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MGMA experts on 2018 payment opportunities: 4 key takeaways

By Chris Harrop
January 12, 2018
Body of Knowledge Domain(s): Financial Management

The new year is filled with new revenue opportunities and changes for physician practice leaders to master.

To that end, two subject matter experts from MGMA recently spoke with Medical Economics to provide an overview of the 2018 payment outlook for medical practices. Here are four key takeaways from their discussion of the top issues to watch this year:

  1. Relationship building with payers: Pamela Ballou-Nelson, RN, MSPH, PhD, senior consultant, MGMA Health Care Consulting Group, emphasized the importance of building relationships with a medical group’s payers to set the stage for future contract negotiations. Practice leaders “need to understand the insurance company’s objectives and ask themselves: ‘How do we as a practice match with those? What is the value proposition we bring to the table?’,” Ballou-Nelson is quoted in the article.
  2. MIPS reporting: Ballou-Nelson also reminded that the reporting deadline for 2017 quality data under the Merit-based Incentive Payment System (MIPS) and the alternative payment program authorized by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is just around the corner — March 31, 2018 — and that some practices will be ahead of others. “If [practices had] been reporting on Meaningful Use or the Physician Quality Reporting System (PQRS) in the past, chances are their EHR system already has a MIPS dashboard set up for them,” Ballou-Nelson said in the article. In a recent MGMA article, Ballou-Nelson noted that practices that were limited by their EHR technology “were forced to hire more staff, work extra hours, reduce patient load or join a larger group” to better grapple with the challenges of MACRA’s quality payment program (QPP). For practices that already had an adequate dashboard, reporting requirements get tougher in 2018, with a full year of quality data required compared to the 90 days of data mandated in 2017.
  3. Coding for risk: Susan Whitney, CPC-I, CRC, CMPE, senior content manager, MGMA Organizational Content Development, noted that Hierarchical Condition Category (HCC) coding for the risk adjustment of patients is an important way for payers to better understand patients’ conditions and the costs to the practice for treating those with multiple conditions present. “If patients aren’t accurately pictured, the practice may well lose out on some money,” Whitney said in the article.
  4. Know your value: Ballou-Nelson urged practice leaders to conduct a thorough review of contracts with each payer, as more agreements look to add value-based components (A Dec. 5, 2017 MGMA Stat poll found that 45% of practice leaders expect value-/quality-based reimbursement to increase in 2018). Knowing the quality measures before entering such a contract is crucial, she says. “You don’t want to sign something and find out later you don’t have the resources or capability to do what’s in the contract,” Ballou-Nelson said. “And if you don’t know how you’re doing on a metric they’re going to score you on, you’d better hold off getting into a downside risk contract until you have a better handle on your own data.”


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Chris Harrop, senior editorial manager, Publications, MGMA

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