HAP Radiology Billing and Coding Blog

The Future for Radiologists in the QPP on July 25, 2018

Recently reported developments in federal health care policy could change the direction radiologists are taking to maintain maximum Medicare reimbursement. 

Categories: radiology reimbursement, medicare, medicare reimbursement, Quality Payment Program, radiology, QPP

What Does APM Participation Mean for a Radiology Practice? on May 31, 2018

In our recent article we explored the ways radiology groups can begin to move toward participation in Alternative Payment Models (APM*) as an option in place of working within MIPS under the Medicare QPP.  But what does APM participation mean for a radiology practice, and what should radiologists look for to begin moving in this direction? 

Categories: MIPS, Quality Payment Program, MIPS participation, radiology, QPP, APM, Advanced Payment Model

2018 Budget Bill Makes Changes to MIPS on April 6, 2018

When Congress finalized the fiscal 2017 federal budget on February 9, 2018, the bill1 contained some changes that will affect the Medicare Quality Payment Program (QPP) in the coming years. Nothing in the bill changes Medicare payment levels or the MIPS2 reporting requirements for 2018. There is, however, a change that affects the 2018 performance year low-volume exclusion.

Here is a summary of the changes:

Categories: MIPS, Quality Payment Program, MIPS participation, QPP

How Radiology Practices Can Drive True Quality of Care on March 13, 2018

Radiologists often identify incidental findings.  When clinically significant, communicating these findings for further evaluation and treatment can be a lifesaving action.  Despite best efforts, documentation in radiology reports does not adhere to a fixed standard, making subsequent analysis of incidental findings quite difficult.  And, while such a finding might be insignificant in the present exam, over time a patient’s status may change and incidental findings may be a key indicator of appropriate follow-up care. 

Categories: Quality Payment Program, radiology value building, quality measures, clinical analytics, incidental findings, lung nodules

A Radically Traditional Perspective on Building Radiology Practice Value on March 9, 2018

Converting the US healthcare economy to a value-based model that rewards both quality and cost savings is an objective that still holds bipartisan support, despite the well-known burdens of compliance that many providers have experienced.  While some significant voices are currently advocating repeal and replacement of MIPS, others are for "charging forward". 

Categories: Quality Payment Program, radiology value building, QPP, quality measures, clinical analytics

How Important Is The MIPS Cost Category to Radiology Practices? on March 8, 2018

The Centers for Medicare and Medicaid Services (CMS) threw a surprise into the Quality Payment Program (QPP) Final Rule for 2018 when it included the Cost Category as 10% of the MIPS Final Score for 2018 reporting.  The QPP Proposed Rule issued a few months earlier stated that Cost would be zero-weighted for 2018 as it had been in 2017.  So what does this mean for radiology?

Categories: MIPS, Quality Payment Program, MIPS participation, radiology, QPP

Results of the Medicare Value Modifier Payment Adjustment for 2018 on February 8, 2018

During 2016 we worked hard to provide our readers with information and advice that would allow them to maximize their performance under the Physician Quality Reporting System (PQRS) and therefore to maximize their reimbursement in 2018 under the associated Medicare Value-based Payment Modifier (VM).  The results have just been announced by the Centers for Medicare and Medicaid Services (CMS), and are available in a CMS Fact Sheet.

Categories: cms, value modifier, Quality Payment Program, QPP, quality measures

It’s Not Too Early to Prepare for a MIPS Performance Data Audit on September 15, 2017

Beginning in 2019 the level of reimbursement from Medicare to many physicians will be determined in part by their performance in the Merit-based Incentive Payment System (MIPS).  Medicare will award a higher level of payment to those eligible clinicians and groups who report that they have successfully met certain criteria for Quality, Advancing Care Information, and clinical practice Improvement Activities.  MIPS is the successor program to the Physician Quality Reporting System (PQRS) and Meaningful Use of Electronic Health Records (MU-EHR) incentive programs, and CMS (the Centers for Medicare and Medicaid Services) has indicated that it will continue its practice of auditing the data submitted by practices just as they did under the earlier programs.  As this article in Healthcare IT News illustrates, the result of failing an audit will be non-payment of expected incentives (in the case of a pre-payment audit) or returning of funds already paid and possibly even federal sanctions depending on the severity of the infraction. 

Categories: MIPS, Quality Payment Program, MIPS participation, radiology, quality measures

Transitioning Your Radiology Practice to MIPS: Improvement Activities on February 2, 2017

This is the third in our series of articles designed to help radiology practices prepare for the Merit-Based Incentive Payment System (MIPS). Previous articles covered the Quality Performance Category, which is the largest portion of the MIPS score, and the Advancing Care Information (ACI) Category.  Quality will initially account for at least 60% of the total MIPS score and ACI will account for up to 25% of the total score.  The Improvement Activities (IA) Category, originally called the Clinical Practice Improvement Activities in proposed regulations, represents 15% of the total score for 2017, the first year of MIPS participation.  The fourth element of MIPS, the Cost Category, has been reweighted to zero for 2017.

Categories: radiology reimbursement, MIPS, Quality Payment Program

Transitioning Your Radiology Practice to MIPS: The Quality Component Updated on December 15, 2016

By now everyone involved in billing Medicare for physician services should be aware of the new Quality Payment Program (QPP) that will be in effect for payments in 2019 based on data submitted in 2017.  The proposed rules for the new system were outlined in our recent article Medicare Quality Reporting Rules are Changing.  The final regulations that will govern the new system were recently issued, and radiology practices will benefit from preparing as early as possible to capture the data they will need to report under the new system.  ­

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Categories: radiology reimbursement, medicare reimbursement, MIPS, Quality Payment Program

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