MACRA Releases Final Rule for 2018 Performance


CMS has issued the final rule for 2018 for the Quality Payment Program (QPP). The QPP program is in the second year of implementation continually trying to adjust the QPP to become more comprehensive and offer better incentives for the providers.

Changes in MACRA will be affecting the reimbursement for the providers here are some things to look for in Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Model (AAPM).

A thorough analysis of the MACRA 1,653 pages rulebook we have created chosen the rules which will affect your billing to the maximum.

Merit-based Incentive Payment Model (MIPS)

  1. CMS has added leniency for providers affected by natural disasters e.g.:- Fire, Hurricane

For the 2018 rule, CMS has made provisions for uncontrollable circumstances of natural disasters and health emergencies to submit hardship exception applications. This would mean that the CMS would reconsider the advancing-care information for 2017 and for the quality, cost, and improvement for 2018. CMS has also exempted many clinicians for quality, improvement and cost categories in 2017.  The final rule for the following will not take effect from 2018.

  1. For 2017 the final score which would depend on the quality-60 percent, improvement activities-15 percent, cost- 0 percent and for the advancing care-25 percent. For 2018 the performance for 2018 is the quality- 50 percent, Advance care information- 25 percent, cost-10 percent and improvement activities-15 percent.
  1. Bonus Opportunities for providers

Small practices which have 15 or less number of physicians can also 5 additional points if they submit on one performance category. Physicians can also earn upto five more points for treating complex patients. For all patients eligible for Medicare and Medicaid insurance.

  1. Threshold for revenue and patient raised

In 2017, if providers have billed less than $30,000 for Medicare Part B or treated less than 100 patients who are beneficiaries of Medicare Part B.  In 2018, the bare is promoted to $90,000 and 200 patients annually. Individual physicians or physicians of less than a group of 10 can band together to report the MIPS parameters.


Extended Advanced APM by two years

This says that at least 8 percent of physician’s revenue has to be in risk to qualify for the extension of performance for the year 2020. The performance standard will be extended till 2020, this rule applies to the physicians under the financial risk and who are APM under the non-Medicare payers can also qualify for the Advanced APM.

The rulebook also provides information on All-payer combination model which will be available by 2019. This will include the determination and data submission for the model which will allow the physicians to qualify for the Advanced APM.

The CMS rules have had a mixed reception, while some providers have lauded CMS and others say that it could have been better under the new regulations. Some of the physicians supported saying that the administration has continued providing the flexibility for the participation of providers. However some of the feel that the CMS has shied away from the value based just to maintain the equilibrium for the providers.

It seems like the CMS want to ease out the process of value-based payment model for the providers before fully plunging into the model. This will provide with a breather for the individual physicians and small practices.  While in later years how the practices would be taking the leap for the value-based care would be an interesting factor to see.

While ASC and emergency service providers feel left out with non-expected departments where the 10 points where cut-down bringing it from 50 percent to 40 percent.

For more information on effects of MACRA rule on your practice contact us through our medical billing and coding specialist.

Posted in Accounts Receivables, Claims Denials, MACRA, Medical Billing, Medical Billing Company, Medical Billing Services, Medical Coding, Medicare Medicaid, Practice Administration, Practice Management, Revenue Cycle Management (RCM) | Leave a comment

Why You Need Urology Practice “Report Card”?


Are my resources performing optimally and will they perform to reduce my overhead cost? These are few questions asked by an urologist as they gear up for the next year. Most of the urologist is looking towards the high overhead cost of running an individual practice or few urologists asked us to do an auditing for their practice most of the practices were running into high overhead cost which includes resource hiring for urology medical billing along with looking for technology for claim management.

The urology physicians for whom we audited the Revenue Cycle Management (RCM) throughout the year they asked us a question why should I audit or track my billing every month?

Now as we move from fee for service to value-based model payment the question becomes imperative to answer as we see a different perspective on the reimbursement and each month audit of billing and practice would become as important as patient care. Although every urology practice is non-tangible in terms of the already established system for the patients.

  1. Creating a benchmark for reporting
  2. Total Charges
  3. Total Payment
  4. Total Adjustments
  5. Total Patient Visit
  6. Ending Account Receivable (AR)
  7. Total Patient AR
  8. Total Insurance AR

Need to understand that setting a benchmark for each of the above will let you determine the how well your urology practice is performing and evaluate the changes you required to make. All the above fields might not be needed for your urology practice but you can still make sure you can capture the maximum of data for benchmarking.

You also have to use same benchmarks to determine the performance of your practice. Take all variables into consideration such as time of billing, account vacations, the timing of charges, etc. before you can conclude on the benchmark factor.

  1. Tracking the use of Codes

The number of times each code is used will provide you with an evaluative option of how many times a CPT code is used by you for practice. This will provide you with easy mapping option for you to double check on surgeries and guide through the evaluation/ management through the month. Coding reports create an easy channel for connecting the physicians to a billing department with providing an in-depth knowledge a practice.

  1. Average charge/ visit, and payment/ visit

Average Charge/ visit helps in tracking the Account Receivable (AR) for each visit from the patient and how much each procedure are earning per visit will provide the patients with a structure of patient earning. Payment/ visit will give you insights on the reimbursement from the insurance and patients.

To provide the final conclusion when you see through all the benchmarks the numbers will tell you what you need to improve your practice and what is going well for your practice? Data should be thoroughly analyzed with keeping in vital signs in mind keeping reporting regular.

Why you need a outsource team of billers and Coders?

An outsource team of revenue managers will provide you with all the necessary reports for analyzing the Revenue Cycle Management (RCM). For more information on urology medical billings call us on- 888-357-3226.

Posted in Medical Billing, Medical Billing Company, Medical Billing Services, Medical Coding, Medicare Medicaid, Practice Administration, Practice Management, Revenue Cycle Management (RCM), Urology Billing | Leave a comment