Accessibility Tools

Resources

Providers are increasingly responsible for quality, cost and outcomes in their populations of patients.

MetroCare is committed to providing the tools and resources to help member physicians succeed in the value-based environment.

The following information is provided for educational purposes only and should not be regarded as clinical or legal advice. Metrocare, Inc. does not ensure the accuracy of this information and does not guarantee that following this information will result in receiving any government payment. It is the attesting healthcare providers responsibility to comply with all program requirements.

Below are the identified areas:

Practice Management Support

SVMIC Training Modules

SVMIC Training Modules

CLICK HERE FOR INFO/ACCESS TO SVMIC PRACTICE MANAGEMENT 101. Online, on demand training modules.

 

Medicare Initiatives

Telehealth Services

Telehealth Services

Telehealth services have been expanded during the COVID PHE (public health emergency). Because of relaxed billing and coding rules during the PHE, the Office of the Inspector General will soon be auditing telehealth claims for proper coding/billing/payment. CMS has provided some helpful resources to assist practices with billing compliance. CLICK HERE FOR CMS WEBPAGE WITH LATEST GUIDES ON TELEHEALTH.

The Center for Connected Health Policy has a series of videos titled " Telehealth 101" that can be very helpful CLICK HERE TO ACCESS

MLN booklet thumbnail                                       MLN video thumbnail

Medicare Learning Network document                                                       MLN Video

Transitional Care Management (TCM)

Transitional Care Management (TCM)

 

Transitional Care Management is the coordination and continuity of care for a patient being discharged from a specific facility type back into their community. To prevent a gap in their care, the provider accepts responsibility for care of the patient with moderate or high complexity medical problems immediately upon discharge. 

The following documents, a detailed MLN summary(front and back) from CMS, and practice templates for workflow, are presented for your reference:

    Pages from TCM 002                                 TCM thumbnail horizontal

   Update 2021 (click image above).                                                  TCM Workflow and Template (click image).

 

Wellness Visits (IPPE/AWV)

Wellness Visits (IPPE/AWV)

Medicare wellness visits are yearly appointments to assess and update the condition of your Medicare patients for the purpose of creating and implementing a preventive health plan tailored to each specific patient with patient counseling and education to support that plan.

These encounters are not routine visits for physical examination and treatment of conditions. They can, however, be performed in conjunction with a routine visit to avoid scheduling a separate appointment to address conditions requiring attention. Access CMS Module here

IPPE (G0402) 

Initial Preventive Physical Examination (Welcome to Medicare visit)
Focus on health promotion and disease prevention and detection

ACCESS IPPE TOOLKIT (click)


Initial AWV (G0438) and Subsequent AWV (G0439) 

Initial Annual Wellness Visit (first AWV- one-time only):
Creation of a preventive health plan for the coming 5-10 years using risk assessment, screens, etc.

Subsequent AWV:
Yearly update to initial assessments, conditions, and screening schedule with education, counseling, and referrals

ACCESS AWV TOOLKIT (click)

  

 

MACRA / MIPS

MACRA / MIPS

The following information is provided for educational purposes only and should not be regarded as clinical or legal advice. Metrocare, Inc. does not ensure the accuracy of this information and does not guarantee that following this information will result in receiving any government payment. It is the attesting healthcare providers responsibility to comply with all program requirements.

MACRA / MIPS OVERVIEW

This value-based payment format for Medicare was enacted as part of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. It allowed for the Medicare SGR (sustainable growth rate) to be abolished.

Measurement began in 2017 with Reporting in 2018 and (fee schedule) Adjustment in 2019.

MIPS, the Medicare Incentive Payment System, combines three previously existing Medicare quality programs: PQRS, Meaningful Use, and Value Modifier.

Though there are some exempt providers, the majority of Medicare Part B providers will be subject to MIPS reporting.

Check your MIPS reporting eligibility by entering your NPI: https://qpp.cms.gov/participation-lookup

MIPS - Medicare Incentive Payment System

https://qpp.cms.gov/mips/overview

MIPS is a four-part program that involves practice reporting in three areas:

1. Quality Measures- formerly PQRS https://qpp.cms.gov/mips/quality-requirements
2. Promoting Interoperability- formerly Meaningful Use https://qpp.cms.gov/mips/promoting-interoperability
3. Practice Improvement Activities-value based activities often associated with Patient Centered Medical Home designation.                https://qpp.cms.gov/mips/improvement-activities   
4. Cost, gathered from your Medicare claims and formerly a part of the Value Modifier, is not reported separately by you and now counts more than ever.
            https://qpp.cms.gov/mips/cost

The cost portion of MIPS will be impacted by the level of risk coding submitted by your practice on your Medicare claims. We  offer frequent risk coding learning opportunities for physicians and staff. 

Your Plan

1. Continue to update your strategic plan each year, as MIPS reporting requirements increase along with possible negative payment adjustment increases.

2. Use your EHR better. Use an EHR. Become more proficient in using your EHR. Claims reporting is not sufficient for MIPS reporting any more.

3. Make sure your EHR software is current. The PI requirements specify a current version. Contact your vendor to update your software, if necessary.

4. Get help. Good performance in MIPS to avoid a negative fee schedule adjustment requires higher scoring and has been increasing in difficulty each year. Specialty providers should consult their professional associations which often have excellent advice and registries to assist their specific practice types. Your software vendor may assist with direct reporting from your EHR.

5. Participate in a Medicare Shared Savings Program or other APM option. CMS is encouraging this option for everyone. 

 

 

MetroCare Trilogy CIN Network Initiatives

Trilogy Network initiatives are all found in Citrix Sharefile

Trilogy Network initiatives are all found in Citrix Sharefile

 

Population Health and Preventive Visits for Commercial Plans

Population Health

Population Health

Preventive Campaigns

In October 2016, MetroCare instituted a targeted plan toward establishing population health efforts in our practices by bringing data and source materials for breast cancer, cervical cancer, colorectal cancer and STD screenings.

MetroCare quality reporting coordinators meet with our practices and upload trend reports via Citrix Sharefile that further define opportunities to improve care along with controlling cost.

We are working with our practices to more firmly establish these steps to further develop their practice plan toward value-based care.

UHC Preventive Services

Cigna Preventive Services

Decreasing Inappropriate ED Visits

A customizable postcard template has been developed with the goal of helping your patients decrease inappropriate ED visits by helping them consider a more appropriate action to take when they are sick, whether a telehealth visit, an office phone call, an urgent care visit or when it may be necessary to go to the ED.

We are sharing this template with you to allow your practice to customize and order, at your expense, from your chosen printing supplier* according to your needs.

Steps to consider when customizing:

  • Verify/change info to fit the needs of your patients
  • Add Logo/practice info (address, website, etc.)
  • List Urgent Care Center info specific to your patient population and location
  • Change colors

If you are interested in assistance with customizing our template to order postcards, please email Wendy Hughes, LPN, Quality Reporting Coordinator at This email address is being protected from spambots. You need JavaScript enabled to view it..

 

ED Mailer TEMPLATE for Practice 11.9.2021postcard back

 

  

Chronic Care Management

To assist with developing PCP-Specialist referral relationships, MetroCare is beginning to partner with some of our specialty practices and our PCPs to establish algorithms for addressing specific chronic disease processes.

 

Publications