Medicare MIPS Reporting Essentials for Physical Therapists

Physical therapists (PTs) are now a breathing part of the Quality Payment Program (QPP). It is a choice they have to make because they can’t back out. Medicare MIPS reporting through a MIPS Qualified Registry or an EHR system can get them through the maze of value-based care smoothly.

Primarily, they have an option to choose between the Merit-Based Incentive Payment System and an Advanced APM. Though AAPMs have a strong influence over clinicians, the popularity of MIPS as an incentive program considerably outweighs it. Therefore, MIPS is the go-to program for most eligible PTs.

Now, PTs who do not meet the low-volume threshold (LVT) can participate voluntarily.

Why?

They must be prepared for what lies ahead and no better way to do it than participating in it.

Medicare MIPS Reporting for Quality and IAs

The good news for PTs is that they are NOT required to report in all the four performance categories. Instead, they are required to report in only two – Quality and Improvement Activities.

Fewer categories mean they have a decreased number of measures to report to CMS. With all the focus on MIPS Quality measures and IA measures, they are more than capable to score high and handsome. It also keeps them very much in the game without the possibility of burnout.

A yearlong report against Quality determines the final score, failing to do so; there are consequences in the form of negative payment adjustments.

Medicare MIPS reporting best happens through certified electronic health record technology (CEHRT) or MIPS Qualified registries such as P3 Healthcare Solutions.

Advanced APM Participation Track

Physical therapists who follow Advanced APM as their participation track cannot go after Medicare MIPS reporting. At one time they can only utilize one track.

They can expect an additional reward of +5% to your Medicare earnings of 2019 if the reporting results are at par with the benchmarks set against measures. Additionally, the high scorers have a chance to collect bonus rewards from the $500 million pool.

While PTs become an active part of the value-based payment system, the removal of functional limitation reporting (FLR) is a healthy change adopted by CMS.

P3Care Reports for PTs and PTAs

The submission of MIPS data is unlike any other data submission. It requires your NPI/TIN and account creation on the QPP portal. Health IT consultants at P3Care activate your accounts with ease and with mutual collaboration, we get to report to CMS on behalf of our clients. In short, accuracy is the key to it. They happen only once so make sure they are errorless.

What about Telehealth?

The final rule doesn’t allow PTs to be reimbursed against Telehealth. The virtual check-ins by physicians and specialty-specific clinicians call for timely reimbursements; moreover, P3Care backs the initiative of Telehealth for PTs and PTAs. Who knew the year 2020 would make Telehealth a necessity rather than an alternative.

Direct Submission Method

PTs can use the registry method for direct submission. For it to happen smoothly, MIPS Clinical Quality measures (CQMs) has to be the collection type. Medicare MIPS reporting 2019 returns optimum results if you are both accurate and smart in terms of selecting high scoring measures.

Generally, outcome measures and high-priority measures hold significance in achieving bonus-worthy scores. They, eventually, turn into financial rewards.

For small practices, individual clinicians and clinician groups can collect and submit measures for Quality through Medicare Part B claims.

Groups with 25 or more clinicians may use the CMS web interface for Medicare MIPS reporting.

Deadline for the QPP 2019 Program

MIPS eligible clinicians have time until March 31, 2020, to submit data for 2019. In addition, if your mode of submission is through claims, you have until 60 days after the closing of the performance year.

Improvement Activities (IA)

For PTs and OTs, the category holds 15% weight in the total score. It estimates 40 points and only the top-performing clinicians will be able to reach that number. The improvement activities you should consider reporting to CMS are –

Care Coordination
Patient safety
Beneficiary engagement
Participation in APM
Achieving health equity
Emergency preparedness and response
Population management

However, take note of the number and format to report in the following classifications.

Two high-weighted measures
One high-weighted measure and one medium-weighted measure
Four or more medium-weighted measures

After the selection of activities to submit, you are ready for Medicare MIPS reporting through QCDR, Qualified Registry, or an EHR system. For those interested in the MIPS attestation process on their own, they can submit activities by logging on to the QPP portal.

Do you think you can gather data and report on your own or is it better to hire third-party intermediaries?

Reply in the comments below, as we’d love to hear your thoughts.