About the Merit-Based
Incentive Payment System (MIPS)
On April 27, 2016, CMS released the proposed rule for one
of the most bipartisan and significant legislative changes to Medicare in a
generation, the so-called "doc fix" bill or “MACRA,” which repeals
the Medicare Part B Sustainable Growth Rate (SGR) reimbursement formula and
replaces it with a new value-based reimbursement system called the Quality
Payment Program (QPP). The QPP consists of two tracks: the Merit-based
Incentive Payment System (MIPS) and Advanced Alternative Payment Models
(Advanced APMs). Each Medicare Part B clinician is in MIPS, an Advanced APM,
both, or neither (regular fee-for-service). CMS predicts that most Part B
clinicians will be subject to MIPS, as MIPS is effectively the “new default”
for Part B where clinicians are exempt from MIPS only under several conditions.
What is MIPS?
MACRA combines the existing Medicare Meaningful Use (MU),
Physician Quality Reporting System (PQRS), and Value-Based Modifier (VBM)
programs into MIPS, starting with the CY2017 performance year.
MIPS payment adjustments are applied to Medicare Part B
payments two years after the performance year, with CY2019 being the payment
adjustment year for the CY2017 performance year.
MIPS defines four categories of eligible clinician
performance, contributing to a MIPS composite performance score (CPS) of up to
100 points (relative weights are indicated for the CY2017 performance year and
associated CY2019 payment year):
·
Quality (50%)
·
Advancing Care Information (ACI, renamed from
Meaningful Use) (25%)
·
Clinical Practice Improvement Activities (CPIA)
(15%)
·
Resource Use (10%)
Although MIPS inherits much from the MU, PQRS and VBM
programs, historical high performance or penalty avoidance under the existing
programs does not guarantee the same under MIPS.
MIPS essentially adopts the quality measures and
reporting methods from the PQRS and VBM programs.
Understanding and preparing for the upcoming changes
requires resources that a provider or organization may not have. For providers to place the responsibility of
compliance solely on their EHR system
is a grave mistake.
For providers to have a successful practice and meet all
the quality measures required, physicians need to review what is required of a
patient before the visit and determine if the physician has coded correctly to
qualify each measure when submitting the claims.
Unlike your EHR
system , Accuchecker will determine the service or measure that is needed
for that patient prior to the visit
and it will scrub your claim prior
to submission. Physicians today spend
too much time on administrative issues , and today you have the one tool that
will guide you to success in meeting the quality measures required.
For more details on the Scrubber from AccuChecker please
contact :
305-227-2383 1-877-938-9311 786-2317585
