Clinical Quality and Payment

TMA Practice Consulting
Get personalized quality improvement services and tailored practice support to help your practice succeed under the Medicare Access and CHIP Reauthorization Act (MACRA).

MACRA Readiness Assessment
Identifies specific clinical processes, electronic health record optimizations, and workflow improvement opportunities to help practices improve MIPS scores. TMA is dedicated to helping practices earn incentive payments, not just avoid penalties. E-mail practice[dot]consulting[at]texmed[dot]org

TMF Networks improve health care quality across the continuum of care. Join a network to receive free assistance on quality improvement efforts in your practice or health care organization.

• Nursing Homes/Skilled Nursing Facilities
• Community Coalitions
• Patients, Families and Caregivers
• Quality Improvement Initiative
• Quality Payment Program

In June, the Centers for Medicare & Medicaid Services released data illustrating the early impact of coronavirus on Medicare patients, saying it “confirms long-understood disparities in health outcomes for racial and ethnic minority groups and among low-income populations.” With those findings in mind, Medicare highlighted the urgency of a transition away from traditional fee-for-service payments to value-based care models.

In response to the coronavirus pandemic, the Centers for Medicare & Medicaid Services (CMS) will provide Merit-Based Incentive Payment System (MIPS) credit to physicians who participate in COVID-19 clinical trials during the 2020 Quality Payment Program (QPP) performance year. If you participate in a COVID-19 clinical trial, be sure to claim credit for the activity to optimize your score and MIPS incentive payment.

The 2020 calendar year is an educational and operations testing period for the new Appropriate Use Criteria (AUC) Program by the Centers for Medicare & Medicaid Services (CMS). Under this new program, when an advanced imaging service is ordered for a Medicare patient, the ordering professional will be required to consult AUC through a qualified clinical decision support mechanism. In preparation for full implementation in 2021, CMS encourages physicians to learn about the AUC program, inform their billing staff and vendors about the new codes and modifiers, and take advantage of the testing period. For claims processing requirements, refer to this CMS guide. For complete details, visit the AUC Program website. Note: Physicians who consult AUC for at least 90 days can receive credit for the MIPS Improvement Activities category under the 2020 QPP performance year by attesting to this high-weighted activity: “Consulting AUC Using Clinical Decision Support when Ordering Advanced Diagnostic Imaging.” For details, visit the QPP website.

The shift to value-based payment models has not been easy on small practices. But new ideas within the Texas Medicaid program have spurred hope and excitement. Physicians, hospitals, and health plans are collaborating on innovations that not only could save millions, but also make medicine more patient-centered and more rewarding.

Learn about reimbursable care management services from the Centers for Medicare & Medicaid Services.

• Chronic Care Management Services
• FAQs about Physician Billing for Chronic Care Management Services
• Connected Care: The Chronic Care Management Resource
• Connected Care Toolkit
• Advanced Care Planning Services
• Behavioral Health Integration Services
• Transitional Care Management Services

Physicians looking for help navigating the Centers for Medicare & Medicaid Services requirements for the Quality Payment Program can benefit from TMF’s Quality Payment Program Network.