Breaking down MIPS – Part 4: Advancing care information

MIPS Advancing care informationWhen it comes to the Quality Payment Program (QPP) and moving Medicare Part B clinicians to a performance-based payment system, most practices know by now that there are 2 tracks to choose from—Advanced Alternative Payment Models (APMs) or the Merit-Based Incentive Payment System (MIPS).  For 2017, MIPS has 4 performance categories, weighted as follows:

This blog post will focus on MIPS and the advancing care information category.

Qualification

First, let’s review the basics of who can participate in the QPP. To qualify for the QPP you must bill more than $30,000 to Medicare Part B and provide care for more than 100 Medicare patients per year.  If you decide to participate in MIPS, you may earn a performance-based payment adjustment.

For MIPS you must also be a:

  • Physician
  • Physician assistant
  • Nurse practitioner
  • Clinical nurse specialist
  • Certified registered nurse anesthetist

You cannot participate in MIPS if:

  • You are newly enrolled in Medicare (2017 is your first year participating)
  • You are below the low-volume threshold
  • You participate in an advanced APM

You can choose to report as an individual or group. If you choose to report as a group, that means there’s more than 2 clinicians whose individual NPIs have reassigned their billing rights to a single Tax Identification Number. Your data get aggregated and sent as the group.

The first performance period began on  January 1, 2017 and closes December 31, 2017. To potentially earn a positive payment adjustment under MIPS, you must send in data about the care you provided and how your practice used technology in 2017 to CMS by March 31, 2018 for a payment adjustment in 2019. If you have not yet gotten started, it’s time to pick your pace.

Understanding Advancing Care Measures

The advancing care information portion of MIPS—which is 25% of your MIPS score—promotes patient engagement and the electronic exchange of information using certified EHR technology (CEHRT). This effectively replaces the Medicare EHR Incentive Program for eligible professionals, also known as Meaningful Use.

In 2017 there are 2 measure set options for reporting. The option you use to submit your data is based on your CEHRT:

  • Advancing Care Information Objectives and Measures (which are based on Stage 3)
    1. Use if you have technology certified to the 2015 edition; or
    2. If you have a combination of technologies from 2014 and 2015 editions that support these measures
  • 2017 Advancing Care Information Transition Objectives and Measures (which are based on modified Stage 2)
    1. If you have technology certified to the 2015 edition; or
    2. If you have technology certified to the 2014 edition; or
    3. If you have a combination of technologies from 2014 and 2015 editions

In 2017, CMS will accept either technology certified to the 2015 edition or the 2014 edition, but by 2018, all MIPS-eligible clinicians must report using 2015 edition CEHRT.

Calculations

To earn points for advancing care information, you must start with the base score. If you fulfill the base score, then you can fulfill the performance score. The performance score is optional, but it can be a good way to increase your score, depending on the measures that you choose. As well, there is a potential bonus score to earn. Total advancing care information score is calculated from base score + performance score + bonus score. This all totals to 25% of your MIPS score.

For the base score, depending on the CEHRT, report either the Advancing Care Information Objectives and Measures or the 2017 Advancing Care Information Transition Objectives and Measures.  The base score is worth 50% of the final advancing care information score.

  • To satisfy base score requirements, the MIPS eligible clinician needs 1 patient in the numerator (i.e., you only need 1 patient for each ACI base score measure)
  • For measures that overlap between the base and performance score measures, additional patients improve the score
  • Clinicians must also submit a numerator/denominator or Yes/No response for each of the following required measures:
    • Advancing Care Information Measures:
      • Security Risk Analysis
      • e-Prescribing
      • Provide Patient Access
      • Send a Summary of Care
      • Request/Accept a Summary of Care
    • 2017 Advancing Care Information Transition Measures
      • Security Risk Analysis
      • e-Prescribing
      • Provide Patient Access
      • Health Information Exchange

If you’ve fulfilled the base score, you can try to earn a performance score for 25% of your final advancing care information score:

  • To earn up to 90% of the performance score:
    • Report up to 9 Advancing Care Information measures or
    • Report up to 7 2017 Advancing Care Information Transition measures
  • Each measure is worth 10-20%. The percentage score is based on the performance rate for each measure.

There are two ways to earn a bonus score for 15% of your advancing care information final score:

  • Earn 5% bonus for reporting on one or more of the following Public Health and Clinical Data Registry Reporting measures:
    • Syndromic Surveillance Reporting (14 and 15)
    • Specialized Registry Reporting (14)
    • Electronic Case Reporting (15)
    • Public Health Registry Reporting (15)
    • Clinical Data Registry Reporting (15)
  • Earn a 10% bonus for using CEHRT to report certain Improvement Activities

Then the score for advancing care information (25% of final score) is totaled (Base + Performance + Bonus):

  • Base Score: accounts for 50% of the total Advancing Care Information Performance category score
  • Performance Score: accounts for up to 90% of the Total Advancing Care Information Performance category score
  • Bonus Score: accounts for up to 15% of the total Advancing Care Information Performance category score

This can add up to a 155% maximum score that is capped at 100 and scaled to the 25 performance points available for advancing care information performance. This structure was deliberately created to make sure clinicians have the flexibility to work on the measures most important to their practice.

Are you ready? We are!

Care360 EHR is fully certified for the QPP based on 2014 Edition Certification and the associated CMS regulatory requirements. The QPP requires EHRs to advance to the 2015 Edition Certification by January 2018, and Care360 will be ready for that deadline. The Care360 EHR solution is prepared to support your practice with MIPS in 2017 and beyond. Read our MACRA brochure to learn more.

For more information on how the Care360 EHR can help you report, call 1.888.491.7900, or read our white paper, “3 things to know about making the EHR switch.”

 

Source:  CMS


Comments

Breaking down MIPS – Part 4: Advancing care information — 1 Comment

Leave a Reply

Your email address will not be published. Required fields are marked *

Time limit is exhausted. Please reload CAPTCHA.