The Healthcare Business Management Association (HBMA) Government Relations Committee was fortunate to have the opportunity to meet with Centers for Medicare & Medicaid Services’ (CMS) directors and Senate Ways and Means Committee staff the day the proposed rule was published.
As I think we all have recognized, the most significant changes are intended to help small providers and practices. The proposed threshold increases in patient volume or dollars have, in effect, exempted many providers from participating in the Merit-based Incentive Payment System (MIPS). The ability to form virtual groups is also intended to allow maximum flexibility. Those are positive steps in recognition of the challenges MIPS presents.
In addition, many new options are proposed. For example, the ability to report 2018 quality measures via multiple methods as opposed to only claims, registry, etc. More measures have been added to increase successful reporting choices and opportunities for participating providers.
The Flip Side of the Coin
While these increased options and choices may sound good at first blush, the fact is that complexity and, therefore, cost for providers also increases. The thoughts and work behind the changes are well-intentioned. However, as author Dean Koontz said, “One man’s idea of perfect order is another man’s chaos.”
Some of the most basic informed decisions that providers must make are whether they want to work toward a bonus, remain revenue neutral, or accept a penalty. Accurately performing those projections based on specialty and practice-specific variables requires increasingly sophisticated software support and data analytics.
The unfortunate fact is that providers can make the best efforts to do everything right and still not be guaranteed of a bonus or even the amount of the bonus. Because the program must be revenue neutral, for every winner there must be a loser. One observation is the fact that “most providers will be forced to the middle”—and, in my opinion, that is the crux of the problem with MIPS.
How much money and work will providers invest when there is no return on that investment? We already know a very large percentage of eligible clinicians never participated in the Physician Quality Reporting System (PQRS). Are we really going to accept that none of those physicians or practices are providing quality care? Are we really going to accept that every physician or practice that does participate is providing the best quality care? I hope not, for that is a false belief that reporting data is the same as providing quality care.
While CMS’s intent to ensure all beneficiaries receive high quality care at a reasonable cost is a noble one, the methodology to achieve it is flawed. Adding myriad options that simply increase cost and complexity for physicians and their representatives, with no return on those investments, continues to whittle away at the precious time physicians have for their real job, which is patient care. That’s where quality happens, not in data-reporting.
Let’s help physicians get back to what they do best by removing the overwhelming administrative burdens. Then we will see real and meaningful quality.
Literature is ripe with classic phrases that seem timelessly apropos. For example, take the partial federal government shutdown. For days, the phrase repeated in the
Worth a second read considering the fatal shooting of the CEO for United Healthcare. The Centers for Medicare & Medicaid Services (CMS) has outlined critical
Please log in to your account to comment on this article.
Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.
Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.
Enhancing outpatient clinical documentation is crucial for maintaining accuracy, compliance, and proper reimbursement in today’s complex healthcare environment. This webcast, presented by industry expert Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, will provide you with actionable strategies to tackle complex challenges in outpatient documentation. You’ll learn how to craft detailed clinical narratives, utilize advanced EHR features, and implement accurate risk adjustment and HCC coding. The session also covers essential regulatory updates to keep your documentation practices compliant. Join us to gain the tools you need to improve documentation quality, support better patient care, and ensure financial integrity.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks. Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.
Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.
During this RACmonitor webcast Dr. Ronald Hirsch spotlights the areas of the OIG’s Work Plan and the findings of their most recent audits that impact utilization review, case management, and audit staff. He also provides his common-sense interpretation of the prevailing regulations related to those target issues. You’ll walk away better equipped with strategies to put in place immediately to reduce your risk of paybacks, increased scrutiny, and criminal penalties.
Copyright © 2024 ICD10monitor. Powered by MedLearn Media.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
