CMS Quality Measures
All healthcare professionals need to be aware of all the changes that may affect the healthcare industry and the physician’s responsibilities to respond to the information given by the government. Additionally, it’s important to stay updated on information from the Centres for Medicare and Medicaid Services (CMS), such as CMS quality measures.
CMS revealed the latest updates in November to the Medicare Physician Fee Schedule (PFS) final rule. It’s interesting for healthcare professionals because of the changes they make to the Quality Payment Program for 2023 and the upcoming years.
You will get some information about CMS Quality Measures in this article. You and your team must keep them in mind so, that you will be better poised to stay in compliance and then provide accountability regarding the data reporting that the government needs to help ensure a better healthcare system.
2023 CMS Changes
According to the CMS instructions you need to anticipate a minimum threshold of 75 Merit-Based Incentive Payment System (MIPS) points for the 2023 performance year. In MIPS 2023, your healthcare organization will have to meet at least 75 points; otherwise, you will get a negative payment adjustment for the payment year 2025.
Also, keep in mind that 2022 was the last year where clinicians were able to earn an exceptional performance bonus, so the new rule for 2023 will impact your bottom-line.
MIPS 2023 Performance Category weights are:
- Cost 30%
- Quality 30%
- Promoting Interoperability: 25%
- Improvement Activities 15%
There is a different weight category for the small practices. You only deal with Quality at 40%, Cost at 30%, and Improvement Activities at 30%. There is no weight category for small practices in terms of Promoting Interoperability at this time.
Government has a keen interest in the collection of quality data for the maintenance of the safety and integrity of the healthcare system. According to it, you need to measure data for January 1 to December 31, 2023, for your reporting. As you get ready to submit your reports, keep in mind that the U.S. government’s Quality Payment Program has five collection types created for MIPS 2023 quality measures:
- MIPS Clinical Quality Measures (CQMs)
- Medicare Part B Claim Measures
- Electronic Clinical Quality Measures (eCQMs)
- Qualified Clinical Data Registry (QCDR) Measures
- The Consumer Assessment of Healthcare Providers and Systems (CAHPS) for the MIPS Survey
What Key Points to Know About MIPS 2023 Quality Measures?
CMS has made the major three main theme changes
- The MIPS model appears to be under threat. The planned retirement of traditional MIPS in 2027 has not yet been officially announced by CMS. If this happens, if you are not going to use the subgroup reporting framework, you will need to interact with an APM entity like an ACO and submit your reports through the APP or APM Performance Pathway framework.
- You can look forward to subgroup reporting by specialty type soon. This will be accomplished via the MIPS Value Paths, or MVPs, a new reporting system. This will require action from specialists like those engaged in rheumatology. Subgroup reporting is currently optional, but once the new framework is implemented after 2026, it will be required, giving you time to assess this type of information report.
- MSSP ACOs will have to start submitting reports utilizing eCQMs or CQMs. The transfer from the CMS web reporting interface is not subject to an extension. You will therefore need to transition to CQMs or the electronic eCQMS by 2025.
What Is the Advice About This Year’s CMS Changes?
Depending on the knowledge and experience of your staff in dealing with the CMS details, then you might prefer to work with the consultant, to help yourself and your staff to speed up on all the things having to do with the Quality Measures in healthcare billing services.
Moreover, you also have access to your computer and software systems to make sure that they are up-to-date. As you will need to have efficient and immediate access to record the patient information to prepare your Quality reports.
It is best to have the most recent versions of all apps, including revenue cycle management and practice management software. You may have the peace of mind that comes from knowing that these systems have been updated and patched for security flaws by making sure you always update the software.
Any new features will also be available to you as soon as they are released. As you comply with the CMS quality measure reports, this will enable your team to more easily handle the complicated information about your practice and patient data.
Stay on Top of The Healthcare Billing Service Developments
With the new CMS updates, there are several things to be aware of. For example, quality, affordability, and fostering interoperability all have new performance category weights.
Also, you must ensure that your team is providing the Centers for Medicare & Medicaid Services with accurate information regarding quality measurements. Preferably, you will also make sure that you are using the most recent versions of essential software and that your network and computer systems are capable of handling all of the qualified data you are gathering.
You’ll be able to manage your practice more effectively this year if you keep up with CMS quality measures. Of course, it can be difficult to find enough time in your hectic schedule to keep up with news and advancements affecting your area when you are focused on the urgent duties at hand for managing a successful healthcare business.