available…what should i do - telligen qpp surs...finally you will receive an email with the...
TRANSCRIPT
© 2016, Telligen, Inc.
Michelle Brunsen and Kelly Smith
July 25, 2019
2018 MIPS Performance Feedback Reports Are Avai lable…What Should I Do Now?
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2020 QPP Proposed Rule Released
▪ CMS is seeking comment, including feedback on the proposed new MVPs
▪ Comments are due 9/27/19
▪ Submit comments electronically through Regulations.gov, regular mail, express or overnight mail or by hand or courier
▪ 2020 Proposed Rule
▪ Press release
▪ Fact sheet
▪ MIPS Value Pathways Diagram
BREAKING NEWS!
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Telligen QPP SURS
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▪ Performance Year 2018 Final Feedback– How to view final performance feedback
– What information is provided
▪ Targeted Review– What is it
– Why request a Targeted Review
– How to request a Targeted Review
▪ Frequently Asked Questions
Today’s Agenda
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Have you already viewed your 2018 Final Performance Feedback Report?
A. Yes-Understand it fairly well
B. Yes-Need help understanding the reports
C. No
Polling Question
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Key Year 2 Dates
▪ Gathered Data Throughout the 2018 Year
▪ Data Submission Deadline: April 2, 2019
▪ Final Performance Feedback and Scores Released: July 3, 2019
▪ Targeted Review Deadline: September 30, 2019
▪ Payment Adjustments Begin: January 1, 2020
MIPS Year 2 (2018)
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MIPS Year 2 Scoring
2018 MIPS Scoring Guide
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MIPS Year 2 Scoring
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2018 Participation Results
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Payment adjustment applied to:
▪ The TIN/NPI level
▪ Medicare Part B “covered professional services” for items/services furnished by the MIPS eligible clinician
▪ Includes CAH Method I and Method II
– Payments made for covered professional services under the Physician Fee Schedule (PFS) that are Medicare Part B allowed charges billed by the MIPS eligible clinicians
.
Understanding the Payment Adjustment
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Payment adjustment is NOT applied to:
▪ The payment adjustments will not apply to payments for Medicare Part B drugs and other services for which payment is not made under or based on the Physician Fee Schedule.
▪ CAH facility payments
▪ Services rendered under RHC all-inclusive rate (AIR) payment methodology
▪ Services rendered under FQHC payment methodology
Understanding the Payment Adjustment
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▪ No change in TIN during performance or payment year– Payment adjustment remains under that TIN
▪ Change in TIN on or after 9/1/2018 – TIN submitted at individual level -> new clinician will receive neutral
payment adjustment
– TIN submitted at group level -> new clinician will receive group payment adjustment
▪ Change in TIN after the performance year– New clinician will be assessed the most advantageous payment
adjustment that is attributed to their NPI
Payment Adjustment Rules
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MIPS Promoting Interoperability
How to Access Final Performance Feedback
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Accessing the QPP Portal
▪ Sign into the QPP website using your HARP credentials: https://qpp.cms.gov/login
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How to Register for QPP
HARP System
For a step by step guide on how to set up a HARP account, please refer to theQPP Access User Guideor Telligen’s Webinar
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Viewing Feedback
▪ Who can view feedback– Individual clinicians with the connected clinician role can see all data
submitted for the clinician across multiple locations, including APM entity score
– Practice representatives can see their practice’s group or individual scores
– Third party entities can view any data they submitted or all data for a practice which has granted them access
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▪ These tabs appear for clinicians who submitted individual data in addition to (or as part of) the data used to determine their final score
▪ The Final Score tab provides feedback on the data that will be used to determine your payment adjustment
▪ The Submission Score tab provides feedback on individual data you submitted that was not used to determine your payment adjustment
Final Score vs. Submission Score
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Final 2018 Performance Feedback Available
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Practice and Connected Clinicians Listed
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View Individual Feedback
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View Total Performance Score and Adjustment
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Performance Category Scores
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Performance Category Scores
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Additional Bonus Points
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Items & Services
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▪ What is the purpose of the Items and Services section of MIPS performance feedback?– Information about your patients’ health care utilization
– Information about your patients’ emergency department use
– Provide clinicians with additional information on the types of Medicare covered items and services used by their patients
– Please note that the Items and Services data is for informational purposes only and will not affect your MIPS performance scores
▪ More information can be found in the Performance Feedback Factsheet on pages 27-32
Items and Services
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Quality Performance Category
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Quality Measures Scored
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Quality Measures – Bonus Points Only
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Quality Measures Not Counted
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Total Quality Score Calculation
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Quality Measure Scoring Breakdown
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Promoting Interoperability Category
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Promoting Interoperability Measures
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Promoting Interoperability Measures
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Promoting Interoperability Optional Measures
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Promoting Interoperability Optional Measures
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Promoting Interoperability Bonus - CEHRT
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Promoting Interoperability Score Calculation
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Improvement Activities Performance Category
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Improvement Activities
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Improvement Activities
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Improvement Activities Score
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Medicare Spending Per Beneficiary (MSPB)
Cost
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Total Per Capita Costs (TPCC)
Cost
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Items and Services
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Items and Services
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Items and Services
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Quality Payment Program
Targeted Reviews
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▪ What is a Targeted Review?– A targeted review is a process in which you can request for CMS to
review the calculation of your 2020 MIPS payment adjustment
▪ Who can request a Targeted Review?– A MIPS eligible clinician, group, virtual group or APM or someone on
their behalf
▪ When should I submit a Targeted Review?– If you identify an error with your 2018 MIPS final performance
feedback and 2020 MIPS payment adjustment factor, submit prior to 9/30/19 at 8:00 p.m. EST
Targeted Review Basics
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▪ Targeted Reviews must be submitted by 8:00 p.m. EST on September 30th
▪ Targeted Review decisions are final—there are no appeals
▪ Certain issues are out of scope for a Targeted Review– The establishment of the performance standards and the performance period.
– The methodology used to determine the amount of the MIPS payment adjustment factor, the amount of the additional MIPS payment adjustment factor, and the determination of such amounts.
– The methodology developed that is used to calculate performance scores and the calculation of such scores, including the weighting of measures and activities under such methodology.
– The identification of measures and activities specified for a MIPS performance category and information made public or posted on the Physician Compare internet website of CMS.
Key Information
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▪ To request a Targeted Review you will follow the link found on the bottom of the Performance Feedback page in the QPP Portal
Requesting a Targeted Review
• If you submitted as a group, you only need to submit one request
• If you submitted as individuals, you must submit a request for each score you would like reviewed
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Steps to Complete a Targeted Review
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Filing Out the Form
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Filing Out the Form
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Filing Out the Form
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Filing Out the Form
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Filing Out the Form
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Filing Out the Form
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▪ The person who submits the Targeted Review will receive a confirmation email that the request has been received
▪ You may also receive an email requesting additional documentation. You will have 30 days to provide the requested documentation.
▪ Finally you will receive an email with the outcome of the Targeted Review. Reviews are handled on a case-by-case basis so the length of time to process will vary. Remember all Targeted Review decisions are final and cannot be appealed.
▪ Contact the QPP Help Desk with any questions you have about Targeted Reviews at 1-866-288-8292
After Submission
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If I paid a third party to submit MIPS data on my behalf, but for some reason CMS did not receive my data, can I request a targeted review?
No. A third party's failure to submit data is outside of the scope of the targeted review process.
FAQs
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What kind of information should I enter in the “Additional Information” section on the Targeted Review Request Form?
Provide as much information as you can to support your request. • Conversation with the Quality Payment Program Help Desk that is related
to your request, noting what was discussed during that conversation.
• QPP Help Desk case numbers (CS0000000) in the Associated Help Desk Tickets box that support your request.
• Any other information you think may support your request.
FAQs
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What are examples of supporting documentation for a Targeted Review?
This documentation may include (but is not limited to):• Supporting extracts from a MIPS EC’s electronic health records
• Copies of performance data provided to a third-party intermediary by the clinician or group
• Copies of performance data submitted to CMS
• QPP Help Desk case numbers (CS0000000)
• Signed contracts/agreements between a clinician/group and a third-party intermediary
• Proof of APM participation
*** Documentation must be received within 30 calendar days of initial request.
FAQs
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Questions?
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Will you do something different as a result of this webinar?
a) Yes
b) No
Polling Question #1
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Did you take away something you can use?
a) Yes
b) No
Polling Question #2
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Do you know more now about the topic than before you participated in this webinar?
a) Yes
b) No
Polling Question #3
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Contact Information
Michelle Brunsen515.453.8180
Kelly Smith515.223.2164
This material was prepared by Telligen, the Quality Payment Program Small, Underserved and Rural Support contractor for Iowa, Nebraska, North Dakota and South Dakota, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. HHSM-500-2017-00012C
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Quality Payment Program
Resources
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Final Performance Feedback FAQs
2018 QPP Participation Infographic
QPP Access User Guide
MIPS Scoring for Year 2 (2018) At-A-Glance
Targeted Review Factsheet
Targeted Review FAQs
Targeted Review User Guide
QPP Resource Center:
866-288-8292
CMS Resources for Final Feedback
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▪ 2018 Participation Results Infographic
▪ 2019 Qualified Clinical Data Registries
▪ 2019 Qualified Registries
▪ 2018 MIPS Scoring Guide
▪ 2019 QP Methodology Factsheet
▪ 2019 MIPS Cost User Guide
▪ 2019 MIPS Quality User Guide
▪ 2019 MIPS Eligibility Decision Tree
▪ 2019 MIPS Data Validation Criteria
New 2019 QPP Resources on QPP.CMS.GOV