Data Aggregation for ACOs
What does it mean and why is it important?
In addition to sourcing data from diverse channels, ensuring accurate patient identification data is imperative. A mandate from CMS necessitates Accountable Care Organizations (ACOs) to rectify duplicate patient records sourced from different providers and suppliers during report submission. This directive targets the inherent challenges in Electronic Health Records (EHRs) and their interoperability. EHR systems lack standardized formats for seamless data exchange and are inadequately equipped to support quality measure reporting or the efficient aggregation, normalization, and removal of duplicate data.
Technologically speaking, this change markedly amplifies the volume of data collection for participating providers. To effectively assess quality metrics across their entire patient population and report on 70% of these individuals, providers must integrate all systems via a robust data and analytics platform. This approach facilitates the establishment of a comprehensive patient record, serving as the authoritative source for each patient's clinical particulars. Embracing this methodology eliminates data ambiguities and obviates the need for laborious (and costly) manual processes, thereby streamlining the patient data collection and reporting workflow. However, achieving this integration hinges on the consolidation of data from disparate EHRs and supplementary sources.
Frequently Asked Questions
Who can be eligible for MIPS?
MIPS eligibility is based on a clinician's National Provider Identifier (NPI) and the associated Taxpayer Identification Numbers (TINs), referred to as the TIN/NPI combination. You must be identified as a MIPS eligible clinician type on Medicare Part B claims, have enrolled as a Medicare provider before end of the previous year, and not be a Qualifying Alternative Payment Model Participant (QP).
Eligible Clinicians (but not limited to):
Physicians, Physician Assistants, Chiropractors, Clinical Nurse Specialists, Nurse Practitioners, Physical Therapists, Occupational Therapists, Clinical Psychologists, Certified Register Nurse Anesthetists, Qualified Speech-Language Pathologists, Qualified Audiologists, Registered dietitians or nutrition professionals, Qualified speed-language pathologists, Certified Nurse Midwives, Osteopathic Practitioners
What are the four performance categories for MIPS?
MIPS adjusts Medicare Part B payments based on performance in four performance categories:
Quality (30%)
Cost (30%)
Promoting interoperability (25%)
Improvement activities (15%)
What happens if you do not report MIPS?
Unless you qualify for an exemption from MIPS in a year, you will receive a -9% payment adjustment to your Medicare Part B fee-for-service (FFS) claims in the following year.
What is the cut off date for MIPS reporting?
You must report data collected during the calendar year by March 31 of the following calendar year.
Payment adjustments, based on the data you submit for services provided, are applied to Medicare Part B claims during January 1 to December 31 of the year following data submission.
