Revenue Cycle Management Blog | GroupOne Health Source

A Cheat Sheet to the Merit-Based Incentive Payment System [Infographic]

Written by Jeff Jones, CPHP | February 17, 2017

Are you eligible for MIPS? With 2017 being the first performance year, it's imperative that you know how the Merit-based Incentive Payment System could affect your revenue cycle management.  We put together a cheat sheet to help you understand your participation options with MIPS in 2017 and the financial impact it could have on your revenue cycle in the coming years.

What is MIPS?

The Merit-based Incentive Payment System (MIPS) was created by the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 to streamline multiple value-based programs including Meaningful Use (MU), Physician Quality Reporting System (PQRS) and Value-Based Modifier (VBM).

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.

 

 

How Will MIPS Be Scored?

Starting Jan. 1, 2017, Medicare Part B eligible providers (EPs) will be measured annually in four performance categories to derive a MIPS score between 0 and 100.

That score will determine positive, neutral, or negative adjustments to each provider’s annual Medicare reimbursement.

The four MIPS performance categories and associated point values for the 2017 performance year are:

  • Cost (0 points)
  • Clinical Practice Improvement Activities (15 points)
  • Advancing Care Information (25 points)
  • Quality (60 points)

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.

[Also: Is Your Brand at Risk? How MIPS Can Impact Physician Brand]

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.