Merit-based Incentive Payment System (MIPS)

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What is MACRA?

The Medicare Access & CHIP Reauthorization Act (MACRA) repealed the Medicare Sustainable Growth Rate (SGR) and replaces it with a new Quality Payment Program (QPP). Participating clinicians will be subject to payment adjustments based on their performance.

Reporting Pathways

Clinicians will follow either the Merit-based Incentive Payment System (MIPS) or the Alternative Payment Model (APM) track, depending on current reimbursement. Eligible clinicians will follow the MIPS path, unless they are in an Alternative Payment Model. CMS has stated that they expect about 90% of clinicians to participate in MIPS.

Alternative Payment Model (APM)

Participating in a qualifying APM can award the clinician a 5% bonus payment from 2019-2024. Clinicians are part of an APM when either of the following conditions are met:

  • 25% of Medicare payments are through an APM in 2017
  • 20% of Medicare patients are through an APM in 2017

Clinicians are considered APM MIPS when they are not part of an Advanced APM.

Merit-based Incentive Payment System (MIPS)

The MIPS track combines three current Medicare programs (Meaningful Use, PQRS, & VBM) and adds an additional category. By 2020, clinicians will see payment adjustments from -9% to +27% based on a composite MIPS score from the four performance categories. Scores for each of the four categories are weighted based on a 1 to 100-point scale.

  • Advancing Care Information (ACI) formerly Meaningful Use (MU)
  • Quality Measures formerly known as Physician Quality Report System (PQRS)
  • Resource Use (Cost) formerly known as Value Based Modifier (VBM)
  • Clinical Practice Improvement Activities (CPIA)

The maximum negative and positive adjustments increase each reporting year.

Merit-Based Incentive Payment System (MIPS)

Quality Reporting
60%
+
Resource Use (Cost)
0%
+
Advancing Care Information (ACI)
25%
+
Improvement Activities
15%
=
MIPS Composite Performance Score
Quality Reporting
60%

Quality Reporting

  • Choose 6 measures out of about 300 for a minimum of 90 days for positive adjustment.
    • One measure must be an Outcome measure OR
    • High Priority measure
  • Clinicians receive 3 to 10 points on each quality measure based on performance against benchmarks.

Examples:

  • Controlling High Blood Pressure
  • Documentation of Current Medication
  • Fall Risk Assessment
  • Use of High Risk Medications in the Elderly
+
Resource Use (Cost)
0%

Resource use (cost)

  • CMS will collect cost data for informational purposes via Medicare claims submission.
  • This will not have any impact on the overall composite score.
  • Feedback will still be provided on this category in 2017, but it will not affect 2019 payments.
+
Advancing Care Information (ACI)
25%

Advancing Care Information (ACI)

In 2017, there are 2 measure sets available for reporting:

Advancing Care Information Objectives and Measures or 2017 Advancing Care Information Transition Objectives and Measures.

  • The measure sets are dependent on the participant's Certified EHR version.
  • Fulfill the required base measures for a minimum of 90 days. Select from additional performance and bonus scores for additional credit.

Examples:

  • Security Risk Analysis
  • E-Prescribing
  • Provide Patient Access
  • Send Summary of Care
  • Request/Accept Summary of Care
+
Improvement Activities
15%

Improvement Activities

  • A clinician must obtain 40 points total from available activities under 9 sub-categories:
    • Expanded Practice Access, Population Management, Care Coordination, Beneficiary Engagement, Patient Safety and Practice Assessment, Participation in an APM, Achieving Health Equity, Integrating Behavioral and Mental Health, Emergency Preparedness and Response.
  • Attest for a minimum of 90 days for positive adjustment.

Examples:

  • Anticoagulation Management Improvements
  • Engagement of Community for Health Status Improvement
  • Implementation of Medication Management Practice Improvements
  • Participation in Population Health Research
=
MIPS Composite Performance Score

Quality Reporting

  • Choose 6 measures out of about 300 for a minimum of 90 days for positive adjustment.
    • One measure must be an Outcome measure OR
    • High Priority measure
  • Clinicians receive 3 to 10 points on each quality measure based on performance against benchmarks.

Examples:

  • Controlling High Blood Pressure
  • Documentation of Current Medication
  • Fall Risk Assessment
  • Use of High Risk Medications in the Elderly

Resource use (cost)

  • CMS will collect cost data for informational purposes via Medicare claims submission.
  • This will not have any impact on the overall composite score.
  • Feedback will still be provided on this category in 2017, but it will not affect 2019 payments.

Advancing Care Information (ACI)

In 2017, there are 2 measure sets available for reporting:

Advancing Care Information Objectives and Measures or 2017 Advancing Care Information Transition Objectives and Measures.

  • The measure sets are dependent on the participant's Certified EHR version.
  • Fulfill the required base measures for a minimum of 90 days. Select from additional performance and bonus scores for additional credit.

Examples:

  • Security Risk Analysis
  • E-Prescribing
  • Provide Patient Access
  • Send Summary of Care
  • Request/Accept Summary of Care

Improvement Activities

  • A clinician must obtain 40 points total from available activities under 9 sub-categories:
    • Expanded Practice Access, Population Management, Care Coordination, Beneficiary Engagement, Patient Safety and Practice Assessment, Participation in an APM, Achieving Health Equity, Integrating Behavioral and Mental Health, Emergency Preparedness and Response.
  • Attest for a minimum of 90 days for positive adjustment.

Examples:

  • Anticoagulation Management Improvements
  • Engagement of Community for Health Status Improvement
  • Implementation of Medication Management Practice Improvements
  • Participation in Population Health Research

Technical Requirements

Successful MACRA reporting requires the following:

  • NextGen Regulatory Release (version 5.9/KBM 8.4) recommend upgrading in early 2018 (required by October 1, 2018). The application and KBM upgrade are performed at the same time. *
  • NextGen Patient Portal or a patient portal solution
  • NextGen Share
  • NextGen HQM
  • NextGen Care or another population health solution is recommended

*Pending release of MACRA 2018 Final Rule from CMS

Elegible Clinicians

The following clinicians are eligible for 2017 and 2018 reporting:

  • Physicians (MD/DO and DMD/DDS)
  • Physician Assistants
  • Nurse Practitioners
  • Clinical Nurse Specialists
  • Certified Registered Nurse Anesthetists

Exempt Clinicians

Select clinicians and facilities are exempt from the MIPS program:

  • First year Medicare participants
  • Below low volume threshold,
    • Less than $30k in allowed Medicare charges
    • Less than 100 Medicare patients seen in a year
  • Participating in Medicaid Meaningful Use
    • Upgrade by January 1, 2018 to participate in Meaningful Use Stage 3. This includes FQHCs, CHCs, and Planned Parenthood.
  • Exempt but may be eligible after 2019:
    • Physical Therapists
    • Occupational Therapists
    • Speech Language Pathologists
    • Audiologists
    • Certified Nurse Midwives
    • Clinical Social Workers
    • Clinical Psychologists
    • Dietitians/Nutritional Professionals

2017 MIPS Reporting Options

Clinicians are offered the following four MIPS reporting options for 2017:

DON'T PARTICIPATE

The clinician will receive a negative 4% payment adjustment if no data is submitted for 2017.

SUBMIT SOMETHING

The clinician will avoid a negative payment adjustment if some data is submitted (ex: one Quality Measure and one ACI).

SUBMIT A PARTIAL YEAR

The clinician will earn a neutral or small positive payment adjustment if 90 days of data is submitted.

SUBMIT A FULL YEAR

The clinician will earn a positive payment adjustment if a full year of 2017 data is submitted.

Group vs Individual Reporting

MIPS participants must decide to report either as a group or an individual.

  • When reporting as a group, all encounters are reported based on the tax ID number. Therefore, all encounters are reported together, regardless of the clinician.
  • When reporting as an individual, encounters are reported based on the clinician's NPI.

Getting Started

Here are your first steps to planning your MACRA transition:

  • Determine your MACRA path: MIPS, APM MIPS, or Advanced APM;
  • Develop a MACRA roadmap and timeline for the next two years;
  • Work on getting organizational buy-in;
  • Create an upgrade budget and allocate resources;
  • Review the TempDev MIPS Toolkit;
  • Contact us to plan your successful MACRA transition.

MACRA: MIPS – Top 10 Things to Know

  • 01
    What is happening to Medicare MU, PQRS, and VBM?
    They are being combined into MIPS. Medicaid Meaningful Use is continuing and not included in MIPS.
  • 02
    How do I report on MIPS?
    • Improvement Activities - yes/no attestation
    • Cost - claim submission
    • Advancing Care Information - NextGen HQM data
    • Quality - NextGen HQM data
  • 03
    Who is an eligible clinician for 2017 MIPS?
    • Physician
    • Physician Assistant
    • Nurse Practitioner
    • Clinical Nurse Specialist
    • Certified Registered Nurse Anesthetist
  • 04
    What if I was not ready by January 1, 2017 for 2017 MIPS Reporting?
    • You can begin reporting anytime between January 1 to October 2
    • As long as you submit something you will not receive a negative adjustment
    • To receive a positive adjustment you only need to submit 90 days.
  • 05
    What if I attest for Medicaid MU?
    You will need to upgrade NextGen by January 1, 2018 to participate in Medicaid Meaningful Use Stage 3 which includes most FQHCs, CHCs, and Planned Parenthood. However, there is a proposed change to the reporting period for 90 days in 2018 meaning you wouldn’t need to upgrade until October 1, 2018.
  • 06
    What can I do now to prepare for MACRA?
    Budget and plan for a new NextGen version and KBM upgrade late 2017 or early 2018.
  • 07
    Which version of NextGen is required?
    • 2017 - Use 2014 CEHRT NextGen version 5.8/KBM 8.3 or higher
    • 2018 - Use the 2015 CEHRT NextGen Regulatory Release (version 5.9/KBM 8.4) which requires a version and KBM upgrade at the same time
  • 08
    What other products do I need in order to be prepared for MIPS?
    You will need NextGen HQM, a patient portal solution, and NextGen Share. We also recommend utilizing NextGen Care or another population health solution.
  • 09
    How will HQM assist with reporting?
    You will need to configure NextGen HQM for Quality Measures and ACI.
  • 10
    How can I use TempDev to increase my likelihood of success?
    TempDev can work with you to help you build your MACRA Roadmap, provide strategic planning, project management, training, go-live support, and development support.
  • #1
    What is happening?
  • #2
    How to report?
  • #3
    How to prepare?
  • #4
    NextGen Version?
  • #5
    Which Products?
  • #6
    Not Ready?
  • #7
    How will I Report?
  • #8
    NextGen Update?
  • #9
    NextGen HQM
  • #10
    How can TempDev Help?
  • #1
    What is happening?
  • #2
    How to report?
  • #3
    How to prepare?
  • #4
    NextGen Version?
  • #5
    Which Products?
  • #6
    Not Ready?
  • #7
    How will I Report?
  • #8
    NextGen Update?
  • #9
    NextGen HQM
  • #10
    How can TempDev Help?
#1
What is happening?
#2
How to report?
#3
How to prepare?
#4
NextGen Version?
#5
Which Products?
#6
Not Ready?
#7
How will I Report?
#8
NextGen Update?
#9
NextGen HQM
#10
How can TempDev Help?

Roadmap for MACRA: MIPS

TempDev will help guide you through this journey

January 1, 2017

MACRA 2017 reporting period begins

September 2017

NextGen Regulatory Release is available

October 1, 2017

Last day to begin 2017 reporting period

January 1, 2018

MACRA 2018 reporting period begins
Upgrade to NextGen Regulatory Release is recommended

March 31, 2018

Deadline for 2017 submission

October 1, 2018

Last day to begin 2018 reporting period
Upgrade to NextGen Regulatory Release is required

March 31, 2019

Deadline for 2018 submission

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