Practice Management

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  • 1.  MIPS Cost Adjustments applied on 2023 for Radiology final scores

    Posted 08-15-2023 12:12

    For the first time, we've been assigned a Cost Score that equates to 30% of our final MIPS 2022 score.   This has seriously impacted our final positive payment adjustment and is nothing that we can control from a professional read perspective.   Cost was waived in prior years and I'm curious if other practices are seeing COST including in their final MIPS score.   If you don't know, you may want to check.     Was this published, and considering we cannot impact cost (my opinion), what recourse do we have? 

    I'll open an appeal, but please share with us any resources you have on this subject.   Cost Measures that impacted our practice was Medicare Spending Per Beneficiary (MSPB) Clinician and Total Per Capita Cost (TPCC).

    The RBMA has to jump on this quickly, any feedback would be appreciated.   Thanks.



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    Dennis J Chaltraw, CRCE
    Director Revenue Cycle Management
    Oregon Imaging Centers / Radiology Associates / ReNew Vascular Institute
    dchaltraw@oregonimaging.com
    Eugene OR
    541-302-7771
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  • 2.  RE: MIPS Cost Adjustments applied on 2023 for Radiology final scores

    Posted 08-15-2023 12:16

    Dennis,

     

    Thanks for this information as the Federal Affairs Committee is currently drafting comments to be included in the RBMA MPFS Proposed Rule comment letter.  Specific examples are always beneficial to include in the comment letter so it would be great to hear from other practices how this negatively effects reimbursements.

     

    Bob Still

     

    Sent from Mail for Windows

     






  • 3.  RE: MIPS Cost Adjustments applied on 2023 for Radiology final scores

    Posted 08-15-2023 15:32

    I pulled our details for Cost.

    not that there is a lot we can do with the data, but i did notice a great many of the patients were SNF patients.



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    Douglas G. Kraus, CPA
    Chief Financial Officer
    South Texas Radiology Group, P.A.
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  • 4.  RE: MIPS Cost Adjustments applied on 2023 for Radiology final scores

    Posted 08-17-2023 19:00
      |   view attached

    We had a couple of groups with a decent size IR Programs get MSPB Cost category attributed to them, but the result did not impact them too badly.  On the other hand we have one group which did have the MSPB Cost category attributed to them and also had attribution in the Total Cost category, which looks to be intended to be focused on primary care services or to the provider who billed the most Medicare allowed charges. CMS Attributed cost to at least three patients who did not have services in 2022 and many more with just $100 in allowed charges for the year. I'm definitely filing a targeted review and expect it to be overturned.



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    Michael Gonzales FRBMA
    Executive Director Client Services
    PBS Radiology Business Experts
    Reno NV
    (805) 286-3830
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  • 5.  RE: MIPS Cost Adjustments applied on 2023 for Radiology final scores

    Posted 08-15-2023 12:52

    We have also been hit hard with the Cost category. At first we thought it was because we have radiation oncology in our practice, as well as IR and NIR. However, we bill for two small radiation oncology groups and neither of them were hit with the Cost category, so we will also be appealing.

     

    Thank you!

     

    Carol Hamilton, MBA, FRBMA, SHRM-SCP

    Chief Administrative Officer

    West County Radiological Group, Inc.

    11475 Olde Cabin Road, Suite 230

    St. Louis, MO 63141

    P: 314-991-8201

    F: 314-991-8282

    C: 314-307-2518

     

    Go to westcountyradiology.com to see our updated website!

     



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  • 6.  RE: MIPS Cost Adjustments applied on 2023 for Radiology final scores

    Posted 08-15-2023 12:55

    wonder how many practices applied for extreme and uncontrollable circumstances legitimately?



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    Douglas G. Kraus, CPA
    Chief Financial Officer
    South Texas Radiology Group, P.A.
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  • 7.  RE: MIPS Cost Adjustments applied on 2023 for Radiology final scores

    Posted 08-16-2023 14:10

    We got hammered on the Cost Score, rated on both Medicare Spending per Beneficiary (MSPB) and the Episode Based Cost Measure for Revascularization for Lower Extremity Chronic Critical Limb Ischemia.

     

    I'm still reseaching, but I know that one issue RBMA previously commented on is that the MSPB threshold is 35 cases, and that holds true whether you have one provider or 100, which simply isn't fair to larger groups.

     

    I haven't done the math yet, but I'm pretty sure the penalty in 2025 payment will far exceed the $16k we got paid for Medicare inpatient E&M services , and also for the 9 cases in the Episode Based Category (which mostly appear to have been train wrecks before we touched them).  I'm thinking of refunding the ones we have billed to Medicare in 2023 and not billing for those things any more so we don't get dinged again in the future. 

     

    That just illustrates that the cost aspect of the program is terribly flawed.  It doesn't make any sense to penalize everything a group does based on a tiny bit of it's work.

     

    Very interested to hear others experience.  Did anyone score better on cost than on quality or practice improvement?  Does anyone know what the maximum incentive bonus came out to be?

     

    Was anyone successful in appealing cost scores when they counted in the past, and if so what was your strategy?

     

    Thanks

     

    Dave

     

           David Smith, FACMPE  |  Executive Director  |  785.393.8387

    5800 Foxridge Dr.  Ste 240  |  Mission, KS  66202  |  www.uickc.com

    p-uic-horizontal-03a

     

                                                              Member of

     

                             

     






  • 8.  RE: MIPS Cost Adjustments applied on 2023 for Radiology final scores

    Posted 08-25-2023 12:13
    This is exactly how they want the plan to work out for them. 





  • 9.  RE: MIPS Cost Adjustments applied on 2023 for Radiology final scores

    Posted 08-25-2023 13:40

    Dave,

     

    16 percent of MSN's Clients earned a perfect score which will yield an 8.25 percent bonus in 2024.  Another 40 percent earned the exceptional performance bonus which will yield a 6 percent bonus in 2024.  We did have one Client who earned 30 points for Cost (a perfect score) and, to answer your question, we had many others who were scored on Cost.  While it's difficult to control performance with respect to Cost, we do strategize with our Clients about factors such as the use of NPPs for E&M services in the outpatient setting.

     

    I hope this helps!

     

    Barbara F. Rubel MBA, FRBMA

    Senior VP, Marketing & Client Services

    Immediate Past President, FRBMA

     

    brubel@msnllc.com

    904-657-2038 (Office) | 770-823-3597 (Cell)
    MSNLLC.com

     






  • 10.  RE: MIPS Cost Adjustments applied on 2023 for Radiology final scores

    Posted 08-15-2023 13:03
    It may be due to billing E&Ms for NPs and PAs .... CMS only classifies NPs and PAs as primary care no matter the specialty and the rules for application within the Cost Category make this normally a surprise for Radiology Groups. 



    Keith E. Chew, MHA, CMPE, FRBMA
    217.971.5293
    Sent from my Verizon, Samsung Galaxy smartphone