mips consulting

What Reporting is required under MIPS?

What Reporting is required under MIPS?

MIPS requires that reporting is done either under a group or as an individual. This reporting is guided by the MACRA statute guidelines on the working of physicians. The reporting is done according to the individual physician’s choice on their participation in the MIPS. The reporting programs for quality previously guided that individuals could only participate in the group reporting and PQRS for larger practices. MACRA has changed everything significantly in that individuals can now report collectively for MIPS data if they exist in groups of two or more. In this way, sub-specialists benefit a lot from this reporting and can succeed in MIPS, (MIPS Program: Choosing Individual Vs. Group Reporting). Moreover, administrative issues for many practices can be successfully eased with time. The practice specialty a physician also matters and is a determinant of the reporting method. The method of reporting whether individual or group depends on the type of practices that a physician is engaging in. MACRA has successfully changed the way that medical care is being offered through its new regulations that have been passed into law. The method of integrating quality measurement into payment has been changed by the new law all thanks to MACRA. Alternative models of defrayment offer incentives on participation all thanks to MACRA.

Operation of groups under MIPS

Most AMCs employ group reporting under MIPS. Depending on the performances of the group reporting, eligible clinicians can get adjustments of payments. If the group is performing well then the payment is adjusted to be better and vice versa for an underperforming group. Alternatively, there is a choice for EC to join APMs to offer services and where they are supposed to offer services responsibly. The tactic is consequential for the type of services being offered to any beneficiaries depending on the quality and cost, (Cohen and Crane, “CMS Releases MACRA Final Rule, Easing 2017 Reporting Requirements – Health Law & Policy Matters”). All the consequences are determined by the ability of the participants in the APMs to meet a certain threshold of standards. This tactic ensures that there are consequences if a group is failing where it should be performing well. There is an APM special scoring standard used to maintain the performances of the ECs. These standards are used to rate how the different ECs are doing in their respective positions. There are also standards or thresholds that are specially maintained for checking in on the performances of the individual ECs.


The CMS has just released a report on how to take care of key qualities that a medical organization should provide while at the same time paying accordingly. The payment should always be done according to the quality of service being delivered from the medical department offering the services. The MIPS reporting currently include offering information on the quality, advancing care, and any improvement activities present or being conducted by the company. The PQRS bears similarities to MIPS. The similarities go up to around 60% of those found the MIPS program, (MIPS Program: Choosing Individual Vs. Group Reporting). Due to criticisms, CMS tries to ensure that all ECs are given more flexible to enable them to report properly to the QRS. Moreover, there are key requirements for the MIPS to work properly. The clinicians are supposed to report at least 6 key measures of quality that they have taken. Any PQRS has an obligation to report on any quality measure which is not specified in the MIPS. Moreover, there are sets of NQS which are to exist but not in the MIPS program. Such an arrangement assist in fostering competition for the benefits of improving the quality. Clinician claims assist ECs to report the MIPS measures. The bottom line is that CMS has now decided to streamline the programs for payment and quality.

Final rule for MACRA by CMS

CMS has plans to make the year 2017 a year of transition by reducing the requirements for reporting and focusing on widespread participation goals and more education for the clinicians. The final rule by CMS for MIPS assists in offering the program more flexibility as opposed to what was present before. Thus, any clinicians who are trying to avoid adjustments by MIPS also have alternatives. The can do full reporting, minimum reporting or minimum submission. Hence, more is concentrated on the services that the clinicians are supposed to offer rather than on reporting by the clinicians. For full reporting, moderate payment is a guarantee as long as the clinicians keep reporting continuously for three months’ periods, (Cohen and Crane, “CMS Releases MACRA Final Rule, Easing 2017 Reporting Requirements – Health Law & Policy Matters”). This reporting is also paid for according to the score of the clinicians. For the partial reporting, the clinicians can only choose one quality measure and report on it. In this reporting option, the clinicians usually do not receive any payment adjustment. In case there is a payment, it is usually very small according to the score that they have attained. For the last reporting alternative, minimum submission, one quality measure and activity in the category of improvements is reported. Unlike the other reporting options, this alternative does not have to be reported continuously. Clinicians operating under this option are never evaluated for positive increases as well as fines.

Work cited

—. “CMS releases MACRA final rule, easing 2017 reporting requirements – health law & policy matters.” Accountable Care Organizations. Health Law & Policy Matters, 18 Oct. 2016. Web. 16 Feb. 2017. https://www.healthlawpolicymatters.com/2016/10/18/cms-releases-macra-final-rule-easing-2017-reporting-requirements/
“MIPS program: Choosing individual vs. Group reporting.” n.d. Web. 16 Feb. 2017. http://www.ascrs.org/sites/default/files/Group%20vs%20%20Individual%20Reporting%20Guide%20.pdf.


iHealthOne in 2017

What We Do

Working with medical professionals for these last few years has been extremely rewarding to both our company and the medical practices we’ve partnered with. Our focus has been in assisting the doctors and dentists that need it the most. With many changes constantly piling up in the healthcare industry surrounding the areas of compliance that we deal with the cost can add up quickly. Every single one of our solutions comes at a fraction of the cost that our competitors offer same or similar services at. We’ve had such great success working with medical providers in the areas of Electronic Health Record Funding, Dental EHR Software, & Consulting under MACRA that we’ve managed to build the most cost effective way for our clients to get the help they need.


Why We Do It

Most of the clients that we work with accept medicare or medicaid and see a significant amount of patients that use these types of insurance. Working with these patients can create budgetary constraints that make it hard to grow with new technological demands. We feel that the smaller the practice is the harder it can be to adapt and grow to meet updates in patient care. With the financial burden of electronic health records for example we’ve came up with a solution for dentists that starts with zero setup cost and for a small practice can cost as little as a couple hundred a month. In comparison to other systems that cost tens of thousands to implement this software is also the only fully integrated, cloud based electronic health record software on the market at this time.

With the Electronic Health Record Stimulus Funding Program ending soon, it’s more important than ever that you receive this funding if your office is eligible. We help our clients receive this funding at no up front cost to your office. You can receive up to $63,750 to offset the cost of implementation and training surrounding adopting the usage of electronic health records for your office. Keep in mind that with our cost effective solutions readily available to you, you will also be able to apply funds to growing your practice in the areas that matter most and improving the overall patient care you are able to offer.


Penalties Against Insurance Billing

When your office accepts medicare and medicaid billing and fails to meet compliance guidelines under MACRA you can end up being penalized on a yearly rolling basis against your insurance billing. We work at a very low monthly cost so you get the healthcare compliance consulting that you need, without all the extras you don’t. No practice is the same, while some of our clients use each and every portion of what we offer here, others benefit from one specific section that they need the most.

In 2017 there will be many more changes to the healthcare compliance industry as we know it. With a full team of over 30 healthcare consultants here we do the same research once that benefits thousands of medical offices in the United States we are able to streamline and offset the cost of your office doing it on your own. There’s no time like the present to get started, give us a call at (888) 893-4495 and your first consultation with us is free.


Regulatory Compliance Training Providers & Your Office Staff

Regulatory Compliance Training & Why You Might Need It

Professional training & certification amidst the constantly changing regulations surrounding the healthcare industry can be difficult while taking valuable time away from running your practice. Going through the repeated audit of your claims and appeal process for denied claims can quickly get frustrating while trying to spend time tending to your business. On a daily basis, you have high priority issues relating the patient care and can quickly distract from the positive impact you can make through effective policies having to do with your financial health.

This is where iHealthOne comes in and makes that impact for you at a fraction of the time and resources you’d have to commit to it on your own. Our Regulatory compliance & MACRA geared programs are some of the very best in the industry of healthcare compliance consulting. Partnering with a healthcare compliance consulting company has never been easier than it is right now. Our dedicated team of over thirty consultants has developed a streamlined approach to office staff and physician training while considering the specific needs of your practice.

Many providers are unaware of grants and funding available to them. These funds exist to cover expenses associated with updating patient records or crucial office training so this is one area we work with you on first. We like to say this is the extra special part of working with us that makes our relationship profitable for both of us in the immediate short term. (Usually within a 4 to 6 week period for most clients.)

While working with your office staff and identifying what your specific needs or regulatory demands are quickly this is an area we make a major positive impact on your day to day operations. Using techniques like more accurate coding of patient records can help reduce the number of denied claims while also eliminating the liability associated with not being compliant. We have very tangible ways of reporting the difference that our techniques have made on thousands of doctor’s and dentist’s offices across the United States. Our team of industry leading consultants and training staff develop your customized plan while utilizing the most current information available as it relates to the medical field.

Regulatory Compliance Services

Some of the popular areas we help our clients with are:

Coding Audits & Training –
Making sure that accurate codes will be billed, we work hand in hand with your physicians and office staff which will bring in higher reimbursements, show the medical necessity, and lower the risk of non-compliance.

Chart Compliance Audits –
By increasing the code accuracy on patient charts, you can increase your efficiency as a provider selecting CPT®, ICD-9-CM and HCPCS II Codes. We run a full audit on a section of time of your charts to get an idea where your most problematic issues reside.

We cover important areas including gap analysis and plan development to deal with both current and future demands in these areas.

Comprehensive Practice Audit & Analysis –
Diving into multiple areas of your practice we can reclaim lost revenues by providing clarity of what services you can bill and receive revenue for. Tackling the most complex specialty practices out there we have been able to make some amazing impacts in this area of what we do.

So Why Choose iHealthOne?

We Consistently Save Your Practice Time & Money While Avoiding Complex Complications That Can Arise When Doing It Yourself.
We have many areas of specialties within our business here at iHealthOne. We wouldn’t ask our content writer for example to read through a new grant and it’s set of guidelines to prepare our strategy of receiving the best results for our client’s practices. In this same manner, we’ve found that many great doctors aren’t that great at paperwork or the monotonous task of researching new compliance regulations. We like to say we’re like having a consultant in your back pocket, use as much or as little as you need each month. This will free up valuable time you can spend on doing what you do best while we do what we do best. This is a team effort and we don’t mind putting in the long hours of research needed to do the best job possible.

One of the best parts about working with us is that your first consultation with a consultant here is totally free. We will do an in-depth analysis of what your exact needs are. We are all about that initial discovery to make certain we are both a great fit for each other. Give us a call today for your first consultation at (888) 893-4495


Meaningful Use Help

Happy 2017 to all our readers out there, with the upcoming changes in healthcare reform, getting help with demonstrating meaningful use could be more important than ever before. Right now we are in modified stage 2 until the end of 2017. By the time we reach 2018 all healthcare providers will be required to move to Stage 3 Meaningful Use. This program will also become one component of the Merit Based Incentive Program based on this years reporting. Here is what we can do to offer meaningful use help this 2017.

Meaningful Use Help Defined

There are 10 mandatory objectives for Meaningful Use Stage 2 and this is what iHealthOne can help with.

  • Protect Patient Health Information
  • Clinical Decision Support
  • Computerized Provider Order Entry (CPOE)
  • Electronic Prescribing
  • Health Information Exchange
  • Patient-Specific Information
  • Medication Reconciliation
  • Patient Electronic Access
  • Secure Messaging
  • Public Health

Protecting Patient Health Information

This measure requires your practice to conduct a security risk analysis and implement necessary security updates as necessary. Furthermore, you must correct identified security deficiencies as part of the eligible professionals risk management process.

Clinical Decision Support

Measure 1: This measure requires your practice to implement five clinical decision support interventions related to four or more clinical quality measures at a relevant point in patient care for the entire electronic health record reporting period. Absent four clinical quality measures related to an eligible professionals scope of patient population or practice, the clinical decision support interventions must be related to high-priority health conditions.

Measure 2: The eligible professional has enabled and implemented the functionality for drug and drug-allergy interaction checks for the entire EHR reporting period.


Computerized Provider Order Entry (CPOE)


Measure 1: More than 60 percent of medication orders created by the EP during the EHR reporting period are recorded using CPOE.

Measure 2: More than 30 percent of the laboratory orders created by the EP during the EHR reporting period are recoded using CPOE.

Measure 3: More than 30 percent of radiology orders created by the EP during the EHR reporting period are recorded using CPOE.


Electronic Prescribing

Measure: More than 50 percent of all permissible prescriptions written by the EP are queried for a drug formulary and transmitted electronically using CEHRT.


Health Information Exchange

Measure: The EP that transitions or refers their patient to another setting of care or provider of care (1) uses CEHRT to create a summary of care record; and (2) electronically transmits such summary to a receiving provider for more than 10% of transitions of care and referrals.

Patient-Specific Information

Measure: Patient-specific education resources identified by CEHRT are provided to patients for more than 10% of all unique patients with office visits seen by the EP during the EHR reporting period.

Medication Reconciliation

Measure: The EP performs medication reconciliation for mroe than 50% of transitions of care in which the patient is transitioned into the care of the EP.

Patient Electronic Access

Measure 1: More than 50% of all unique patients seen by the EP during the EHR reporting period are provided timely access to view online, download, and transmit to a third party their health information subject to the EP’s discretion to withhold certain information.

Secure Messaging

Measure: For 2017: For more than 5% of unique patients seen by the EP during the EHR reporting period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative) during the EHR reporting period.

Public Health

Measure 1: Immunization Registry Reporting: The EP is in active engagement with a public health agency to submit immunization data.
Measure 2: Syndromic Surveillance Reporting: The EP is in active engagement with a public health agency to submit syndromic surveillance data.
Measure 3: Specialized Registry Reporting – The EP is in active aengagement to submit data to a specialized registry.

Meaningful Use Help From iHealthOne.

Give us a call or email today for your first free consultations. We are in the practice of helping practices everywhere demonstrate meaningful use and avoid costly penalties. You have a busy practice to run and we have done all of the research already in this area. We can get done what would take many hours to learn how to do for yourself in less than half the time at a much lower cost than paying costly in house staff.

We’ve worked already with thousands of practices across the United States, when you work with us you will see the difference we bring to the healthcare compliance consulting industry. We aim to be number one in the area of meaningful use help. If you have any questions or comments please email pauld@ihealthone.com and we’ll get right back to you.


Healthcare Compliance Consultants – Why you might need one & how to pick the right one.

With the Affordable Care Act going into effect, the sheer number of hospitals, insurance companies, and other healthcare providers, that have struggled to successfully implement major changes in their working – without assistance – has increased drastically. Before that, most of the physicians were comfortable in their working. With the major reforms looming; many doctors decided to join hospitals, and by default – leave their private practice. If only they approached the correct issues by hiring the right team, or even the right person, everything would have been different. This is where a healthcare compliance consultant becomes the most useful.

Healthcare compliance consultants can notice the full potential of a practice, a hospital, or any other health facility. They base their strategies on data analysis, knowledge, professionalism, and dedication – while showing the right way to an efficient, low-cost working. Therefore, many healthcare providers since have decided to hire a healthcare compliance consultant.
The global healthcare consulting market is constantly growing. With a value of over $6 billion in 2014, the market amounts to 7% of the whole healthcare consultant industry. With the aspect of further growth, especially in the U.S. – which holds almost two-thirds (62%) of the whole $6.33 billion because of the reforms – the competition in the field is also rising. Meaning, finding the right consultant, whether an individual or an agency, can be challenging.

What to Look for in Healthcare Compliance Consultants

Due to the consultant’s high level of importance to their client, one might ask – what should you even begin to look for in a healthcare reform consultant? My first response to that question is knowledge, this is essential. You need an individual or a team that understands the emerging healthcare market. Reliable consultants have the tools to monitor trends and factors that influence the industry. They depend on data, but still develop their own view of the way the entire system functions. An independent thinker will always understand things better than anyone else. Look for someone that has a unique point of view. It can be wise to test the person’s or the team’s knowledge by having them around for a while. It is a small investment, but it will eventually pay off. Look for someone that will blend with your team and will be interested enough to see what’s beyond the medical practice. These individuals develop suitable strategies that will help you save, improve your management, and teach you how to stand on your own feet. Always look for a well-educated, experienced person. In the healthcare compliance consulting field, a Bachelor degree is the minimum criteria. In case you decide to hire a consultant company, inform yourself on their latest successful projects. Evaluate their views, approaches, and values. It is important for the company to invest in professional development and growth. Getting references can be helpful during the evaluation. However, consultants only show their success. Digging a little bit deeper, for example, spending time in networking can reveal some unexpected information.

Secondly, look for experience. In consulting, the power of experience can’t be underestimated. Many companies don’t include individuals with a minimum of 10 years of experience as their team members. While the size of the consultant company doesn’t make a huge difference, many years of experience are an advantage in solving big projects.

Finally, you must take into account the overall efficiency of your new consultant.The right consultant will have backup plans, but still get manage to finish the project on time. Simply because the team has failed to finish a project in a timely manner before; doesn’t mean that you should hesitate to hire another consultant now. Additionally, an efficient consultant will approach the problem with long-term goals in mind, offering quality work that will stay with your practice, even after the project is officially over. They will provide you with the necessary guidance that will help you manage your practice in a more profitable and efficient way.

Benefits that come from having the right consultant on-hand.

Now as you could imagine, there’s a vast amount of benefits that can come from having a consultant on your team throughout the healthcare reform and implementation processes. First and foremost, the overall easier managing of large projects is one of the main benefits that’s noticeable almost right away. Have you ever tried to fix a problem without a success? With the consultant’s management skills and technical expertise, your project has higher chances to succeed. It is of great value that a consultant develops a strategy by finding the causes of the problem. They will focus on the major issues that need to be solved and by making the project a priority, you will maintain profitability and improve patient service. The consultant is an outsider. Sometimes the issues you might not know you’ve had, will be revealed by a person that is not familiar with the situation and has a clear point of view. Meaning, you need an individual or a team that will commit and spend their time focusing their attention on a particular field.
The second benefit is huge: the increased ROI. The initial cost of the consultant won’t overweight the saving that you will make in the long run. Consultants develop an in-depth strategy that includes all your costs, research on your competitors, measures that you can take to save, and much more, that contribute to organized, effective, and improved practice. Keep in mind that bringing your practice to that level requires an individual or a team that is able to see the flaws and propose an efficient approach.

Watch your practice grow exponentially.

As well, you begin to learn how to run a practice as it is – a business. Many physicians and hospitals are dedicated and focused on providing the best medical service to their patients. Usually, they don’t think of running their practice as a business. This brings them to the point when they face many problems and hope to solve them on their own, or with a help of their team. Eventually, they realize that their team can’t solve all of those problems. Dealing with a complex issue that requires dedication, plan, and analysis can’t be solved by a non-expert team in the field. Healthcare consultants have the required tools and a team that not only will help you solve your problem, but understand the operating and management your business needs.
Next, you will save time figuring out everything by yourself. Implementing planning strategies in your practice is not your expertise. Even if you think you know the best way to run your business, trust me, there is someone that is much better. Spare yourself of all the struggles. You will save time, energy, and money. And save your team the extra effort of figuring everything out. Let them do what they do best. Serve your patients.
In conclusion, you will also improve the quality of your services and operations. Healthcare compliance consultants pay attention to every detail in your practice. They collaborate with your team, developing a new way to improve everyday operations, which leads to the final goal – helping patients. By improving the quality of your overall working, you have higher chances to reduce medical errors, improve patient safety, improve staff, and create a safe environment. Healthcare compliance consultants provide a plan with realistic goals for your organization, set a reasonable deadline, and finished the project successfully. They are well-informed, knowledgeable, innovative, and great leaders.


Regulatory Compliance

Regulatory Compliance – How Does it Affect Your Practice?

Within the ever-changing landscape of the healthcare industry, new rules and regulations to protect patients interest, and to make the industry more efficient have been being developed at a record pace. A flood of new regulations got introduced in recent years in light of  the Affordable Care Act (ACA) with a very harsh penalties for those that are not compliant. Now, more than ever before it is crucial stay up-to-date with the changes.

In the United States, HIPAA (Health Insurance Portability and Accountability) was enacted in 1996-and Protected Health Information (PHI)  to protect the interests of patients. Following the ACA, and with recent developments in electronic health record (EHR), HIPAA had to bring many new, unforeseen, rules to cope with the situation. HIPAA had to pave the way to digitalize all most every single manner of health care records and processes. This brought on many stringent, yet unexpected implications. Any violation, intentionally or unintentionally, meets with a variety of penalties which get categorized in 4 criteria where “Category-1” is least serious and “Category-4” is most serious. Thus, staying relevant with the ever-evolving regulatory minefield is more important than ever.


Healthcare Compliance Fines

In 2015, many Healthcare companies had to pay huge amounts of fines and penalties for reasons ranging from unintentional mistakes to sheer negligence. If we track back the record, we will find examples like Tuomey Healthcare System in South Carolina paying $237.5 million in fines and penalties, Adventist Health System and its affiliated White Memorial Medical Center in Los Angeles agreed to a settlement of $14.1 million, and Cooper Health System and Cooper University Hospital in New Jersey agreed to a settlement of $12.6 million. Many companies were fined simply because they could not protect patient medical data from hacking.

Now, questions arise, are you up-to-date with new rules and regulations? If the answer is “No”; then, you can expect a hefty amount of fines incurred on your practice for violating a rule that you may not have even heard of. Did you know that all the information regarding patients should be kept in a secure server as an example? If any information can be accessed by any unauthorized personnel this will result in serious fines like “New York-Presbyterian Hospital and Columbia University” had to face in 2014. That hospital paid a 4.8 million dollar in fine to compensate for the deactivation of a network server which resulted in the disclosure of protected health information of more than 6,800 individuals.

How A Consultant Can Help

Now, what does a healthcare consultant do? What does he/she do to save you from costly penalties?  First and foremost, a healthcare consultant identifies the problem in the company he/she is working for. Then that consultant does some preliminary research and examines the  data available to them at that moment to find a solution.  During that process, that consultant considers new rules and regulations. By analyzing that information, a healthcare consultant can find the flaws and correct those.

How can a consultant help avoid costly penalties? Well, a consultant specialized on Healthcare regulations has an extensive experience in this field. Here at iHealthOne we have over thirty such consultants ready to help with a variety of issues surrounding healthcare compliance and regulatory compliance. Leveraging our wide array of clients that have faced similar issues you can get much more done with our team than the hundreds of hours you or your office staff will spend just doing the research. Consultants also have various analytical tools at their disposal to analyze the ensuing new rules and regulations to reach  the best possible conclusion. Our consultants also stay up-to-date with the changes made by HIPAA and other regulatory organizations.

Healthcare Compliance & Your Future.

Healthcare Industries in United States alone have more than $3 Trillion dollars in traction per year, according to Forbes. However, the very same magazine Forbes termed the recent Industry regulatory changes as draconian, and summarized its analysis by describing the industry as an industry which is focused on compliance and regulation rather than patient care. Now, staying penalty free is no longer a matter of economic well-being, rather a way to stay afloat and competitive in an ever-shifting market place. Hiring a Healthcare consultant will benefit a practice in many ways in such a turbulent market climate.

If you need help with compliance issues for you’re medical practice iHealthOne can help. Give us a call today for your first consultation at no cost to you.