Provider Quality Incentive & Care Management Programs

At Emrsive Medical Billing Solutions, we help healthcare providers navigate the complexities of quality incentive programs and care management initiatives. Our expert team offers comprehensive consultation, implementation, review, and audit services tailored to enhance provider performance and patient outcomes. By focusing on quality improvement, we ensure that your practice meets the stringent requirements of these programs, leading to increased reimbursements and overall success.

We assist in understanding, deploying, and optimizing the following key programs

  • Quality Payment Program (QPP): MIPS
    The Merit-based Incentive Payment System (MIPS) is designed to reward providers based on quality, cost, improvement activities, and the use of electronic health records. We guide you through each step, ensuring compliance and maximizing your performance scores.
  • Care Management Programs: CCM, RPM, BHI
    Chronic Care Management, Remote Patient Monitoring, and Behavioral Health Integration support. Our team helps implement these programs to improve patient outcomes and increase provider reimbursements by promoting continuous, coordinated care.
  • Quality Measurement and Improvement Programs: HEDIS, PCMH
    The Healthcare Effectiveness Data and Information Set and the Patient-Centered Medical Home standards emphasize quality care and patient satisfaction. We offer consulting and review services to help you meet these criteria, demonstrating excellence in healthcare delivery.

Quality Payment Program (QPP)

MIPS and the MVPs

The Merit-based Incentive Payment System (MIPS) is a vital component of the Quality Payment Program (QPP) under MACRA, linking Medicare reimbursement adjustments to provider performance. At Emrsive, we offer expert consultation for both Traditional MIPS and the new MIPS Value Pathways (MVPs), empowering providers to enhance their performance while ensuring compliance with reporting requirements and avoiding penalties in Medicare reimbursement.

Our services include assistance in managing QPP and HARP accounts, support for filing exceptions for small practices, and guidance on meeting specialty-specific quality measures and electronic clinical quality measures (eCQMs). By partnering with Emrsive, healthcare providers can confidently navigate the complexities of the MIPS program, align with the unique demands of their field, and ultimately maximize their performance and financial incentives.

Care Management Programs

CCM, RPM, BHI

Care Management Programs such as Chronic Care Management (CCM), Remote Patient Monitoring (RPM), and Behavioral Health Integration (BHI) enable providers to offer proactive, continuous care for patients. These programs are supported by both government and private payers. Emrsive assists in the implementation and optimization of these services, ensuring that both physical and mental health needs are addressed. Our approach helps you deliver value-based care while increasing reimbursements from diverse payer sources.

Quality Measurement and Improvement Programs

Optimize Healthcare Outcomes with Comprehensive HEDIS Management

At Emrsive, we provide specialized HEDIS (Healthcare Effectiveness Data and Information Set) services to help your practice meet quality care benchmarks and maximize incentive opportunities. Our expert team ensures streamlined reporting, effective gap closure, and improved patient outcomes while maintaining strict compliance with HEDIS standards.

Key Services:

HEDIS Gap Closure & Reporting

  • Identify and close care gaps through accurate data reporting.
  • Integrate with EHR systems for seamless data collection.
  • Generate regular care gap reports for payers like Health First, Fidelis, and UHC.

Supplemental Data Submission

  • Ensure timely and accurate submission of supplemental data to health plans.
  • Enhance chances of achieving HEDIS incentives with complete reporting on preventive care and chronic disease management.

Workflow Optimization

  • Integrate HEDIS codes into daily operations to capture all quality indicators.
  • Provide ongoing staff training and support for compliance.

Data Analytics & Performance Improvement

  • Monitor HEDIS performance with detailed analytics and monthly reporting.
  • Offer custom recommendations to improve quality scores and close care gaps.

Patient Outreach & Engagement

  • Implement personalized outreach campaigns to engage patients in preventive care.
  • Schedule reminders for screenings and follow-up appointments