Reporting MIPS, Medicare’s “Merit-based Incentive Payment System” is Easier Than You Think


MACRA-MIPS has been with us since January and this year’s data will determine your penalty/bonus in 2019.  This applies to all your outpatient Traditional Medicare revenue.  The penalty starts at 4% and increases to 9% over the next 5 years.  For a practice with $200,000 in Medicare revenue, this would be $8,000 this year to $18,000 in 2023.

Many doctors have accepted the penalty because they don’t want to spend time and money addressing another burdensome government regulation.  They feel the money is not worth the effort and stress to comply.  They are overwhelmed with all the changes occurring in healthcare and they have chosen to ignore this particular burdensome regulation.

In June 2017, CMS updated the MACRA-MIPS regulations, and one of the most important measures was to allow providers to report only Quality data, this year, to avoid the penalty.  In this article, I will show you how to report that data and then how to develop a plan for 2018 to protect money for 2020 and forward.

MACRA-MIPS has four components, Quality, Advancing Care Information (ACI), Clinical Practice Improvement and Utilization  

The Quality requirement is similar to PQRS, ACI is similar to Meaningful Use (MU) and Clinical Practice Improvement is new.  Utilization is determined from billing data which you submit through your billing service.

Quality Data can be reported using a service like MDinteractive.  For $199 per year, they provide all the tools and information you need to handle MIPS.  They are the number two CMS Qualified Medicare Registry, and they provide one- stop shopping for submitting Quality, Advancing Care Information, and Improvement Activity data to CMS to fulfill requirements of the Merit-based Incentive Payment System (MIPS).  I would recommend finding a service like this to use as your reporting platform.

Why is avoiding the penalty so easy?

Because you are probably already doing what MIPS requires and all you have to do is report it.  The quality requirement is 6 quality measures that you select from a menu of 50 choices.  Your six simple quality measures can include HgA1C and Eye Exam in diabetics, ACE/ARB in heart failure patients and Flu Shot, Mammogram and Colonoscopy for all patients.  There are many others to choose from and you should choose what you already do and chose metrics that will be simple and easiest for you to report.

In our next article, we will discuss Advancing Care Information, Clinical Practice Improvement Activities and Utilization metrics.  Right now, your best use of time would be to study the quality metrics and see if you can report something for 2017 to avoid the penalty this year.  Look into a qualified Medicare registry like MDinteractive to help. Remember that MIPS is graded on a “curve”, so all you have to do is be better than your peers.  In 2017, this will be easy since most doctors are ignoring MIPS.  Good luck!

Jeffrey E. Epstein, MD is double boarded in geriatric medicine and general internal medicine.  For the last 7 years, he has been a hospital medical director working in the area of documentation, compliance and operations.  He has studies MACRA-MIPS in great detail and is staring a company that does Annual Wellness Visits on Medicare Patients.  His company partners with physician practices to get the AWVs done.  Once an AWV is done, all elements of MACRA-MIPS can be reported for maximal bonus and physician’s professional reputation soars because of the quality reporting that the do.

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