For TINs that utilize an Ambulatory Certified EHR, proactive steps must be taken to meet compliance requirements. CMS requirements for sharing, receipt, and use of digital data could have a serious impact on your reimbursement.

Our HIE Optimization platform is a vital and proactive solution for all MIPS eligible ACO’s, TINs, physicians, and clinicians from all payor classes and MA plan providers. It is particularly important for TINs who score well on CQM, but more must be done to qualify for the maximum payment adjustment under the QPP & MACRA by improving their Promoting Interoperability (PI) Score, which is an integral part of the CMS MIPS score calculation.

To learn more about increasing your payment adjustment under the QPP & MACRA, see our MACRA Optimization webpage.

Your PI Score is a major component of your Final MIPS Score and measured by CMS through the calculation of:

1. Effective Use of Your EHR (Integration & Feedback with CMS)

You might think all EHR’s handle compliance requirements. EHR’s are only the start - not the finish.

Even the best EHRs only keep up with CMS requirements at the superficial level, and only Ambulatory certified EHRs can submit data directly to CMS. No Inpatient certified EHRs can submit.

PI Scores are EHR driven because all reportable metrics come from EHR systems. And your EHR needs to define the relationship between eligible clinicians and TIN.

The platform will help you optimize your EHR by coordinating with your IT team (and the EHR vendor) to have all CMS integration add-ons activated (this comprises up to 30% of your PI score). 

2. Coordination of Care Among Multiple Providers (Referral Network)

The most challenging part of meeting CMS compliance and achieving a high PI score lies in you and your members managing your Referral Network data. CMS prefers the use of a bi-directional HIE, but this option is not available in all areas.

There is an alternative for those without a viable HIE. It is possible to share relevant clinical data by incorporating information about their referral network into their EHR – and incorporating information about them into theirs.

The platform analyzes the options available in all areas. And if available, coordinate between an EHR vendor and HIE providers. If an area is not supported, we have a fallback process for managing Direct Messaging (in the event you need to take this step, there may be additional fees) or we can coach you through the process of doing this on your own.

We will help you achieve the most effective referral pathways to exchange clinical data, which will help you meet requirements and dramatically improve your PI Score and the efficiency of your entire Referral Network (this comprises up to 40% of their overall PI score).Top of Form

3. Patient Care Coordination & Integration (Patient Outreach/Data Collection)

Increasing Quality of Care by directly assessing and highlighting gaps in care at the individual patient level is required by CMS. The platform’s engagement gathers risk-level data on your members entire patient population across all payors utilizing assessments that have been designed to gather the maximum relevant health information (this comprises up to 30% of their PI score).

To learn more, see our Patient Outreach Optimization webpage.

A Must Know for Those MIPS Eligible

The PI Category Weight is worth 25% of your Final MIPS Score and requires a minimum of any continuous 90-day reporting period during the calendar year. Under certain circumstances, CMS will reweight the PI Category to 0% and the 25% would be added to other MIPS Category Weights.

The last day for you to start a minimum 90-day reporting period to attest to PI is October 1^st. So. you need to start optimization as early in the year as possible or risk failing on PI, and therefore fail to maximize their payment adjustment under the QPP & MACRA in next the PAY.

Though most TINs and their IT departments did a good job with PI in the past, due to complexity and the failure of HIE and EHR vendors to provide TINs and their providers with the proper expertise, tools, and/or training, most are NOT meeting CMS requirement benchmarks and targets.

Administrators even boast about their PI score. Unfortunately, they are still apathetic about actions needed because up until now requirements have not amounted to any significant increase in revenue. This has now changed.

So, now when ownership, boards, and/or stakeholders ask why your TIN’s reimbursement has been reduced or why you failed to maximize reimbursement, and no one can explain why or do anything about it, ignorance or apathy will not be an accepted excuse. Don’t let this to happen to you!

Though most TINs and their IT departments did a good job with HIE in the past, due to complexity and the failure of HIE and EHR vendors to provide TINs and their providers with the proper expertise, tools, and/or training, most are NOT meeting CMS requirement benchmarks and targets.

Administrators even boast about their robust IT. Unfortunately, they are still apathetic about actions needed because up until now requirements have not amounted to any significant increase in revenue. This has now changed.

So, now when ownership, boards, and/or stakeholders ask why your TIN’s reimbursement has been reduced or why you failed to maximize reimbursement, and no one can explain why or do anything about it, ignorance or apathy will not be an accepted excuse. Don’t let this to happen to you!

You are required to share and have access to patient data and compile and collect data for use in treating patients. But what makes this difficult is the goal post is moved every year and the National Quality Strategy (NQS) will make it much more challenging for TINs to navigate compliance and be subject to the penalty of lower reimbursement.

To ensure you avoid the penalty and improve reimbursement, you must make the commitment to optimize your EHR and improve your Referral Network pathways. If you don’t - this oversight will cost you a lot of money. And to avoid non-compliance, you must use the CMS requirements as part of your broader strategy around interoperability and patient engagement/outreach.

While the requirements present significant challenges, they also provide an impetus to gather new levels of clinical data. And if you’re looking to do more than check the compliance box, it will allow you to turn your compliance into a competitive advantage by developing new services in line with Value-Based Care and CMS’s Population Health / CCM programs.

To learn more, see our Population Health Optimization webpage.

CMS’s NQS requirements have begun. And these have and will continue to create lower reimbursement and a significantly higher risk of an audit if not handled properly.

The NQS advances electronic health information exchange and streamlines cumbersome health care processes by establishing standardized requirements across the industry. These rules reflect the deep collaboration between CMS and ONC to ensure that providers and payers adopt common, open-industry standards to advance interoperability and industry innovation.

It develops and expands the requirements for sharing, receipt, and use of digital data, including digital quality measures, across CMS quality and value-based programs. And to transition to all digital quality measures and digital data collection by 2030 to reduce burdens and enable timely availability of quality data.

Highlighted Initial Actions of the NQS

• Annually increase the percentage of digital quality measures used in CMS quality programs.
• Build one or more CMS quality data receiving systems that can receive data using the *FHIR standard with **Application Programming Interface (API) delivery by 2030.
• Collaborate with ONC to promote interoperability and ensure standardized digital data elements for quality measures through USCDI and USCDI+.

* Fast Healthcare Interoperability Resources - defines how healthcare information can be exchanged between different computer systems regardless of how it is stored in those systems. **The Beneficiary Claims Data API (BCDA) gives organizations the insights they need to provide high quality, coordinated care. BCDA uses the FHIR® standard as a simple, flexible, and effective way for Medicare Shared Savings Program, ACO REACH, and other Alternative Payment Model participants to receive Medicare Part A, B, and D claims.

Our HIE Optimization platform will enhance your EHR and help you achieve the most effective referral pathways to exchange clinical data, which will help you meet requirements, and improve your PI score and your entire Referral Network.

Understanding the financial implications of HIE Compliance helps in making the decision on whether to invest in optimization services or stay the course with your vendor, or your own efforts very easy.

Take a few moments to download our supporting materials.

• NQS 2024 (pdf).
• Advancing Healthcare Safety for All 2024 (pdf).
• CMS Optimizing Care Delivery Framework 2025-2030 (pdf).
• New CMS Rules Advancing Interoperability Article (pdf).

Our Provider Partner is a MACRA & HIE expert and CMS Certified Clinical Qualified Registry that specializes in the processes of MIPS, the QPP & MACRA, and HIE Optimization for financial ROI.

They support thousands of independent and hospital-based physicians & clinicians, multi-TIN organizations, and ACOs and their Member TINs. As a Certified Clinical Qualified Registry their a CMS approved entity that collects clinical data from MIPS eligible TINs, physicians, and clinicians (both as individuals and groups) and submits it to CMS on their behalf for purposes of MIPS (reporting options are limited to measures within MIPS and the Quality Payment Program).

They possess a knowledgeable team of people that handle all necessary tasks and provide frequent reporting and useful analysis.

In a 30-60-minute Zoom call we will talk about the simple enrollment. A reasonable fee applies.

Take a moments to download our NCND. Complete and email it to: support@livewellaps.com. Then reserve your Zoom call with us.

1. Click Here to download our Mutual NCND (pdf). We are NOT data miners. Your info will be kept strictly confidential. We will also be sharing proprietary and confidential information with you on the Zoom call.
2. Click Here to go to our Calendly page to reserve your Zoom call (complete the required fields and when asked “purpose of call,” click: HIE Optimization).