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Get Ready for MIPS in 4 Steps

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  • December 14, 2016
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Get Ready for MIPS in 4 Steps

Are you ready for the first performance year of the Merit-based Incentive Payment System (MIPS)? Do you even need to get ready? The Centers for Medicare & Medicaid Services conducted a webinar on Nov. 29 that lays it all out for you in four steps.

1. Determine your eligibility status.

In 2017, you are a MIPS-eligible clinician if you are a physician, physician assistant, nurse practitioner, clinical nurse specialist, or certified registered nurse anesthetist who provides care for more than 100 Medicare patients and bills Medicare Part B more than $30,000 a year.
Exceptions are:

  • If you enroll in Medicare during the performance year;
  • Bill Medicare Part B less than $30,000 a year or see less than 100 Medicare Part B patients a year;
  • Receive 25 percent of your Medicare payments or see 20 percent of your Medicare patients through an advanced alternate payment model (APM).

Non-patient-facing clinicians are eligible to participate in MIPS as long as they do not quality for any of these exceptions.

2. Gauge your readiness and pick your pace.

If you do nothing, you will receive a negative 4 percent payment adjustment to your Part B claims in 2019. CMS has made it very easy to participate at your comfort level so you can avoid the reduction. You have three choices:

  1. Submit something.

Avoid a downward adjustment by submitting one Quality measure, one Improvement Activity, or four to five Advancing Care Information measures (depending on the edition of certified electronic health record technology you’ll use).

  1. Submit a partial year.

Depending on performance, you may earn a positive payment adjustment by submitting 90 days of 2017 data to Medicare. You’ll need to report on at least six Quality measures, including at least one outcome measure. The 90-day performance period can start any time between Jan. 1, 2017 and Oct. 2, 2017.

  1. Submit a full year.

Depending on performance, you may earn a positive payment adjustment in 2019 by submitting a full year of data. You will need to report on at least six Quality measures, including at least one outcome measure, for the full year.
All performance data must be submitted to Medicare by March 31, 2018.

3. Decide whether to participate as an individual or in a group.

Your decision will determine your reporting options. Groups are given a couple of additional avenues for reporting Quality and Advancing Care Information measures.

4. Assess your feedback.

The Quality Resource and Use Reports (QRURs) released on Sept. 26, 2016, is being used as the first MIPS performance feedback. Physicians and physician groups are encouraged to review their quality and cost information.
After you take these steps, review the three performance categories (Quality, Advancing Care Information, and Improvement Activities) and select the measures/activities on which you will report, based on practicality. Positive adjustments are based on the quality of data you submit, not the quantity, so choose wisely.

CMS Webinar, The Merit-based Incentive Payment System Overview, Nov. 29, 2016

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Renee Dustman, BS, AAPC MACRA Proficient, is managing editor - content & editorial at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 30 years' experience in journalistic reporting, print production, graphic design, and content management. Follow her on Twitter @dustman_aapc.

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  1. Janeen Bryan says:

    Where do you go to learn all the new information?