Merit-Based Incentive Payment System (MIPS)

CMS' Quality Payment Program Website

https://qpp.cms.gov

More information on the final rule (Updated 10/14/16): https://qpp.cms.gov/education

MACRA

MACRA (Medicare Access and Summary CHIP Reauthorization Act)

On April 27, 2016, the Department of Health and Human Services issued a Notice Executive of Proposed Rulemaking to implement key provisions of the Medicare Access and Summary CHIP Reauthorization Act of 2015 (MACRA), bipartisan legislation that replaced the flawed Sustainable Growth Rate formula with a new approach to paying clinicians for the value and quality of care they provide.

MACRA implements these changes through the unified framework called the “Quality Payment Program,”

The Quality Payment Program policy will:

  • Reform Medicare Part B payments for more than 600,000 clinicians
  • Improve care across the entire health care delivery system
  •  
    Clinicians have two tracks to choose from:

  • Merit-Based Incentive Payment System (MIPS): If you decide to participate in traditional Medicare, you may earn a performance-based payment adjustment through MIPS.
  • Advanced Alternative Payment Models (APMs): If you decide to take part in an Advanced APM, you may earn a Medicare incentive payment for participating in an innovative payment model.
  • MIPS

    MIPS streamlines three quality programs, Physician Quality Reporting System (PQRS), Value-based Payment Modifier (VBM), and Medicare Electronic Health Record Incentive Program (aka Meaningful Use), into one single program.

    MIPS Eligible Clinicians (EC) will be measured on:

  • Quality (Formerly PQRS)
  • Advancing Care Information (Formerly Meaningful Use)
  • Clinical Practice Improvement Activities (New on a national level)
  • Resource Use/Cost (Formerly VBM)
  • PQRS, Medicare MU, and VBM sunsetted on December 31. 2016. Payment adjustments under these quality programs will end at the close of 2018.
  •  

    MIPS 2017-2018 Eligible Clinicians

    Medicare Part B clinicians billing more than $30,000 a year AND providing care for more than 100 Medicare patients a year :

  • Physicians
  • Physician Assistants
  • Nurse Practitioner
  • Clinical Nurse Specialist
  • Certified Registered Nurse
  •  

    Who is excluded from MIPS?

    1. Newly-enrolled in Medicare - Enrolled in Medicare for the first time during the performance period (exempt until following performance year).
    2. Below the low-volume threshold - Medicare Part B allowed charges less than or equal to $30,000 a year OR see 100 or fewer Medicare Part B patients a year.
    3. Qualified Participant (QP) in an Advanced APM – QP receives a bonus payment for their participation in an Advance APM and are not subject to MIPS.

     

    MIPS Begins January 1st 2017!

    mips-pie-chart

    Resource Use/Cost category will not be factored into the EC composite score in 2017.

    An EC’s composite score (0-100 points) is the sum of points achieved for the identified performance categories.

    2017 MIPS Performance Threshold is set at 3 points

    EC’s composite score is compared to an overall MIPS performance threshold. Those who fall above the threshold will received a positive payment adjustment. Those who fall below the threshold will receive a negative payment adjustment. Those who fall on the threshold will receive a neutral payment adjustment.

    MIPS Payment Adjustments begin January 1st 2019.

     

    mips-payment-timeline

     

    2017 Exceptional Performance threshold is set at 70 points

    Eligible clinicians can earn up to an additional 10% if their 2017 composite score is above 70 points.

     

    Pick Your Pace for Participation for 2017

    Test Pace – Submit 90 continuous days of data on either one quality measure OR one CPIA OR the Base Score measures of the ACI to avoid a downward payment adjustment.

    Partial Year – Submit 90 continuous days of data on all required activities and measures in the 3 performance categories.

    Full Year – Submit a full year of data on all required activities and measures in the 3 performance categories.

    EC who do NOT participate will automatically receive a negative 4% payment reimbursement in 2019.

    MIPS data must be submitted by March 31, 2018

    WEBINARS

    Need MIPS help?  Attend or watch one of our webinars for MIPS assistance!

     

    Introduction to MIPS Webinar: (Based on the Proposed Rule)

    This webinar was the first in our series on MIPS and covered the basics of the program to give you a better understanding of the new Medicare quality payment model for physicians and how it will potentially affect your Medicare reimbursements.

    This series was held live from June through July 2016.  A recorded version of this webinar can be found on our YouTube page.

    MIPS: Steps to Take in 2016 Webinar:

    This was the second webinar in our series on MIPS which was aimed at providing information on what you need to do in 2016 to avoid 2018 payment penalties under Medicare. We reviewed the 3 current quality programs: Physician Quality Reporting System (PQRS), Value-based Modifier Program (VBM) and Meaningful Use (MU).

    This series was held live from August through September 2016. A recorded version  of this webinar can be found on our YouTube page.

    MIPS: Quality Performance Category Webinar: (Based on the Proposed Rule)

    This was the first webinar we held in a series related to the Performance Categories that make up MIPS.  This webinar is aimed at providing details on this heavily weighted category including how the Composite Performance Score is calculated, the differences between PQRS and this new Quality category and how to submit data.

    This series was held live from September through October 2016. A recorded version  of this webinar can be found on our YouTube page.

    MIPS: Advancing Care Information Performance Category Webinar: (Based on the Proposed Rule)

    This was the second webinar in a series related to the Performance Categories that make up MIPS.  This webinar is aimed at providing the differences between Meaningful Use and this new ACI category, measure details and exclusions available.

    This series will be held live from October through November 2016. A recorded version of this webinar is available on our YouTube page.

    MIPS: Clinical Practice Improvement Activities Performance Category Webinar: (Based on the Final Rule)

    This was the third webinar in a series related to the Performance Categories that make up MIPS. This webinar is aimed at providing information on this new program that focuses on practices goals to improve care coordination, beneficiary engagement and patient safety. It will also provide updates on changes to the quality and advancing care information categories as per the final rule.

    This series will be held live from October through November 2016. A recorded version of this webinar is available on our YouTube page.

    MIPS: Resource Use Performance Category Webinar: (Based on the Final Rule)

    This was the final webinar in a series related to the Performance Categories that make up MIPS.  This webinar is aimed at providing information on the differences between VBM and this category, how to submit data and the new episode-based measures.

    This series will be held live from November through December 2016. A recorded version of this webinar is available on our YouTube page.

    Why You Need STI’s Clinical EMR for MIPS Webinar:

    This webinar explained why you need an EMR to achieve MIPS requirements.  In order to avoid 2019 payment penalties under Medicare, certain data needs to be submitted to CMS. This data will need to come from your EMR.  We reviewed our MIPS Assistance Program, which is aimed at supporting you through this process.

    This series was held 3 times throughout September and October 2016.  A recorded version of this webinar is available on our YouTube page.

    MIPS: Setting Up Quality Measures

    This webinar will review the requirements for the Quality Performance Category; provide step by step instructions for setting up quality measures; and discuss how scoring is calculated. The Quality Performance Category is the most heavily weighted category of MIPS making up 60% of the Clinician’s composite score in 2017. We encourage all MIPS Eligible Clinicians who have not signed up for our MIPS Assistance Program to attend. >>> Register here

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