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What CMS is Saying About MIPS Guidelines for ENT Practices Performing In-Office CT

Laura Dennis | Xoran Director of Sales |

In the January OTO Scope for AOA Now, Xoran published an article with tips about how to maximize your reimbursement for in-office CT under MACRA, the new payment system adopted by CMS. I’ll highlight the main points here, and share some updates to CMS guidelines for how it will be implemented.

Under MACRA, CMS will be reducing reimbursement rates for traditional fee-for-service models and will be increasing reimbursement for providers who adopt “quality performance measures” under one of two programs: (1) MIPS (Merit-Based Incentive Payment System) or (2) APM (Advanced Alternative Payment Model).

MACRA’s overall goal is better care and smarter spending. It is a competitive program that distributes payments between healthcare providers based on relative performance. The program is scored on a 100-point scale, and those earning a final score of 70 or higher in 2017 will be eligible for an “exceptional performance adjustment” from a pool of $500 million.

Per Andy Slavitt, Acting Administrator of CMS, by participating in MIPS for part of 2017, your practice could see a small positive payment adjustment. By participating in MIPS for the entire 2017 calendar year, your practice could see a modest positive payment adjustment. (The details of these payment adjustments have yet to be announced.)

You may be wondering what specific areas Medicare will be evaluating when giving higher ratings to physicians. You may also be wondering if MIPS measures are going to limit your practice’s ability to perform necessary diagnostic CT scans on your patients in your office.

Wonder no longer!

MINICAT IQ GIVES YOU OBJECTIVE, MEASURABLE DATA OF BETTER CARE AND SMARTER SPENDING

MIPS reimbursement rates are based on performance in four categories: quality, advancing care information, clinical improvement activities, and cost.

Quality: CMS will measure quality of care via evidence-based clinical quality measures. MiniCAT IQ provides objective evidence of successful clinical resolution of disease via pre- and post-treatment scans. By using MiniCAT IQ, physicians can correlate patient symptoms with on-site diagnostic CT during exams for more accurate diagnosis and treatment planning, reducing the unnecessary use of antibiotics and other medications.

Advancing Care Information: Same-visit imaging with MiniCAT IQ takes less than a minute and eliminates delays in diagnosis and treatment caused by off-site imaging. It enhances the interaction between physicians and patients, builds trust, and educates patients about their condition, improving compliance. “XoranConnect,” a HIPAA-compliant, web-based software system coordinates patient treatment and billing records and seamlessly links MiniCAT IQ images with EHR systems. XoranConnect is an efficient, coordinated treatment and payment system that provides 24/7 secure remote access to scans for treating physicians, radiologists, consulting physicians and patients. It also enables transmission of MiniCAT IQ images directly to PACS and similar programs and is compatible for deployment with telehealth systems.

Clinical Value: CT is recognized as the diagnostic standard of care by the AAO-HNSF. MiniCAT IQ incorporated into exams provides instant access to high quality diagnostic images of the head and scull base, with significantly lower effective radiation dose than conventional CT.

Cost: Since MiniCAT IQ is a compact, specialized head CT scanner, it is a fraction of the cost of conventional, full-body scanners to purchase, house, and maintain. Moving imaging out of the expensive hospital setting and into private practices reduces overall imaging costs. Since the scan is performed at the patient’s point of care, diagnosis is timely and accurate, avoiding the costs of unnecessary antibiotics prescribed while waiting for off-site scanning diagnosis. It also cuts unnecessary costs for your patients by eliminating the need for multiple office visits and imaging center appointments.

CMS GUIDELINES FOR OTOLARYNGOLOGISTS USING IN-OFFICE CT

CMS has published specific guidelines for Otolaryngologists who perform CT in their offices, which will be overseen by your very own Academy of Otolaryngology and Head and Neck Surgery. To avoid potential reductions in reimbursement for your in-office CT, your documentation should reflect the proper use of your CT, and should not reflect misuse or overuse of your CT, such as:

• A CT scan of the paranasal sinus of an adult ordered at the time of a diagnosis of ACUTE sinusitis or within 28 days after the date of diagnosis (potential misuse)
• More than one CT scan of the paranasal sinus of an adult within 90 days after a diagnosis of chronic sinusitis (potential overuse)

It’s important to remember that ENTs are not being asked to reduce the number of scans they perform within their practice. The diagnostic need for low dose scanning in ENT and allergy is not being questioned. Rather, MIPS aims to measure the time to diagnosis—a clear way to observe whether a practice is treating its patients as quickly as possible.

Practices that use a MiniCAT IQ at the point-of-care should benefit from MIPS, since patients can be scanned on the same day as their initial exam.

 

 

Laura Dennis
Director of Sales
laura@xorantech.com
800.709.6726