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.

Below are the identified areas:

Medicare Initiatives

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.

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 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)

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.

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

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.

You are exempt from MIPS 2021 if:

1. You have been a Medicare provider for <1year (but only exempt for that one year)    OR
2. You have <200 unique Medicare Part B patients OR <$90,000 in ALLOWABLE Part B Medicare charges in one year OR < 200 covered professional services for Part B patients   OR
3. You are participating in an ADVANCED APM (such as CPC+ or MSSP). This must be a program designated by Medicare as an Advanced APM and involve 20% of your Medicare patients or 25% of your Medicare payment dollars
4. You are a non-patient-facing provider (i.e. pathologist, radiologist) with <100 patient-facing episodes in a designated period (or your group has >75% non pt facing providers).

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-measures
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    If you have achieved official PCMH recognition, you are exempt from this portion of MIPS.
4. Cost, gathered from your Medicare claims and formerly a part of the Value Modifier, is not reported separately by you and will count 15% in 2020.
            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.

2. Use your EHR. Get one up and running or to become more proficient in using your EHR. Claims reporting will phase out over time though it is still available for small practices (<15 providers)
3. Make sure your EHR software is current. The PI requirements specify that it must be at least a version 2015. Contact your vendor to update your software, if necessary.

4. Get help.  Small groups (<15 providers) are eligible for free assistance from a CMS approved vendor. 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. Take a look at the Improvement Activities. If you are already designated as a PCMH practice, you get full credit. If you consult your state database for controlled substance monitoring, you can report that activity.

6. You may file for an exception due to the COVID 19 pandemic emergency allowing you to completely opt our of MIPS reporting for the 2021 performance year.  The deadline for filing is December 31, 2021. Use your login access to the QPP to request this exception. 

 

 

MetroCare Trilogy CIN Network Initiatives

Trilogy Network initiatives are all found in Citrix Sharefile

 

Population Health and Preventive Visits for Commercial Plans

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

 ED Unnecessary Visit Campaign

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