Do you have to MIPS in 2017? CMS has a tool for that


Want to know if Medicare’s Merit-based Incentive Payment System (MIPS) is in your future?

The Centers for Medicare & Medicaid Services launched a Web tool on May 9. To see if you must participate in MIPS in 2017, just enter your national provider identifier. The agency is also in the process of mailing letters to update physicians on their status. The Web tool can be found at the CMS website.

MIPS is one of two tracks in the Quality Payment Program, the value-based payment initiative created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Participants in MIPS have the potential to earn bonuses for delivering higher value care and will face penalties only if they do not submit any data that are required from participants. The first performance-based payment adjustments begin Jan. 1, 2019.

Physicians who bill Medicare Part B more than $30,000 and see more than 100 Medicare patients must participate in MIPS this year. That threshold will be determined by means of claims submitted Sept. 1, 2015, through Aug. 31, 2016, and Sept. 1, 2016, through Aug. 31, 2017.

Those who don’t meet those criteria but want to participate may do so, but they won’t receive either a bonus or a penalty.

Under the MIPS “pick your pace” option, physicians who meet the threshold but are not ready to participate for either the 90-day period or the full year can report on one measure for 2017. Data on the lone measure need to be submitted to CMS no later than March 31, 2018.

Data need only be submitted for one patient, and, in 2017, all forms of submission – via registry, electronic health record, administrative claims, or attestation – are acceptable, though options may vary based on the performance option selected. Doing this minimum effort will result in no adjustment to Medicare payments in 2019.

Submitting no data at all for 2017, however, will mean a 4% Medicare pay cut in 2019.

To do the bare minimum to avoid any penalty, select a single data measurement from one of three categories: quality measures, improvement activity, or, in the case of Advancing Care Information, four or five base measures, depending on which certified EHR is being used.

There are 271 quality measures from which to choose, as well as 92 improvement activities. Improvement activities focus on care coordination, patient engagement, and patient safety.

For each measure, there is a downloadable spreadsheet that gives detailed information about the measure and how to meet it. The spreadsheet can also be used by physicians to track the data that are collected for submission.

Physicians who are new to Medicare in 2017 do not have to participate in MIPS in 2017.

Another way to be exempt from MIPS is to participate in the Advanced Alternative Payment Model track of the QPP. Doctors participating in APMs will have the opportunity to earn higher payment bonuses but will have to assume more risk and could see payment reductions if quality and value thresholds are not met.

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