Understanding MIPS

MIPS chartThe Department of Health and Human Services (HHS) has issued its final rule for Medicare Access and CHIP Reauthorization Act (MACRA) and the implementation of the Quality Payment Program. This legislation will reform Medicare reimbursement for more than 600,000 clinicians across the US. Eligible healthcare providers include Physicians, Nurse Practitioners, Clinical Nurse Specialists, and Certified Registered Nurse Anesthetist that bill more than $30,000 to Medicare and provide care for over 100 Medicare patients per year.
Eligible providers may choose which program they choose to participate in based on practice size, specialty, location or patient population. There are two options for provider participation: Merit-Based Incentive Payment System (MIPS), and the Advanced Alternative Payment Model (APM).

What is the Merit-Based Incentive Payment System?
The Merit-Based Incentive Payment System (MIPS) is a program that determines Medicare payment adjustments. Eligible providers that participate in MIPS will earn a performance-based payment adjustment to their Medicare payment. The payment adjustment will be based on evidence-based and practice-specific quality data. CMS estimates approximately 500,000 clinicians will be eligible to participate in the first year of the program.

What are the Medicare reimbursement adjustments?
Based on performance in 2017, providers will see a positive, neutral, or negative adjustment of up to 4% to Medicare payments for covered professional services furnished in 2019. This adjustment percentage grows to a potential of 9% in 2022 and beyond.

How is MIPS reporting program structured?
MACRA replaced three of the previous Medicare reporting programs (Meaningful Use, the Physician Quality Reporting System, and the Value-Based Payment Modifier) and defined four new performance categories for MIPS:

  • Quality (Physician Quality Reporting System(PRQS)/CAHPS) (60% for 2017) Most participants must report up to six (6) quality measures, including an outcome measure, for a minimum of 90 days. Groups using the web interface must report 15 quality measures for a full year.
  • Advancing Care Information (Meaningful Use) (25% for 2017) Participants must meet the following requirements for a minimum of 90 days:
    • Security Risk Analysis
    • e-Prescribing
    • Provide Patient Access
    • Send Summary of Care
    • Request/Accept Summary of Care
    • Choose to submit up to nine (9) measures for a minimum of 90 days for additional credit.

  • Improvement Activities (New category) (15% for 2017) Most participants must attest to having completed up to four (4) improvement activities for a minimum of 90 days. Groups with fewer than 15 participants or if participants in a rural or health professional shortage area must attest to having completed up to two (2) activities for a minimum of 90 days.
  • Cost (Value-Based Modifier) (0% for 2017), no data submission required. Calculated from adjudicated claims and will be weighted for 2018

    On-Demand Video Demo of M3 Patient Experience

Futher Reading: https://qpp.cms.gov/docs/Quality_Payment_Program_Overview_Fact_Sheet.pdf 

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