Date: Nov. 7, 2016
Contact: , | 800-288-2818 | info@MedicMgmt.com
On October 14, 2016 CMS released the final rule for the Quality Payment Program (QPP). The QPP for 2017 includes two payment tracks: Advanced Alternative Payment Models (APM) and Merit Based Incentive Program (MIPS).
Currently, Medicare measures the value and quality of care provided by doctors and other clinicians through a mixture of programs, including the Physician Quality Reporting System (PQRS), the Value Modifier Program, and Meaningful Use. Through the law, Congress streamlined and improved these programs into one new Merit-Based Incentive Payment System (MIPS). CMS projects the majority of participants will be embracing the QPP via MIPS.
MIPS has three categories for 2017:
Clinical Practice Improvement Activities (CPIA) = 15%
Advancing Care Information (ACI) (formerly Meaningful Use) = 25%
Quality (formerly PQRS/VBM) = 60%
Please keep in mind that every point counts in MIPS. Increase your participation in each category by selecting extra measures and exceeding thresholds. If you are currently meeting the 2016 PQRS and Meaningful Use requirements, continue to do so. MIPS participation in these categories for 2017 are much lower than 2016. You can do it!
If you were familiar with the proposed rule, there was a fourth category called Cost/Resource that was weighted at 10%. The final rule has removed this category for 2017 and increased Quality from 50% to 60%. The cost/resource category will be back in 2018.
Pick Your Pace:
Under the final rule, 2017 will be a transition year for the program. The rule finalizes a period during which clinicians and CMS will build capabilities to report and gain experience with the program. Clinicians can choose their course of participation in 2017 with four options:
1. Don't report anything
2. Report one measure in Quality, one measure in CPIA, OR all required measures for ACI
3. 90 day reporting on most measures
4. Report 90 days+ on all measures (Aim for full year reporting to get the most bonus potential)
Who is Eligible to Participate under MIPS?
YEARS 1 and 2 (2017 & 2018)
Who is NOT Eligible to Participate under MIPS?
CMS also has changed the definition of “hospital-based” clinicians (who are not required to submit data under the ACI component) to include those clinicians who perform at least 75% of covered professional services in a hospital inpatient, on-campus hospital outpatient, or emergency department setting. CMS will make this determination based on claims for a specified period prior to the performance year.
Additionally, non-physician practitioners – regardless of where they practice – may elect not to submit data under the ACI component, in which case it will be re-weighted as 0%. CMS has recognized these clinicians may require additional time to meet the requirements of the ACI component, given they were not subject to the Meaningful Use program.
MIPS Scoring and Payments:
Depending on the “Pick Your Pace” option you choose to participate - the Composite Performance Score (CPS) would be used to determine whether a MIPS Eligible Clinician receives:
Need guidance on success? Ask yourself these questions:
For more information on MIPS, contact us by email: info@MedicMgmt.com or phone: 800-288-2818
You can also reference the CMS website: QPP.CMS.GOV