Embracing Pay for Performance with Ease

MIPS  

medaptus simplifies compliance with MIPS proactively as the patient visit is being charted and charged. Within Charge Pro, every current MIPS measure is available for activation. Once a measure is enabled, each time a charge containing the measure’s condition (via ICD-10 code), along with patient demographics that also fit criteria, an alert appears asking for the appropriate measure response from a list of possible actions.

Though a long-established QPP, MIPS still challenges practices today. medaptus reduces the confusion and overhead associated with program participation by presenting MIPS measures in language that providers readily understand. If a provider overlooks a MIPS opportunity – which is essentially lost reimbursement –  support users of Charge Pro are alerted for provider follow-up.

Our MIPS platform can additionally be utilized to support other and emerging QPPs (i.e., HCPR) and even custom measures. Many medaptus customers have taken advantage of this flexibility to capture and submit data for unique quality programs, both at the facility and payer level.

Hierarchical Condition Categories (HCC)  

For nearly ten years, medaptus has provided its customers with features to help adhere to requirements associated with the Centers for Medicare and Medicaid Services (CMS) Hierarchical Condition Categories (HCC) model.  Since 2004, this model determines payments for patients covered by Medicare Advantage (MA) plans and increasingly, other QPPs.

Providers overseeing care of these plan members are at financial and administrative risk to properly document and manage patient clinical status. This is because the HCC model relies on a measure of an individual’s prospective risk based on demographics and conditions coded on previous encounters or the patient problem list.

The process of HCC coding often challenges physician groups because CMS requires new problem documentation each year to create a current profile of member risk.  If this is not documented in an accurate and timely manner, payment is reduced.

The Charge Pro technology suite includes the following features related to HCC:

• Tagged diagnosis (ICD-10) codes relevant to the HCC model for application on appropriate patient charges
• The identification of opportunities based on payer information and patient clinical history
• Alerts to the group when a covered member has a visit (inpatient and outpatient)
• Profiling of documented patient demographics and clinical conditions relevant to HCC for review during the encounter

Bundled Payments for Care Improvement (BPCI)   

Even as new quality-based payment programs continue to emerge – consider the Bundled Payments for Care Improvement (BPCI) Initiative as one example – medaptus Charge Pro can automate the process of participation.

Around BPCI, medaptus can flag patients and their clinical episodes relevant to bundled payments.  This flagging and alerting are critical to identifying patients and episodes covered by BPCI. Such insight helps teams reduce excess care and services with an eye towards reducing re-admissions.