As a follow up to our first article on the Medicare Access and CHIP Reauthorization Act (MACRA), the Centers for Medicare and Medicaid Services (CMS) created this program to help reform Medicare payments. A goal of the MACRA Quality Payment Program (QPP) is to pay for value and better care, linking quality to payments. The two paths to payment are the Merit-Based Incentive Payment System (MIPS) and the Advanced Payment Models (APMs).

 

In breaking down the first link to payment, MIPS is a new program that consolidates the Medicare quality programs into one program incorporating elements from Meaningful Use (MU), Physician Quality Reporting System (PQRS) and Value-based Payment Modifier (VBPM).

 

MIPS will base payments on four categories:

EPs will be evaluated on these measures incorporated into the weighted score payment based on a 100-point scale. MIPS is aimed at improving physician accountability and reducing the amount of reporting among these four categories. CMS will begin measuring clinician performance in January 2017 with payments effective in 2019 based on MIPS measurements.

As a reminder, clinicians who will not be subjected to MIPS guidelines are 1st year Medicare part B participants, along with selected participants that are in Advanced Alternative Payment Models and also those that are below the low patient Medicare volume threshold.

**Be sure to check out the next newsletter article defining and exploring the Alternative Payment Models. For more information on MACRA visit the CMS website .

The Physician Alliance reached out to Blue Cross Blue Shield of Michigan for clarification and updated information regarding coding for physical activity for pediatric patients. A sports physical can be used/billed to satisfy the physical activity component of a well child visit. However, the sports physical documentation must include all necessary elements to be considered a well child visit.

An updated document for provider tips for pediatric HEDIS measures has been posted to TPA's website. The pediatric weight assessment and counseling tip sheet has also been updated.  

Four out of 10 teens think that prescription medications are much safer to abuse than illicit drugs, even if they're not prescribed by a doctor. At least half of all U.S. opioid overdose deaths involve a prescription opioid. Every 19 minutes someone dies from an unintentional drug overdose.*

 

Electronic prescribing of controlled substances (EPCS) has great potential to improve quality, safety and practice workflow and efficiency. EPCS combines traditional e-prescribing with security measures that allow physicians to also electronically order these regulated substances. EPCS provides opportunities for physicians and patients, including:

E-prescribing of controlled substances requires physicians to present a two-factor authentication to prove their identity as an approved provider. The Drug Enforcement Administration (DEA) requires two of three authentication options: something the provider knows, something the provider has, and something the provider is. Options for two-factor authentication include:

Practices should contact their EMR vendor for specific education and requirements on e-prescribing.

Click here for a list of EMR systems that use e-prescribing.

 

*Sources: Centers for Disease Control and Prevention, U.S. Drug Enforcement Administration, Blue Cross Blue Shield of Michigan

With numerous patient data breaches occurring in healthcare, physicians need to consider cyber liability insurance policies to protect the assets of their practice. If a physician is subject to a data breach and their patients' personal information is compromised, the fines, penalties and expenses can be significant.

 

Here are some items to consider when purchasing a cyber liability policy:

• Make sure the insurance carrier is financially stable and has the background and experience.
• Ensure adequate coverage limits for patient notification and credit monitoring expenses in the event of a data breach. Average cost is $355 per patient file; $1,000,000 liability limit is recommended.
• Consider First Party and Third Party Liability coverage. First Party protects and covers your direct costs of a data breach. Third Party coverage protects your practice from a potential liability claim.
• Make sure your practice's crime and cyber liability policy provides coverage for computer fraud including theft, transfer of funds and business email compromise coverage.

Take advantage of the Cyber Liability Insurance program provided to The Physician Alliance members. Rates include $1,000,000 liability limit /$990 per physician.

Contact Rick Loss at Huntington Insurance today - [email protected] or (419) 461-0511.