I have been privileged to work with many practices and specialties, helping them navigate the very confusing Medicare Quality Programs. I wanted to leave you with a few tips for the 2018 reporting year:
- Remember that everything related to MIPS is based on standard Part B Medicare and does not include Medicare Advantage plans.
- Be sure to confirm if any of your providers are exempt from MIPS in 2018. The low-volume threshold was raised to $90,000 in Medicare allowables OR 200 unique Medicare patients during the time period 9/1/2016-8/31/2017. To check participation status, visit:
https://qpp.cms.gov/participation-lookup. Generally, a provider listed as exempt will not earn any payment adjustment (positive or negative). However, if the provider is listed as “Included in MIPS” for Group Reporting, and the practice chooses to report as a Group, then that provider’s data will be included and s/he will earn the same payment adjustment as others in the Group.
- The Advancing Care Information Category (previously Meaningful Use) has been renamed again to Promoting Interoperability or PI. Nothing else about the requirements or scoring in this category has changed, just the name.
- Quality data reported for 2018 must reflect the full calendar year of 2018. Data for the ACI/PI and Improvement Activities category can reflect any period of 90 days or longer during the calendar year.
- To avoid the penalty on 2020 Medicare payments, you must reach a threshold of 15 points (out of 100). Small practices that have 15 or fewer providers will automatically receive 5 points if they report any data in any category. With this bonus, providers in small practices can attain 15 points by reporting 4 quality measures on at least 1 Medicare patient each, or by reporting the base measures in the ACI category, or by reporting on 2 medium or 1 high-weighted improvement activity.
- The Cost category counts for only 10% of your score in 2018 and does not require any data submission. CMS will calculate your score based on 2018 Medicare claims data. In future years, the Cost category will grow to 30% of the total score. CMS will analyze 2017 data on the same cost measures to provide you historical results. Watch for these to be released over the summer.
- Enter your data and estimate your 2018 MIPS score with a free MIPS Estimator from Stratis Health: https://www.mipsestimator.org/.
- Where to look for additional help with MIPS:
- Your EHR vendor
- Your Specialty Society
- CMS: qpp.cms.gov – View the Help & Support Page and the Resource Library under About Tab; for specific questions call the helpdesk at 1-866-288-8912 or email to firstname.lastname@example.org.
- Mingle Analytics (mingleanalytics.com) assists practices with selecting measures, monitoring performance and is a Qualified Registry for reporting data to CMS.
- eHealthConsulting (https://www.ehealthconsults.com) offers educational classes and consulting services related to MIPS.