Big changes are coming to the way Medicare pays care delivered to its enrollees, and being well prepared will have a big impact on the revenue stream of individual doctors and healthcare providers. These changes come from the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), a law that implemented the Quality Payment Program. This program incentivizes healthcare providers to improve quality of care for patients through two tracks, one of which is the Merit-based Incentive Payment System (MIPS).
Who Qualifies for MIPS?
MIPS is a payment program that's designed to pay care providers more for what they should be doing best- providing high quality care for patients. Organizations will be part of the MIPS track, rather than APMs, depending on certain conditions. These include:
- Billing $30,000 or more for Medicare Part B
- Providing care for more than 100 Part B patients
- Treating Medicare patients for more than a year
- Not going above threshold for Advanced APM
Providers can check the current status of their participation in MIPS by visiting QPP.CMS.GOV. Clinicians who qualify should also receive a letter in the mail notifying them of their status.
Preparing for MIPS
Being prepared for participation in MIPS will improve chances of increasing revenue and avoiding penalties. Before the chosen reporting period begins for a provider, there are five steps they should take to ensure a smooth transition:
- Choose to submit data as an individual or group. Doctors will either be given a unique ID as an individual clinician or a group ID as part of an organization that pools data.
- Choose how data is submitted. There are several different mechanisms available, including the Qualified Clinical Data Registry (QCDR), Electronic health record (EHR), Qualifying registry, Claims, or CMS web interface.
- Verify reporting abilities. Providers should ensure that the method they choose to submit data actually works before their reporting period begins. Vendors of reporting systems should be able to verify whether records successfully reach CMS.
- Select measures and pick pace. Different measures work best for different practices, and clinicians can research their options according to their specialty by visiting the CMS website. They should also use their existing billing data and Quality and Resource Use Report to make their decision.
- Verify the elements and reporting periods required by the selected measures. If clinicians start collecting and submitting the right information right away, they'll avoid costly complications.
Ongoing Support for MIPS
Even when offices and hospitals thoroughly prepare for MIPS as much as possible, they're still likely to have questions and obstacles for a period of time. Many clinicians and healthcare providers get support directly through The Centers for Medicare & Medicaid Services, but there is also assistance available from Practice Transformation Networks (PTNs), and Quality Innovation Network (QIN)-Quality Improvement Organizations (QIOs).