MIPS and who to report this information

574coding

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HI,

I have been asked to help my administrator with MIPS. Right now, we have been reporting the information to only CMS/Medicare. When I was looking at the guidelines for 2019, it looked like it was not payor driven, that we should also report the codes to Aetna, the blues, work comp, all payors that we bill. Is this correct? I think we only have a financial requirement with CMS/Medicare, but what about the rest?

Thank you for your time with this question.
 

kdlberg

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You have to have a certain amount of Medicare payments/patients to be able to report for MIPS, but the measures submitted for quality and PI must include ALL patients. So let's say you have 2,000 patients but only 500 are Medicare. You decide to us Documentation of Current Medications as a measure. Your denominator should be closer to 2,000 (your entire panel) than 500 (your Medicare panel.)

That's what they mean by not payor driven: that it doesn't matter who the insurer is, the patient still has to be counted in the measures they qualify for. The data for MIPS only has to be submitted to Medicare, because those are the only payments that will be affected.

Hope this helps.
 

574coding

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Thank you! That helps, but one more question about it...
so say as an example, we are using "tabacco non user code 1036F" or "BMI is documented paramenters code G8417 - G8420" as measures we are reporting. Right now, we document in the report tabbacco no user or BMI info and we add the codes on the claim that we send to Medicare and report the measures as required to CMS/Medicare. For other payors, (BS, BC, Aetna, Work Comp, etc) should we also be adding the code on the claim that we send in? Or do we just document the "tabacco non user or BMI info" in the report and not add the codes to the claim for the "other payors"?
Thank you!
 
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