Positive Results
May 2015
Positive Results Newsletter
Quarterly Newsletter
In This Issue


  • What is MIPS?
MIPS is an Incentive Program, consolidating MU, PQRS and VBM, that measures provider performance based on a variety of factors.
  • Who is MIPS Eligible?
1st two years of MIPS- Physicians, PAs, NPs, Clinical Nurse Specialists, and Nurse Anesthetists.
2nd and subsequent years of MIPS- physical and occupational therapists, speech-language pathologists, audiologists, CNMs, clinical social workers, clinical psychologists, dietitians/nutrition specialists, and provider groups.
  • How is MIPS Measured?
MIPS measures provider performance annually, 0-100, in four separate categories, VBM-measured Quality(up to 30 points), VBM- measured Resource(up to 30 points), MU(up to 25 points), and a new category, "clinical practice improvement"(CPI)(up to 15 points).
  • How Will Your Score Affect Your Payment?
Beginning in 2019, your maximum MIPS score impact would be +/- 4% and increasing to +/- 9% by 2022 and subsequent years.
  • When will scoring begin for MIPS?
As with previous Medicare Incentive programs, there is generally a 2 year lag between measurements and payments. Therefore, performance measures will presumably begin in 2017. For 2015 and 2016, MU, PQRS, and VBM will continue to stand alone as distinct measurements separate from MIPS.

  Why You Should Get Audited

   Self-auditing is one of the best ways to evaluate your coding compliance and efficiency, as well as verifying that all those live classes and online courses, you send your staff to, are being applied correctly. A self-audit is used to identify where your practice may be at risk for a true audit and how to avoid those circumstances. 

   While the idea of auditing all of your patient charts, codes, and policies may seem daunting, Positive Results has an excellent solution. Introducing, Karen Maurice, CPC; CPMA. 

   Unbiased and professional, Karen is a certified professional coder and certified medical record auditor with over 35 years experience. Currently a coding instructor at Greenfield Community College, she is also an active member of the American Academy of Professional Coders and the National Alliance of Medical Auditing Specialists.


Summer Time Holidays

Positive Results will be closed in observance of the following Holidays:
  • Memorial Day-  May 25th
  • Independence Day- July 3rd
  • Labor Day- September 7th
   The first quarterly newsletter of 2015 is packed with important information that will assist your practice in preparing for ICD-10, the Sustainable Growth Rate appeal, New Incentive Programs rolling out and more! Read on for topics of discussion at this year's Memorial Day barbecue.
Medicare Reimbursement Increases are Coming
On April 16th, without further delay, President Obama signed the repeal of the Sustainable Growth Rate(SGR) formula, allowing for increased reimbursements to providers, starting June 2015. The law, Medicare Access and CHIP Re-authorization Act of 2015(MACRA), is said to improve physician payments because "it starts encouraging payments based on quality, not the number of tests that are provided or the number of procedures that are applied, but whether or not people actually start feeling better..." 
  The signing of MACRA avoids a 21% reduction in payments, replacing it with a 0.5% physician reimbursement increase annually, from 2015-2018. This update will occur July 1st for the 2015 calendar year, and every subsequent year. Services prior to July 1, 2015 will be paid at the current 2014 rate.
   The greater change may be that MACRA also ends incentive payments under the Meaningful Use program and PQRS, replacing both of those programs with Merit-based Incentive Payment Program, or MIPS(To learn more about MIPS, read the article below)

The New Medicare Incentive Payment System(MIPS)
MACRA, as described above, replaces three current Medicare Incentive Programs, including: Physician Quality Reporting System(PQRS), Meaningful Use(MU), and the Value Based Modifier Program(VBM). These programs won't quite disappear, as much as the incentives will be under one umbrella. In 2019, these programs will be reformed under the Merit-Based Incentive System(MIPS). In addition, there will be Alternative Payment Models(APMs). APMs offer higher payments, but scrutinize services more closely. Positive Results will continue to research the latest information on these programs to keep your practice in the know. In the meantime, see our left side column bulletin for FAQs on MIPS.

Be Prepared for ICD-10... Again

ICD-10 has been on and off the schedule so many times now, it may be hard to believe that it is really going to remain in progress for the implementation date of October 1, 2015. Regardless of whether or not you think it will go through without another delay, you're better off being prepared for that date. Here are some things to remember as you prepare:
1. With regard to submission, your claims are safe with us. You use our billing company, so you're already ahead of your competition both economically and timely. We are in communication with all affected clearinghouses, verifying testing is completed positively for each carrier.
2. If your practice uses Electronic Health Records(EHR), your system will likely not only direct you to the most appropriate ICD-10 code to apply, but may also convert codes for you, making the transition relatively easy for you and staff. Reach out to your vendors about ICD-10 readiness. This info may also be listed on their websites.
3. If you need assistance with the nearly five times as many ICD-10 codes, this ICD-10 Crosswalk is user friendly and convenient.
4. Lastly, remember, ICD-10 is supposed to help you identify the most distinct encounters with a specific code. Injured in a Chicken Coop? There's a code for that(Y92.72). Got burned when your water skis caught fire? There's a code for that(Y91.07XA). Forced landing of a spacecraft, injuring the occupant? There's a code for that(V95.42XA). No more wondering if you coded that subsequent encounter of the gentlemen that was sucked into a jet engine because there's a code for that too!(V97.33XD) 
**For more ICD-10 codes that may surprise you, or make you chuckle, check out HealthcareDive 
Physician Phunny

Samantha Cole,
Provider Outreach Coordinator/Credentialing Specialist/HIPAA Privacy & Security Officer
Positive Results, LLC