+ All Categories
Home > Documents > Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017...

Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017...

Date post: 03-Jul-2020
Category:

Documents
Upload: others
View: 8 times
Download: 0 times
Download Report this document
Share this document with a friend
39
Medicaid MU and the Quality Payment Program: Connecting the Dots Rachael Tomaskovic, MHA, PCMH CCE, CPHIMS Outreach Specialist, HealthIT and QPP-SURS
Transcript
Page 1: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

MedicaidMUandtheQualityPaymentProgram:ConnectingtheDots

RachaelTomaskovic,MHA,PCMHCCE,CPHIMS

OutreachSpecialist,HealthIT andQPP-SURS

Page 2: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 2

Objectives

§ OverviewoftheMedicareAccessandCHIPReauthorizationActof2015(MACRA)

§ IntroducethecomponentsoftheQualityPaymentProgram§ StructureoftheMerit-BasedIncentivePaymentSystem(MIPS)

Page 3: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 3

Disclaimer

§ ThesourcematerialforthispresentationwastakendirectlyfromQPP.CMS.gov.Allinformationwascurrentatthetimethepresentationwaswritten.PleaserefertoQPP.CMS.gov forthemostcurrentQualityPaymentPrograminformation.

Page 4: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

TheMedicareAccessandCHIPReauthorizationActof2015(MACRA)

§ SignedintolawonApril16,2015

§ RepealstheMedicaresustainablegrowthrate(SGR)formula

§ ChangesthewaythatMedicarerewardscliniciansforvalueovervolume

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 4Source:qpp.cms.gov

Page 5: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 5

MACRA

QualityPaymentProgram

Source:qpp.cms.gov

Page 6: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

MIPSTheMerit-BasedIncentivePaymentSystem

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 6

Page 7: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

TwoAlignedProgramsin2017

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 7

Medicare

BillMedicarePartBgreaterthan$30,000orseemorethan100Medicare

patients?

IfnotpartofanAdvancedAlternativePaymentModel,MIPSreporting

required.

Report3ofthe4MIPScategoriesin2017.

Medicaid

ParticipateintheMedicaidMUprograminthepast?

Stillabletoreachthe30%patientvolumethreshold?

AttesttoMedicaidMUin2017throughtheMAPIR

Medicare

BillMedicarePartBgreaterthan$30,000orseemorethan

100Medicarepatients?

Ifnotpartofanadvancedalternativepaymentmodel,MIPSreportingrequired

ReportthreeofthefourMIPScategoriesin2017

YES,REPORTTOBOTHPROGRAMSIN2017.

Page 8: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 8

MIPS

PQRS New Category

Medicare Meaningful

Use

Value Based

Modifier

Source:qpp.cms.gov

Page 9: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 9

MIPS:Whoqualifiesasaneligibleclinician?

WhoisconsideredaPhysician?

→ DoctorsofMedicineorOsteopathicMedicine(MDorDO)→ DoctorsofDentalMedicineorDentalSurgery(DDMorDDS)→ DoctorsofPodiatricMedicine(DPM)→ DoctorsofOptometry(OD)→ Chiropractors(DC)

Source:qpp.cms.gov

Page 10: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 10

Whowillnot participateinMIPS?

Duringone oftheyearlongdeterminationperiods:Sept.1,2015– Aug.31,2016Sept.1,2016– Aug.31,2017 Source:qpp.cms.gov

Page 11: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 11

MIPS:HowCliniciansareScored

2017

Source:qpp.cms.gov

Page 12: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 12

2017TransitionYear:PickYourPace

Source:qpp.cms.gov

Page 13: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 13

MIPSTestOption:MinimumRequirementtoAvoid4%Penalty

Source:qpp.cms.gov

Page 14: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 14

MIPSPartialParticipation

EligibleClinicianscanreportdifferent90dayperiodsforeachMIPScategory.CMSrecommendsquarterlyreportingbecausedataisreviewedquarterlybyCMS.

Source:qpp.cms.gov

Page 15: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 15

MIPSFullParticipation

Source:qpp.cms.gov

Page 16: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 16

MIPSParticipationNotes

Source:qpp.cms.gov

Page 17: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 17

Individualvs.GroupReporting

Source:qpp.cms.gov

Page 18: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 18

MIPSCategoryReportingMethods

Source:qpp.cms.gov

Page 19: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 19

MIPSQualityPerformanceCategory

Source:qpp.cms.gov

Page 20: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 20

MIPSQualityPerformanceCategory

Source:qpp.cms.gov

Page 21: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 21

MIPSQualityPerformanceCategory

Source:qpp.cms.gov

Page 22: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 22

MIPSQualityPerformanceCategory

Source:qpp.cms.gov

Page 23: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 23

MIPSQualityPerformanceCategory

Source:qpp.cms.gov

Page 24: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 24

MIPSCostPerformanceCategory

Ø Nodatasubmissionrequired;0%offinalscorein2017

Ø Calculatedfromadjudicatedclaims.Ø CMSwillstillprovidefeedbackonhowyouperformed

inthiscategoryin2017,butitwillnotaffectyour2019payments.

Ø UsesmeasurespreviouslyusedinthePhysicianValue-BasedModifierprogramorreportedintheQualityandResourceUseReport(QRUR)

CMSseekstoprovideclinicianswithinformationtoreducehealthcarespendingandpromotethedeliveryofhigh-valuecare.

Source:qpp.cms.gov

Page 25: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 25

MIPSImprovementActivities(IA)

Source:qpp.cms.gov

Page 26: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 26

MIPSImprovementActivities(IA)

Source:qpp.cms.gov

Page 27: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 27

MIPSImprovementActivities(IA)

Source:qpp.cms.gov

Page 28: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 28

MIPSImprovementActivities(IA)

Source:qpp.cms.gov

Page 29: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

Source:qpp.cms.gov5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 29

MIPSAdvancingCareInformation(ACI)PerformanceCategory

2014CEHRT2015CEHRT

Page 30: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 30

MIPSAdvancingCareInformation(ACI)PerformanceCategory

Source:qpp.cms.gov

Page 31: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 31

MIPSAdvancingCareInformation(ACI)PerformanceCategory

Source:qpp.cms.gov

Page 32: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 32

MIPSAdvancingCareInformation(ACI)PerformanceCategory

Source:qpp.cms.gov

Page 33: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 33

MIPSAdvancingCareInformation(ACI)PerformanceCategory

Source:qpp.cms.gov

Page 34: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 34

MIPSAdvancingCareInformation(ACI)PerformanceCategory

Source:qpp.cms.gov

Page 35: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 35

MIPSAdvancingCareInformation(ACI)PerformanceCategory

0or50points

0to90points

0to15points

TotalACIScore=0to100points(potentialfor155points,butcappedat100)

Source:qpp.cms.gov

Page 36: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

ACIvsMedicaidMU

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 36

ACI2017TransitionObjectivesandMeasures

1. ProtectPatientHealthInformation2. e-Prescribing3. HealthInformationExchange4. ProvidePatientAccess5. Patient-specificEducation6. View,Download,Transmit(Portal)7. SecureMessaging8. MedicationReconciliation9. ImmunizationRegistryReporting

Bonus:SyndromicSurveillance,SpecializedRegistryReporting,andReportingIAsviaEHR

MedicaidMU2017ObjectivesandMeasures

1. ProtectPatientHealthInformation2. ClinicalDecisionSupport3. CPOE(Medications,Labs,

Radiology)4. e-Prescribing5. HealthInformationExchange6. Patient-specificEducation7. MedicationReconciliation8. PatientPortalAccessandView,

Download,Transmit9. SecureMessaging

PublicHealthReporting(2Required)1. ImmunizationRegistryReporting2. SyndromicSurveillance3. SpecializedRegistry

Page 37: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 37

MIPSTechnicalAssistance

Source:qpp.cms.gov

Page 38: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 38

Questions?

Page 39: Medicaid MU and the Quality Payment Program: Connecting ... · Attest to Medicaid MU in 2017 through the MAPIR Medicare Bill Medicare Part B greater than $30,000 or see more than

5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 39

MACRA

QualityPaymentProgram

Source:qpp.cms.gov


Recommended
CENTERS FOR MEDICARE & MEDICAID SERVICES Medicare You/media/Files... · CENTERS FOR MEDICARE & MEDICAID SERVICES & Medicare. Y. ou. 2012. This is the official U.S. government . Medicare

CENTERS FOR MEDICARE & MEDICAID SERVICES Medicare You/media/Files... · CENTERS FOR MEDICARE & MEDICAID SERVICES & Medicare. Y. ou. 2012. This is the official U.S. government . Medicare

Documents

Medicare and Medicaid Audit Sampling Strategiesmedia.straffordpub.com/products/medicare-and-medicaid-audit-sam… · Medicare and Medicaid Audit Sampling Strategies Tuesday, August

Medicare and Medicaid Audit Sampling Strategiesmedia.straffordpub.com/products/medicare-and-medicaid-audit-sam… · Medicare and Medicaid Audit Sampling Strategies Tuesday, August

Documents

Medicare + Medicaid 2014

Medicare + Medicaid 2014

Documents

Medicare-Medicaid Network Analysis

Medicare-Medicaid Network Analysis

Documents

Medicare and Medicaid $

Medicare and Medicaid $

Documents

Medicare and Medicaid Audit Sampling Strategiesmedia.straffordpub.com/products/medicare-and-medicaid...Presenting a live 90‐minute webinar with interactive Q&A Medicare and Medicaid

Medicare and Medicaid Audit Sampling Strategiesmedia.straffordpub.com/products/medicare-and-medicaid...Presenting a live 90‐minute webinar with interactive Q&A Medicare and Medicaid

Documents

Medicare and Medicaid

Medicare and Medicaid

Education

MAGI Medicaid-to- Medicare TransitionsMAGI Medicaid-to-Medicare transitions Transitions from MAGI Medicaid to Medicare will often look different from transitions for those with traditional

MAGI Medicaid-to- Medicare TransitionsMAGI Medicaid-to-Medicare transitions Transitions from MAGI Medicaid to Medicare will often look different from transitions for those with traditional

Documents

Integrating Care for Medicare- Medicaid Enrollees Medicare-Medicaid Coordination Office Centers for Medicare & Medicaid Services November 2011.

Integrating Care for Medicare- Medicaid Enrollees Medicare-Medicaid Coordination Office Centers for Medicare & Medicaid Services November 2011.

Documents

CENTERS FOR MEDICARE & MEDICAID SERVICES Youcdnmedia.endeavorsuite.com/images//organizations/... · 2013-11-18 · CENTERS FOR MEDICARE & MEDICAID SERVICES &Medicare Yo. u. 2013.

CENTERS FOR MEDICARE & MEDICAID SERVICES Youcdnmedia.endeavorsuite.com/images//organizations/... · 2013-11-18 · CENTERS FOR MEDICARE & MEDICAID SERVICES &Medicare Yo. u. 2013.

Documents

Centers for Medicare & Medicaid Services Center for Medicare

Centers for Medicare & Medicaid Services Center for Medicare

Documents

Navigating Medicare...Medicare & Medicaid (Dual) • Called “Dual-eligible” or “Duals” • Medicare costs are covered • Medicare pays first, Medicaid second, IHS last *unless

Navigating Medicare...Medicare & Medicaid (Dual) • Called “Dual-eligible” or “Duals” • Medicare costs are covered • Medicare pays first, Medicaid second, IHS last *unless

Documents

Centers for Medicare & Medicaid Services - Medicaid Education ...

Centers for Medicare & Medicaid Services - Medicaid Education ...

Documents

Improving Care for Medicare-Medicaid Enrollees Medicare-Medicaid Coordination Office Centers for Medicare & Medicaid Services August 19, 2015.

Improving Care for Medicare-Medicaid Enrollees Medicare-Medicaid Coordination Office Centers for Medicare & Medicaid Services August 19, 2015.

Documents

Medicare-Medicaid Plan (MMP) Marketing Training · Medicare-Medicaid Plan (MMP) Marketing Training Medicare-Medicaid Coordination Office. Centers for Medicare & Medicaid Services.

Medicare-Medicaid Plan (MMP) Marketing Training · Medicare-Medicaid Plan (MMP) Marketing Training Medicare-Medicaid Coordination Office. Centers for Medicare & Medicaid Services.

Documents

Medicare and Medicaid Repayments and Disclosuresmedia.straffordpub.com/products/medicare-and-medicaid-repayments... · Medicare and Medicaid Repayments and Disclosures ... Robert

Medicare and Medicaid Repayments and Disclosuresmedia.straffordpub.com/products/medicare-and-medicaid-repayments... · Medicare and Medicaid Repayments and Disclosures ... Robert

Documents

Medicare & Medicaid

Medicare & Medicaid

Documents

Medicare and Medicaid Enrollment and Revalidation Screening Requirementsmedia.straffordpub.com/products/medicare-and-medicaid-enrollment... · Medicare and Medicaid Enrollment and

Medicare and Medicaid Enrollment and Revalidation Screening Requirementsmedia.straffordpub.com/products/medicare-and-medicaid-enrollment... · Medicare and Medicaid Enrollment and

Documents