The Merit-based Incentive Payment System (MIPS) of the Quality Payment Program is already underway. MIPS participants who did not start their activities by Oct. 2, 2017, are no longer eligible for a positive payment adjustment in 2019.
However, MIPS-eligible clinicians can still avoid a 4% penalty by reporting one quality measure for one patient. While clinicians have the option to report on any one quality measure, the steps below outline the process you need to follow to report any of the four sleep-specific quality measures:
1. Complete lines 1-20 of the CMS 1500 form as you normally would.
2. Complete line 21 by entering the appropriate ICD-10 code for the appropriate diagnosis or nature of illness or injury.
3. Review the Quality Measure Specifications document for the sleep-specific measure you will be using:
- Sleep Apnea: Assessment of Sleep Symptoms (Quality ID 276)
- Sleep Apnea: Severity Assessment at Initial Diagnosis (Quality ID 277)
- Sleep Apnea: Positive Airway Pressure Therapy Prescribed (Quality ID 278)
- Sleep Apnea: Assessment of Adherence to Positive Airway Pressure Therapy (Quality ID 279)
4. Review the numerator quality data coding options and choose the appropriate scenario and associated code. Enter the Quality Data Code (QDC) in 24D along with codes for all other procedures, services or supplies associated with the service.
5. In 24F, list the charges associated with each code. List a line-item charge of one cent ($0.01) for the QDC entered in 24D. Failure to enter this $0.01 charge may lead your carrier to reject the claim.
6. Finish entering information in boxes 25-33. 7. Submit your 1500 form to your Medicare Administrative Contractor (MAC). The activity associated with the claim must have been completed by Dec. 31, 2017. The claim must be submitted to your MAC by Feb. 28, 2018.
Note: It is recommended that clinicians submit more than 1 claim for the chosen measure(s) to be sure to avoid a penalty in 2019.
Ready to submit your MIPS data now? MIPSwizard is now available to guide you through the process of rapidly collecting, validating, and submitting your results to CMS.
