The Merit-based Incentive Payment System is something that is mystifying to some medical care providers. This value-based payment model uses reporting data from the clinician and other data to determine if the provider qualifies for a payment adjustment upward or downward.
The requirements for the MIPS system are covered under the Medicare Access and CHIP Reauthorization Act of 2015, which was the bipartisan effort to overhaul the Medicare system. The goal is to get providers to focus more on quality of care than on quantity of patients moving through the office.
The Final Rule for MACRA and MIPS provides a clear set of qualifiers for clinicians who voluntarily participate the in the program. Each year, the final rule for the following year is issued in November. This gives medical professionals two months to get ready for the updated reporting requirements.
These reporting requirements are one of the points of the Quality Payment Program for 2018 that is concerning for practitioners. The good news is that there are tiered requirements this coming year that enables those just coming into the program to enjoy some of the benefits of it without having to meet stringent reporting requirements.
The final rule for 2018 also provides small practices with greater benefits. First, practices that have less than $90,000 in allowed Medicare Part B charges or have fewer than 200 Medicare beneficiaries are exempt from MIPS.
Around 80 percent of small practices are expected to have a positive or neutral pay adjustment in 2018. Practices with up to 15 clinicians can get 5 points just by reporting in one MIPS category. Furthermore, practices with up to 10 clinicians can submit all data as one entry if they team up. The location and specialty don’t have any part in this ability.
Of the four areas measured, two require only 90-day reporting. These two are Improvement Activities and Advancing Care Information. Practices will be happy to learn that you can still use electronic health record programs that was certified in 2014 or 2015; however, you can enjoy incentives if you opt to upgrade to a more recent certified system. Cost is another area, but this one is determined automatically by CMS. The final area, Quality, requires a full year of reporting this year.
Finally, if you want to avoid a negative adjustment for 2018, you will need to accumulate 15 points. This is a big increase from the 3 points that was required to avoid the negative adjustment in 2017.