Revenue Cycle Management Blog | GroupOne Health Source

A Beginners Guide to the Merit Based Incentive Payment System (MIPS)

Written by Jeff Jones, CPHP | January 16, 2017

As of January 1, 2017, the first performance period for the new Merit-based Incentive Payment System (MIPS) is officially underway for eligible physicians. The new payment system aims to change how physician services are paid by moving away from fee-for-service payments to performance-based payment adjustments. Depending on the data you submit by March 31, 2018, your 2019 Medicare payments could be adjusted up, down, or not at all.

MIPS is touted to become one of the most historic legislative changes to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and is why physicians should start grasping how physician reimbursement will be affected in 2019.

[Also: New CMS Study Helps EPs Receive Full Credit in MIPS CPIA Category]

What is MIPS?

If you opt to take part in MIPS, your Medicare Part B payment amounts will be based on your performance and the value you give to your patients.

MIPS value metrics will be measured in four categories: quality, cost, advancing care information, and improvement activities.  

According to CMS, nearly 600,000 clinicians will participate in MIPS under the Quality Payment Program.

The Quality Payment Program has two tracks to choose from: the Advanced Alternative Payment Models (APMs) or the Merit-based Incentive Payment System (MIPS). To learn more about APMs, visit here.

If you choose to participate in the Merit-based Incentive Payment System, you will be responsible for sending accurate data by the following deadlines to earn a positive Medicare payment adjustment by 2019:

  •     October 2, 2017: Eligible Providers have until October 2, 2017 to begin recording quality data and how technology was used in their practice to improve performance.
  •     March 31, 2018: Send performance data for MIPS and receive feedback on your performance from CMS within the same calendar year.
  •     January 1, 2019:  Positive MIPS payment adjustments begin January 1, 2019 if you submit your 2017 data by March 31, 2018.

Please note, the following groups are not eligible to participate in MIPS:

  •     Physicians in their 1st year of Medicare Part B participation
  •     Physicians whose practice falls below the low patient volume threshold with Medicare billing charges less than or equal to $10,000 or if you provide care for 100 or fewer Medicare patients annually.

How can Practices Start Preparing for MIPS Today?

Now that the performance period for MIPS has officially begun, the sooner you put processes into place to collect performance data and adhere to MACRA guidelines, the better.

To adapt to the fast-moving changes, stay current with CMS legislative announcements pertaining to MIPS and educate your organization. A great place to start is the American Medical Association’s STEPS Forward program which offers online educational resources to help practices make the shift to value-based health care.

The “Preparing your practice for value-based care” module is ideal for beginners in that it includes the top five steps for success under the new payment model:

  •     Identify your patient population and opportunity: to see which patients are driving your highest cost of care.
  •     Design the care model: to have a plan and workflows in place to better adhere to the value-based care model.
  •     Partner for success: to get the resources you need through partnerships with other practices, hospitals, or other organizations.
  •     Drive appropriate utilization: to find ways to reduce costs while delivering high-quality service.
  •     Quantify impact and continuously improve: to track progress and achieve positive outcomes under the performance-based payment model.

To maximize your MIPS score, invest in the educational and tech resources you’ll need to avoid a negative payment adjustment in 2019 and beyond.

What Providers Need to Know to be Successful with MIPS

Value-based care is here and simply doing nothing will hurt your practice over the long term —  taking action today is the key to success under the new payment model.

Physicians who choose not to send performance data by the 2018 deadline will receive a negative payment adjustment. Eligible Providers (EPs) that decide to participate in MIPS should understand the flexible reporting options and how the size of payment received will depend on how much data you submit and performance results.

[Also: How to Pick Your Pace for the Quality Payment Program]

For example, you can avoid a downward payment adjustment of negative 4% just by reporting one quality measure or one improvement activity for a minimum of 90 days for any point in 2017.

If an Eligible Provider chooses to submit a partial year (90 days of 2017 data) then the EP may earn a neutral or positive payment adjustment.

EPs that submit a full year of 2017 data to Medicare will be more likely to avoid a penalty and earn a moderate positive payment adjustment.

Don’t risk taking a ding to your income due to not submitting performance data by the deadline. If you’re too overwhelmed to handle additional paperwork, a data analyst could help you streamline processes while saving you time and money in the long run.

In the early stages of MIPS, do your research, educate your team, make improvements, and collect performance data before the appointed MIPS deadline.

Your success under the value-based care model will depend heavily on the actionable steps you take today to protect your future income.

[Also: 4 Ways Small Practices Can Best Prepare for Value-Based Care]