Merit-Based Incentive Payment System (MIPS)

MACRA replaced three Medicare reporting programs with MIPS (Medicare Meaningful Use, the Physician Quality Reporting System, and the Value-Based Payment Modifier).

Under the combination of the previous programs, you would have faced a negative payment adjustment as high as 9% total in 2019, but the MACRA ended those programs, reduced the potential negative payment adjustments in the early years, and streamlined the overall requirements. While these three programs will end in 2018, if you have participated in these programs in the past, then you will have an advantage in MIPS because many of the requirements should be familiar.

To check if you need to submit data to MIPS, enter your 10-digit National Provider Identifier (NPI) number in the link below,

https://qpp.cms.gov/participation-lookup

MACRA defined four performance categories for MIPS, linked by their connection to quality and value of patient care.

Quality : Replaces the Physician Quality Reporting System (PQRS)

Most participants: Report up to 6 quality measures, including an outcome measure, for a minimum of 90 days.

Groups using the web interface: Report 15 quality measures for a full year. To submit data as a group through the CMS Web Interface, you must register your group between April 1, 2017 and June 30, 2017.

Groups in APMs qualifying for special scoring under MIPS, such as Shared Savings Track 1 APM or the Oncology Care Model one-sided risk APM: Report quality measures through your APM. You do not need to do anything additional for MIPS quality.

Advancing Care Information : Replaces the Medicare EHR Incentive Program, also known as Meaningful Use

Fulfill the required measures 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 9 measures for a minimum of 90 days for additional credit.

For bonus credit, you can:

    Report Public Health and Clinical Data Registry Reporting measures

    Use certified EHR technology to complete certain improvement activities in the improvement activities performance category

OR

You may not need to submit advancing care information if these measures do not apply to you.

Improvement Activities : New category

Most participants: Attest that you completed up to 4 improvement activities for a minimum of 90 days.

Groups with fewer than 15 participants or if you are in a rural or health professional shortage area: Attest that you completed up to 2 activities for a minimum of 90 days.

Participants in certified patient-centered medical homes, comparable specialty practices, or an APM designated as a Medical Home Model: You will automatically earn full credit.

Participants in certain APMs under the APM scoring standard, such as Shared Savings Program Track 1 or OCM: You will automatically receive points based on the requirements of participating in the APM. For all current APMs under the APM scoring standard, this assigned score will be full credit. For all future APMs under the APM scoring standard, the assigned score will be at least half credit.

Cost : Replaces Value-Based Modifier

No data submission required. Calculated from adjudicated claims.

Retrieved from https://qpp.cms.gov/