Understanding the QCDR, 2017 MIPS Performance Feedback Now Available, Payer's Evolving Approach to Reimbursement


Understanding the QCDR

Qualified Clinical Data Registries (QCDR) were established so that providers could create and choose quality measures that would be more aligned to their specialty. To be used for Merit-based Incentive Payment System (MIPS) reporting under the Quality Payment Program, the Centers for Medicare & Medicaid Services (CMS) must approve each QCDR quality measure not currently listed under the MIPS program.
 
The QCDR will collect data from an individual MIPS-eligible clinician, group and/or virtual group and submit the data to CMS on their behalf. QCDRs are typically owned by specialty societies or regional collaboratives.  No individual specialty group, like a large practice, can "own" or create a QCDR.

To read more, see here.
 
 


2017 MIPS Performance Feedback Now Available - and Should be Reviewed

CMS has announced that eligible clinicians who participated in MIPS in 2017 can now review their final performance feedback, which includes the final score and payment adjustment information for the 2019 reimbursement year. Sign into the Quality Payment Program website at https://qpp.cms.gov/ to see if your practice will receive a positive, negative or neutral payment adjustment to the Medicare paid amount under professional services. You may ask for a targeted review if you believe an error has been made.

To find out how, see here. 

 


How is Your Practice Tackling Payer's Evolving Approach to Reimbursement?

Practices often create spreadsheets to help compare payer reimbursements, the number of patients they treat with specific carriers, etc. in order to make their practices run more efficiently. There are a number of metrics practices should consider when creating their payer spreadsheets, including:

  • Percentage of gross charges
  • Percentage of net revenue
  • Percentage of patient volume (or how many unique patients per payer)
  • Are the payer's communications with the practice accurate and timely? How is their customer service? How often do they fail to answer phones or you reach busy signals?
  • Net collection rate
  • Percentage of payments of A/R greater than 90 days
  • Number of days in A/R
  • Average number of days to initial payment
  • Payments vs. contract rate variance
  • Top three reasons for denial
  • Percentage of denials on claims
  • Is there online claim status verification? Insurance verification? Eligibility?

To read more, see here.

 

Back to News