Quality Payment Program Modified Due to COVID-19 Outbreak

Quality Payment Program Modified Due to COVID-19 Outbreak 2

What is the Quality Payment Program(QPP)? 

The Quality Payment Program is the payment reimbursement procedure for the clinicians which ensures better payments with the least paperwork to all the medical service providers. Its aim is to improve medical services and ensure timely payments. Its objective is to give focus on the quality of the treatment to the patients. 

It has two participation tracks- The merit-based incentive payment System   (MIPS) and the Alternative Payment Method (APM). In the first one i.e. MIPS, the payment is based on the performance and it is adjusted according to the performance of the clinicians. In APS, the payment system is developed by the Centre for Medicare and Medicaid Services (CMS) in a customized manner to provide incentives to the medical service providers who provide high quality and high-value care. It focuses on specific clinical conditions and cares about episodes and populations. 

Modification of QPP due to COVID-19

We all know that the whole world is going through crises due to the outbreak of deadly pandemic- COVID-19 or Coronavirus. Therefore keeping in view the urgent requirement of all the medical staff in treating the patients and handling the situation, the CMS has granted exceptions and extensions from all the reporting requirements and data submissions for the Medicare Quality Payment Program. Some of the modifications which have been implemented are:

  1. The situation has become extreme and uncontrollable due to which the data submission deadline was extended from March 31 to April 30, 2020.  
  2. The clinicians who did not submit the data by April 30 will be eligible to receive a neutral payment for the 2021 MIPS payment year.
  3. Clinicians will automatically get their final score equal to their performance threshold. This will result in a neutral payment adjustment on the covered professional services furnished in the year 2021 MIPS payment year. 
  4. The Individual, group or virtual group MIPS eligible medical providers who could not submit their MIPS data by the deadline will qualify for the 2019 automatic extreme and uncontrollable circumstances policy which has arisen due to the COVID-19 pandemic.
  5. If an extreme and uncontrollable circumstance application has been submitted between April 3 and April 30, 2020, citing COVID-19 and it has been approved by CMS then it will override any previous data submission by the clinicians.
  6. Also, the hospitals in the program will not be required to submit the data to the CMS for January 1 through June 30, 2020, and the CMS will not count this period for payment or the performance program. 

Why These Modifications are Necessary? 

The CMS is basically trying to reduce the bureaucratic efforts for the health care professionals so as to reduce the hurdles. This can, in turn, help them to prioritize the patients and care for them instead of involving themselves in paperwork. Due to the current pandemic, most of the medical staff is working double shifts and additional paperwork will only increase their woes. So keeping in mind all the factors, the deadlines have been extended to show them support and to free them from unavoidable work. The extension will also ensure that the Medical staff is protected and taken care of. 

The entire world is facing severe crises due to the spread of COVID-19 and the hospitals all around the world are full of patients who need constant care and treatment from the doctors. The data collected during this time may not reflect the true performance of the doctors and even the hospitals are so overburdened that it is not possible for them to record and submit all the data. Thousands of patients are dying each day and it is not in the hands of the doctors to protect them. There is no medicine, treatment or vaccination for the disease as a result of which the doctors can only try to treat them and care for them. 

All the people are advised to strictly stay at home and all the unnecessary and routine appointments of the doctors have been delayed to focus on the COVID-19 patients. Virtual consultations are given preference over direct consultations so as to avoid the spread of the disease. 

This scenario has made it important for the service providers and the payers to band together to adjust and cooperate with each other and face this tough situation together. This extension of deadlines is a positive step by the CMS to provide a new health care environment and give its contribution to the medical providers. 

Further with Medeye LLC, the hospitals and doctors can leave all the work of documentation with the experts from the firm and concentrate on giving maximum care and support to the patients without having to worry about the reimbursements. The team of experts at the medical billing company can streamline all the bills and submit them to ensure maximum reimbursement at the earliest. 

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