Accuracy is one of the biggest challenges faced these days in the medical billing sector. CMS introduced a draft plan last week; describing the methods, it is going to follow in order to develop quality measures in the clinical sector.
The suggestions made in the plan are to be used by Alternative Payment Models (APM) and Merit-based Incentive Payment System (MIPS). Three Medicare quality programs are currently consolidated under MIPS. They are EHR Meaningful use, Value-based Modifier, and Physician Quality Reporting System.
The demand for the new plan was there for almost year. The CHIP reauthorization act and the Medicare Access act passed by the Congress last year had cancelled the Medicare Sustainable Growth Rate Formula (SGR) after finding that it was ineffective and corrupted.
The CHIP authorization Act allowed the physicians to take part in APMs and MIPS. Both programs gave them a chance for payment increases. MIPS and APMs do not focus on the volume of services. Their key focus is on converting the Medicare payments to a system tied to quality and value.
CMS sees the draft as a strategic framework that can support APMs and MIPS. It is also intended to be used as yardstick to improve clinical quality measures in the future. In a recent press release, CMS said it is keeping this draft (on the Quality Measure Development Plan) open to public comments. The draft document is being reviewed by the staff and the HBMA Government Relations Committee. They will give feedback to CMS shortly.
In the draft, CMS mentions the challenges of preparing an effective set of APMs that providers can participate. These challenges include reducing provider burden, participating patients in the measure development process, improving meaningful outcome measures, improving data acquisition for measure testing, designing patient-reported outcome measures (PROMs) and ensuring their appropriate use, and implementing measures that can promote shared accountability across different providers and various settings.
While the clinical aspect is given significance in many of the above points, the challenges faced by practice managers and billing companies remain unanswered. This somewhat appears clearer when moving to the other sections in the document where it says clinicians have full control over the data they want. CMS thinks that it is unnecessary to implement a quality data collection process as it affected the workflow.
The draft plan brings up many futuristic suggestions that will not only reduce the workload, but also will ensure better data collection from caregivers and patients.