Medicare Part B clinicians billing more than $30,000 a year AND providing care for more than 100 Medicare patients a year.
Exemptions from MIPS include:
The low-volume threshold is calculated at the participation level of the EC. If reporting as a group, the low-volume threshold would be calculated at the group level. If reporting as an individual, the lowvolume threshold would be calculated at the individual level.
CMS will calculate an EC’s low-volume threshold status using two sets of claims data. For the 2017 performance period, the first data set will include claims data from September 1, 2015, to August 31, 2016.
The second data set will include claims data from September 1, 2016, to August 31, 2017. CMS will not change the low-volume status of ECs who fall below the low-volume threshold during the first review period, but not the second.
Our goal is to help physicians document all the diseases for Medicare Audit compliance, which will result in the appropriate RAF score for each patient. This will in turn improve your CMS 5 Star/HEDIS measures
The MIPS is based on the FFS model with a direct tie to quality performance. You earn a payment adjustment based on evidence-based and practice-specific quality data. You show you provided high quality, efficient care supported by technology by sending in information in the following categories.
MIPS consolidates 3 existing reporting systems—the Physician Quality Reporting System (PQRS), the Physician Value-based Payment Modifier (VBPM) and the Medicare Electronic Health Record Incentive Program (also known as "Meaningful Use")—into a single program for performance assessment. It also includes a new improvement activities category.
|CATEGORY||PREVIOUSLY CALLED AS|
|Advancing Care information (ACI)||Replaces Meaningful use (Medicare EHR Incentive Program)|
|Improvement Activities (IA)||-|
|Cost||Replaces Value-Based Modifier|
The cost category will be calculated in 2017, but will not be used to determine your payment adjustment. In 2018, cost category will be used to determine your payment adjustment. Based on their performance in these four categories, physicians and eligible providers will receive a payment adjustment. The payment adjustment will be capped at +/- 4 percent in 2019, rising to +/- 9 percent in 2022 and subsequent years.
Final Score = (Quality Score*Quality Weight) + (ACI Score*ACI Weight) + (IA Score*IA Weight) + (Cost Score*Cost Weight)*100
|FINAL SCORE||PAYMENT ADJUSTMENT|
|70 or more points||Positive Adjustment and Eligible for Performance Bonus|
|4-69 points||Positive Adjustment and NOT Eligible for Performance Bonus|
|3 points||Neutral Payment Adjustment|
|0 points||Negative Payment Adjustment of -4%|
If you send MIPS data in as an individual, your payment adjustment will be based on your performance. An individual is defined as a single National Provider Identifier (NPI) tied to a single Tax Identification Number. The ACI and IA categories will include attestation options.
You’ll send your individual data for each of the MIPS categories through an electronic health record, registry, or a qualified clinical data registry. You may also send in quality data through your routine Medicare claims process.
If you send your MIPS data with a group, the group will get one payment adjustment based on the group’s performance. A group is defined as a set of clinicians (identified by their NPIs) sharing a common Tax Identification Number, no matter the specialty or practice site. Groups will also be able to attest for the ACI and IA performance categories.
Your group will send in group-level data for each of the MIPS categories through the CMS web interface or an electronic health record, registry, or a qualified clinical data registry. To submit data through our CMS web interface, you must register as a group by June 30, 2017.