IS YOUR PRACTICE READY FOR PERFORMANCE-BASED MEDICARE REIMBURSEMENTS?
In 2015, the US Senate voted (98-2) to permanently repeal the Medicare Part B Sustainable Growth Rate (SGR) reimbursement formula and passed the “Medical Access and CHIP Reauthorization Act of 2015” creating a new, pay-for-performance Medicare reimbursements program, called the, Merit-Based Incentive Payment System (MIPS)
WHAT IS MIPS?
Effective January 1, 2019, the “Meaningful Use” (MU) Electronic Health Record Incentive Program, Physician Quality Reporting System (PQRS), and Value-Based Modifier (VBM) program will be consolidated into the new MIPS program. MIPS will merge measurement and reporting tools, along with claims-based financial records. MIPS applies to Medicare Part B clinicians, including physicians, physician assistants, nurse practitioners, clinical nurse specialist, and certified registered nurse anesthetists.
HOW DOES MIPS WORK?
A provider’s “MIPS score,” is rated on a scale from 0 to 100, and significantly influences your Medicare reimbursement payments each year. There are four categories that comprise the score: VBM-measured resource use (claims data), VBM-measured quality (PQRS data), Meaningful Use (EHR data), and the newly introduced “clinical practice improvement” measure.
MIPS 2017 Score Components
- QUALITY 50%
- ADVANCING CARE INFORMATION 25%
- RESOURCE USE 10%
- CLINICAL PRACTICE IMPROVEMENT ACTIVITIES (CPIA) 15%
The 2019 payment adjustment – your 2019 Medicare reimbursement-- will be based on your 2017 performance under the new MIPS scoring model. Each eligible professional’s MIPS score and individual category scores will be made publicly available the Physician Compare website.