MU).

Under the new system, providers will be given a single MIPS Composite Score factoring in performance in four weighted performance categories.

1. Quality Reporting
Quality reporting is replacing the current function of PQRS. Clinicians will choose six measures to report to CMS that best reflect their practice.

2. Resource Use
Resource use is replacing VBM. There is no actual reporting required for this category. CMS will calculate these measures based on claims.

3. Clinical Practice Improvement Activities (CPIA)
CPIA is a new criterion that providers have not previously been required to report on. CPIA involves the activities of care coordination and safety checks. Eligible clinicians will be required to meet one CPIA activity but will be given more credit if reporting on additional activities beyond the requirements.

4. Advancing Care Information
Advancing care information will replace the current reporting for Meaningful Use. This performance category will also include the Health Information Exchange (HIE). The major change with this category is the elimination of CPOE measures.

Timeline

The MACRA legislation and new MIPS program will have its final ruling on November 1, 2016. The current projected implementation date is January 1, 2017. MIPS will be based on the full calendar year for 2017, with the first payment period taking place in 2019.

What’s in it for me?

The MIPS payment adjustment percentage is based on the relationship between the provider’s Composite Performance Score (CPS) and the MIPS performance threshold. A CPS below the threshold will yield a negative payment adjustment while a CPS above the threshold will yield a neutral or positive payment adjustment.

Instead of Medicare payment adjustments going up exponentially under the current laws, the new program will have more limited payment adjustment growth. The payment adjustment for the first reporting period will take place in 2019 and will involve a 4% adjustment, positive or negative depending on the CPS. The following period in 2020 will involve a 5% adjustment, then 7% in 2021 and 9% in 2022.

MIPS Payment Adjustments

CMS Quality Payment Program (2016)

How is FoxFire impacted?

Important: For the 2016 calendar year, FoxFire clients will be attesting to Meaningful Use as in previous years. As the new MIPS program will not be implemented until 2017, you must complete the 2016 calendar year as planned.

For the 2017 calendar year, FoxFire clients must participate in MIPS. There are two possible exemptions from participation:

  • 1st year Medicare Part B providers
  • Below low patient volume threshold (Less than or equal to $10,000 Medicare billing charges and provides care for 100 or fewer Medicare patients in one year)

Because of the wide diversity of practices, CMS will allow physicians to pick their pace of participation for the first performance period. The following outlines the options under the “Pick Your Pace” program.

  1. Test the Quality Payment Program – Providers who are not ready can participate with partial data (partial data has not yet been defined). This option is designed to ensure your system is working before full participation moving forward.
  2. Participate for part of the calendar year – Providers who need more time can participate in less than one calendar year (less than one calendar year time requirements have not yet been defined). This option may allow you to still receive a small positive payment adjustment.
  3. Participate for the full calendar year – Providers can participate in all four categories for the full calendar year starting January 1, 2017 through December 31, 2017. This will be the most common.
  4. Participate in an Advanced Alternative Payment Model – Providers can use or join an advanced alternative payment model. Because FoxFire does not work with any other alternative payment models, this will not be an option.

As you can see, your current methods for quality reporting will be changing drastically come the first of the New Year. FoxFire will continue to provide information and instructions as to how these changes will be implemented within our system. Please be on the lookout for additional emails specific to MIPS. If you have any questions at this time, please email or call FoxFire Customer Service.

ICD-10 Upgrade Recap

On October 1, 2016, providers took another step forward in the transition from ICD-9 to ICD-10. Although you are already actively using ICD-10 coding, there are significant changes that took place in the most recent upgrade. To ensure you are fully aware of how to accurately code moving forward, we’ve recapped some key points to keep in mind.

What changes took place?

Over 1,400 new codes related to eye care were added to the ICD-10 code set.

Providers not have laterality and severity codes to utilize.

Example of changes

Base Code When Left Eye Selected
CRVO Stable = H34.81×2 CRVO Stable OS = H34.8122
CRVO with macular edema = H34.81×0 CRVO with macular edema OS = H34.8120
CRVO with retinal neovascularization = H34.81×1 CRVO with retinal neovascularization OS =   H34.81×1

 

Base Code When Left Eye Selected
BRVO Stable = H34.83×2 BRVO Stable OS = H34.8322
BRVO with macular edema = H34.83×0 BRVO with macular edema OS = H34.8320
BRVO with retinal neovascularization = H34.83×1 BRVO with retinal neovascularization OS =   H34.8321

Using new coding in FoxFire software

The new codes added to the ICD-10 code set will only be housed in EyeMD EMR. After you save and send the charges to FoxFire Practice Management you will be prompted for additional action. The Practice Management software will recognize that there are new codes being used and ask the user to save the changes. Once saved, these codes are automatically added to Navigator.

As with every new update, if you have any questions or any issues, please don’t hesitate to reach out to Customer Service.

See More Patients More Often with 4PatientCare

FoxFire 4PatientCareFoxFire Systems Group is proud to partner with the leading patient communication platform on the market. If you want to see more patients, more often, take a look at what 4PatientCare can offer your practice. Built right into FoxFire software, 4PatientCare is streamlined right into your current patient process.

Here are a few of the 4PatientCare Solutions:

  • Fill Your Schedule Automatically – use the comprehensive patient engagement platform to funnel new patients into your office.
  • Online Marketing – optimize your online prescence to reach new patients from online sources.
  • Reduce No Show Rates – use patient preferred method of communication to send reminders and reduce no show rates.
  • Receive Valuable Feedback – learn how you may be able to adjust and improve your practice based on your patients’ feedback.

Learn more about what 4PatientCare has to offer or get signed up today!

FoxFire Upcoming Tradeshows

Academy 2016FoxFire Systems Group will be traveling across the country this month to two different tradeshows. We’re hitting the road for the Georgia Optometric Association Fall Conference and the American Academy of Optometry Academy 2016. From Athens, GA to Anaheim, CA, we’re spreading the word about FoxFire’s efficient, full-service software.

GOA Fall Conference – Athens, GA – Saturday, October 22 & Sunday, October 23, 2016

Academy 2016 – Anaheim, CA – Wednesday, November 9 to Friday, November 11, 2016

If you’re in the area or attending either of the shows, let us know! We’d welcome you to stop by and say hi! Or, if you know of something attending that is looking for EHR, send them our way. Remember, we offer a great client referral program.

October Tip of the Month

Customizing Fast Diagnosis List

With the recent ICD-10 upgrade, there were several new codes added to the ICD-10 code set. To make diagnosing quick and easy, we’re showing you how to update your Fast Diagnosis list on the Assessment screen. This list is just as easy to customize as any other drop down in the EHR.

Double click on the title and the customization window will appear.

Assessment Screen

You can then customize your list based on the most common diagnosis codes you use. You can also move items up or down and reorder by alphabet.

Fast Diagnosis