Gastroenterology Coding Alert

Eliminate penalties - report at least one of 16 GI-specific measures in transition year 2017

MACRA is here to stay. Wondering how to work your way through and thrive in the new value-based reimbursement system? On October 14, CMS released the 2,398 pages long MACRA rule. If you are an eligible clinician who bills Medicare more than $30,000 a year in services and provides care for more than 100 Medicare patients, you will be required to participate in the Quality Payment Program (QPP) in 2017. Here’s a brief overview and analysis of critical facts, and how to prepare for the upcoming changes.

Start Reporting Anytime Between January 1 and October 2, 2017, says CMS

“No further delays in implementation are expected,” says Michael Weinstein, MD, former representative of the AMA’s CPT® Advisory Panel. Despite the fact that the transition begins this January, the good news is that CMS lets you pick your pace for the Quality Payment Program. “If you’re ready, you can begin January 1, 2017 and start collecting your performance data,” says CMS in its QPP website www.qpp.cms.gov. “If you’re not ready on January 1, you can choose to start anytime between January 1 and October 2, 2017. Whenever you choose to start, you’ll need to send in your performance data by March 31, 2018.”

Use 2017 to Learn How to Participate

CMS is considering 2017 a “Transition year” for the QPP and has brought down the reporting requirements to help ease the switchover for the providers. In earlier proposals, CMS had asked providers to review about 300 measures and pick the appropriate ones for their specialty. However based on provider feedback that this created confusion, CMS has designed specialty-specific measure sets now.

2017 Gastroenterology Measure Set for you: The MACRA final rule includes 16 gastroenterology measures:

Don’t get overwhelmed! In order to meet the performance threshold for the 2017 transition year, your physician will just need to:

• Submit one out of at least six quality measures (more measures are required for groups that submit using the CMS web Interface).
• Attest to at least one improvement activity.
• Report on the required measures in advancing care information.

For full participation in the quality performance category, the providers now have the option to either report on:

• Six quality measures that the you would selects among the list of available measures, including one outcomes measure; or
• Six measures in one specialty-specific measure set, including one outcomes measure, for a minimum of a continuous 90-day period.

If there are no appropriate outcomes measure in the measure set, the provider may report on one high-priority measure in one of the following national quality strategy domains:

• Appropriate use,
• Patient safety,
• Efficiency,
• Patient experience or care coordination.

“This will definitely impact… EHR providers who are not prepared for this implementation,” says Catherine Brink, BS, CMM, CPC, CMSCS, CPOM, president, Healthcare Resource Management, Inc. Spring Lake, NJ. Reporting these measures and advancing care options will necessitate upgradation of the EHR systems as well.

Why: The component of advancing care information, which stands for 25 percent of the MIPS score, is all set to replace the Electronic Health Record (EHR) incentive program (Meaningful Use). This lets you enjoy the freedom of choosing customizable measures to demonstrate how you use EHR in your practice.

Get Clarity on the Pick Your Pace Options

For the sake of a smooth transition, CMS has provided four options for reporting in 2017 to allow clinicians to pick their own pace.

“Now is the time for coders and administrators to review these options and discuss their impact on their practices with the managing partners in your practice to make a decision on the direction the practice should take,” says Brink.

Small Providers Stay Unscathed

CMS has extended its support to the small practices by excluding them from reporting requirements in 2017 due to low-volume threshold, which has been set at less than or equal to $30,000 in Medicare Part B allowed charges or less than 100 Medicare patients. That’s not all. CMS also offers to provide $100 million in education and technical assistance to small and rural practices in 2017.

Final takeaway: “Providers need to prepare their practices now for this implementation by ensuring their EHR vendors are in compliance with their platforms,” says Brink.

Plus: CMS understands that you would need to know important dates, scoring calculations, measures specifications and other helpful resources as you transition into the QPP. “Thus the new CMS web site was launched on October 14th,” says Weinstein. “This is far better than any prior CMS site and is worth a look.” You may go to the website www.qpp.cms.gov for updating yourself.

Editor’s note: Stay tuned for more information on how to prepare for implementation of MACRA and safeguard your reimbursement in the MACRA era.

For more details refer www.gastro.org/MACRA, www.qpp.cms.gov.