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5 ways to help Critical Access hospitals to best prepare for MIPS

The CMS final ruling on the Medicare Access and the Chip Reauthorization Act (MACRA) was one of the biggest changes in Medicare for more than a decade. This introduces a new age of value-based care instead of the customary volume-based care. This new law and its implementation will have a severe impact on the Critical Access Hospitals (CAHs) that were exempt from past programs and mainly operate on limited resources. Here are a few guidelines for CAHs to best manage the complexities of compliance.

Determine eligibility

Under the Merit-Based Incentive Payments System, it is important for all Medicare Part B Clinicians to comply with intermittent exception. This means that providers that are within any organization that satisfies the volume threshold of 100 unique Medicare patients and $30,000 annual Medicare billings must comply.

Know more about the program

To fully comply with the Merit-Based Incentive Payments System, it is crucial for CAH facilities to educate themselves and their providers on the key elements of this program. Getting more information from different portals regarding how the program works will ensure that your facility complies with all the set elements. For instance, when you develop an understanding of the quality measures that clinicians are evaluated on, the organization will know how to update workflows, enhance care coordination and even access provider performance. This will help in putting the medical facility in the best position to optimize the scores in the quality category.

Know who it affects

CMS notes that approximately 600,000 medical providers are affected by the MIPS requirements. However, there are currently a few groups of medical providers that are exempt from the obligation of submitting their data to the system. With information on clinicians that are eligible and those that are not, you will guarantee compliance of your CIHs. Clinicians that were exempt from the program included clinicians that were enrolled for Medicare in 2017 for the first time, those that serve 100 or less Medicare patients, and clinicians who billed Medicare for less than $90,000 within one year.

Pick a path

Most Critical Access Hospitals may be thinking that being part of an ACO may be the best chance for them to join an AMP. However, this can be or cannot be the right option for your medical facility. You need to determine what path your organization will choose and remember that all paths must comply with the Merit-Based Incentive Payments System. This means that irrespective of the path that you choose, you will have to work and optimize your score.

Formulate an effective Plan

After the above steps, you will need to formulate an effective plan on how your facility will comply with the Merit-Based Incentive Payments System. To comply effectively, it is important to leverage technology and use data analytics in order to boost patient engagement and enhance the overall quality of medical care. Always remember that success with medical data is critical to your success with the new Medicare payment system.

To guarantee compliance with the Merit-Based Incentive Payments System, it is important that Critical Access Hospitals do not act alone. This is essential, especially for facilities that have not complied with past programs such as VBM and PQRS. The use of Certified EHR Technology can help in automatically extracting data without the need for resources from the organization. This will result in a significant reduction in the administrative burden, especially for resource-strapped CAHs. With the right partner, you will be guaranteed of automated compliance requirements and ongoing access to data analytics. This will ensure that CAHs facilities boost their scores and maximize their Medicare reimbursement.


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