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Required Programs

  • 1.  Required Programs

    Posted 10-20-2017 05:31
    Good morning,

    I read the various posts in the forum regarding the government programs including MIPS and Macra. I am exempt from these two programs due to my practice size.

    I still see Meaningful Use listed in various posts. I thought Meaningful Use had been replaced by MIPS and Macra?

    I also saw PQRS discussed as assessing a penalty for those who do not meet the requirements. In my first year of practice I was unable to meet the requirements regarding patient portal usage. Most of my patients are elderly and do not use a computer or have dementia. Based upon this one measure, I was not allowed to submit my data for PQRS. I use Practice Fusion for my EMR. From what I understand this software reports for MIPS and Macra.

    Could anyone give me a very brief listing of other similar government programs which I need to be reporting to in order to avoid a Medicare penalty? I do not accept Medicaid. It seems like there are numerous programs which I’m not aware of the reporting requirements.

    Thank you,
    Laurie Troup

    Sent from my iPad

  • 2.  RE: Required Programs

    Posted 10-22-2017 13:05

    There should be a "Quality Improvement Organization" for your region that can help with this issue.  My understanding is that there is no cost for these services/advice; CMS is paying them to help us.  I would google the QIO phrase plus your state and see what you get.

    Michael Barron MD

  • 3.  RE: Required Programs

    Posted 10-23-2017 17:30
    I thought it was just MIPS now if you are MIPS eligible.

    Mamatha Agrawal, MD
    Family Doctor CaryNC
    Cary, NC
    Live in Raleigh, NC
    Solo since 2012
    Practice Fusion and NueMD

  • 4.  RE: Required Programs

    Posted 10-24-2017 07:07
    The requested page "/contact-zones?map=qin" could not be found.

     Like so many other government projects, a big circle leading nowhere.

    Laurie Troup
    Naples FL

  • 5.  RE: Required Programs

    Posted 10-24-2017 15:33

    I have been researching this as well.   You can call the QPP phone line.  They are helpful.  But be prepared to spend several hours on the phone.
    and to still come away confused.  I have called several times and am starting to understand this mess.

    My understanding is if you have less then 100 medicare patients or less then $75,000 in MCR billings during the 12 month calculation period, you should be exempt from MIPS / MACRA for 2017, which means there should be no penalty in 2019 (but no positive adjustment either).

    The other thing to do, to further assure you are not penalized, which I plan to do, is to submit in 2017 one quality code on one patient for $0.01  That should qualify as meeting your MIPS / Macra submission requirement for 2017, and again, no negative adjustment.

    If you are exempt you do not need to submit any QPP data for 2017.

    If you are not exempt, there are a few ways to potentially earn a positive adjustment in 2019.   You could submit QPP data and do the MIPS / MACRA reporting for 2017 reporting period.  OR  If you join an ACO or APM group in 2017, that submits your data for you, you may qualify for an upward adjustment in 2019.

    If I am wrong, I suspect others will chime in.

    Michael S. MD

  • 6.  RE: Required Programs

    Posted 10-25-2017 06:24

  • 7.  RE: Required Programs

    Posted 10-26-2017 05:26
    Good morning Michael,
    Thank you for the link. I still don’t see any current programs to sign up for.

    Sent from my iPad

  • 8.  RE: Required Programs

    Posted 10-26-2017 11:44
    1.  If you are exempt from MIPS/MACRA, you should have received a letter from CMS stating so.  If you are a new practice, I believe you are automatically exempt this year.  You need to find out.  See below for the .pdf to find help (Page 1).

    2.  If you are exempt, you "can" submit MIPS/MACRA data but it won't count.  You won't get incentives or penalties.

    3.  Meaningful Use for Medicare has been absorbed into MIPS.

    4.  If you are involved in MU for Medicaid, you can continue the program until the last year of eligibility.  I think it's too late to start MU for Medicaid.  The law was an attempt back in 2010 to get providers into EMRs but you had to commit by a certain date.  Double check this.  It was great b/c all I had to do was "attest" the first year and prove 30% of my patients during any 3 month period where Medicaid (easy for a start up if you take Medicaid).  For that, I got an $18,000 check - big $$ for a start up.  Now I get $8000/yr but the work is more and more painful.

    Here is where you can go for help:

    There are two programs.  The first page lists the CMS contracted/funded corporations that can guide you and educate you on all these quality programs.  The one for Michigan helps me report Medicaid MU.  I've also signed up for MIPS assistance because it was free.  I'm exempt so I can't report MIPS but I'm still using their help to set up my practice to be ready to report if/when I am required to report.

    The second page lists Practice Transformation Networks.  These CMS contracted/funded corporations help you to change practice systems to "conform" to what CMS/Medicare wants you to be doing.  Of course, what they want matches the MIPS incentives.  Some of it is stupid and I choose not to do it.  Some of it is helpful.  My PTN has a depression screening and treatment practice improvement program which I'm doing.  It's not very helpful because I've already been screening everyone but it checks the box for ABFM practice improvement requirement.

    Total cost for all this help is $200 for the year.  CMS picks up about $2500.  Some of it is REALLY helpful (assistance with SRA and electronic registries for Medicaid MU) and some of it is so-so (PTN).


    Craig Ross, M.D.
    Family Medicine
    South Arbor Family Care
    Ann Arbor, MI
    M: 734-756-8446
    W: 734-707-7075

  • 9.  RE: Required Programs

    Posted 10-27-2017 16:59
    Thank you for all your input. I don't have to do MIPS and don't take Medicaid. So I guess there is nothing further that I need to do.

    Laurie Troup
    Naples FL

  • 10.  RE: Required Programs

    Posted 11-01-2017 07:16
    I agree I am completely confused. I have about 8 Medicare patients and called CMS over a year ago and they told me I was exempt due to not billing enough/few Medicare patients (although I never received a letter.)  I just received a letter from CMS yesterday that we're being penalized 2% since we didn't fulfill requirements.

    When I go to CMS website and look at the pages of instructions full of MIPS/MACRA/APM/PQRS my head spins and it just doesn't feel worth it for 8 patients.  In addition at one point I contacted our EHR ECW to see how to use their program to report and you have to purchase a separate product and then also pay per patient.

    Now I'm wondering if there is another component I'm missing for which I am not exempt to warrant the penalty.

    Jessica Rongitsch MD, FACP
    Capitol Hill Medical
    Seattle, WA

  • 11.  RE: Required Programs

    Posted 11-01-2017 08:53

    I'm jumping in the middle of the discussion back to you.

    I think I had the exact same thing- letter that I'm exempt a bit ago (for future I don't need to submit and won't be penalized) but penalty letter of 2% yesterday for past (2016 MU).

    Given the numbers I'm not sure worth my time/ staff time to figure out why we'll get the 2% penalty in 2018 as we tried to comply with 2016 MU requirements. The letter states to look on-line at your data before talking to them but doesn't really say where to go to look. It gives a link just to "find out more" about where you might go to get your data.  But it rubs me wrong so I have to decide to track it down or not. How is it in medicine we're told we didn't make the grade but aren't given any information supporting this claim.

    They really don't make it easy to say the least.

    I've been talking with insurers and some of the institutional groups of late.  They do seem to get how hard as IMPs it is to make this all work. But I sometimes wonder if they get its equally hard for the big groups- they just have a bunch of money to throw at it to make it work.  I imagine there is likely plenty talk but I'm not hearing the conversation that this is a crummy way to be spending health care dollars.


    Melissa Weakland MD
    Ballard Neighborhood Doctors
    Seattle WA
    IMP since 2007

  • 12.  RE: Required Programs

    Posted 10-27-2017 06:55

    I think you would have to call them.  When I did it years ago they sent someone to my office.  It can also be done on the phone I believe.


  • 13.  RE: Required Programs

    Posted 10-27-2017 09:43
    Do you   belong to your local medical  society or local chapter of AAFp- so many groups have webinars or help about all this;I myslef am  bombarded by offers for  webinars etc.

     If you are in an ACO they   report most of it
    I worried when you said PF will report for you
    Practice Fusion  is like most EMRs- it collects the data It doesn t report it.

    Jean Antonucci

  • 14.  RE: Required Programs

    Posted 10-29-2017 19:38

    I am under impression, users will be able to request PF to submit their 2017 MIPS data to CMS via PF's registry, known as QCDR,  between January and March 2018.   I also spoke to a PF support person this week who stated that was correct.    Here is a link to something on their support site.   ( I am not recommending or not recommending PF, merely clarifying what I understand.)

    Laurie - Here is how to check your 2017 MIPS status, if you have not done so already.:

    Michael S. MD

  • 15.  RE: Required Programs

    Posted 10-31-2017 07:48
      Had no idea! Gawd what else do I miss ?Although  I am in an ACO and they will drag data  out of me to report it

    Jean Antonucci

  • 16.  RE: Required Programs

    Posted 10-31-2017 11:47
    If your ACO is reporting clinical data, you will still need to do the ACI portion yourself. At least that's who it is for me.  Personally, I am going for a hardship exemption as I can't meet one of the 4 mandatory requirements.

    Kathleen Saradarian, MD
    Branchville, NJ

  • 17.  RE: Required Programs

    Posted 11-01-2017 06:33
    Hi Kathy yes and thanks my ACoguy just sent me something about this this morning so you have telepathy
    I’m a little distracted since I have not had any electricity for 48 hours we have solar for lights upstairs but pretty soon even though my screened in porch off the kitchen has become the refrigerator I may have to dump some food from the freezer so I’m a little distracted please send electricity
    I am spending a lot of time boiling water on the wood stoves sigh
    the only place I think I’m stuck is the ability to do an electronic communication with the consultant to be honest with you I thought I would just fudge I think that’s the only one I can’t do I don’t know anyone else who has a direct address but I thought maybe I could use a friend in Rhode Island or one of the other practice fusion people and do a test consult for Mickey Mouse not really lying it’s proving to them I can do it I just don’t have anybody on the other end to do it with

    Sent from my iPhone