MRO Viewpoints

One of the most important tools utilized by payers across the country is the Health Effectiveness Data and Information Set (HEDIS), which is maintained by the National Committee for Quality Assurance (NCQA). HEDIS is a measurement set used to determine the efficacy of...

If you’re participating in the Merit-based Incentive Payment System (MIPS) or MIPS Value Pathways (MVPs), you’ve likely encountered a familiar scenario: you review your estimated MIPS score in your dashboard, only to find that months later, when CMS releases the final...

Internal audits and monitoring are essential practices to ensure coding and billing compliance, protect revenue, and defend against payer audits and clinical denials. However, with limited time and resources, it becomes impossible to internally review every physician,...

As healthcare moves deeper into the digital age, the seamless exchange of clinical data between health systems and payers has become increasingly critical. Earlier this year, MRO in collaboration with the College of Healthcare Information Management Executives...

What is FHIR? The HL7® FHIR® (Fast Healthcare Interoperability Resources) standard is the accepted standard for exchanging healthcare information, regardless of how or where the information is stored. By enabling secure access to both clinical and administrative data,...

Value-based care (VBC) is not new. The concept began in the 1980s with the introduction of managed care and capitation models, where providers were paid a set amount per patient rather than per service. However, it gained significant traction in the early 2000s and...

In the rapidly evolving landscape of healthcare, staying ahead of regulatory changes and quality reporting requirements is crucial for both Accountable Care Organizations (ACOs) and clinicians participating in the Quality Payment Program (QPP). The Centers for...

In the dynamic landscape of healthcare, where quality care and cost-effectiveness are paramount, initiatives like the Medicare Shared Savings Program (MSSP) play a pivotal role. As healthcare providers strive to deliver better outcomes while managing costs,...

As the healthcare landscape continues to evolve, so do the challenges and opportunities presented by CMS’ Quality Payment Program (QPP). Since its inception in 2017, QPP has become increasingly complex, making it harder for providers to avoid penalties and maximize...