Merit-Based Incentive Payment System
- May 18, 2016
The Centers for Medicare and Medicaid (“CMS”) issued a proposed rule featuring information related to the Merit-Based Incentive Payment System (“MIPS").
The following is an overview of some key areas:
- The targeted effective date is 1/1/2017.
- Eligible providers who report using claims-based reporting will have an increased threshold from 50% to 80%.
- Eligible providers who report using a registry will have an increased threshold from 50% to 90%.
- Most Medicare-enrolled providers will be considered eligible for MIPS.
- The one exception to a provider being eligible is to have fewer than 100 Medicare patients and bill less than $10,000 in 2017.
- One scorecard will replace the current 3 quality-reporting programs of (1) meaningful use, (2) physician quality reporting system (“PQRS”) and (3) the value-based modifier (“VBM”).
- Providers’ performance can result in either an incentive payment or a penalty, either of which could range from 4% to 9% per year.
- There are 4 new reporting categories:
- Quality – replaces PQRS – 50% of total performance score.
- Advancing clinical information – 25% of total performance score.
- Value-based modifier – 10% of total performance score.
- Clinical practice improvement activities – 15% of total performance score.
- The new clinical practice improvement activity category relates to practice improvement activities (e.g., expanded practice access, population management, care coordination, etc.).
The MIPS program will have a significant and enduring impact on how health care is delivered in our society. We will continue to update you on any changes to this important proposal.
If you have any questions, we'd like to hear from you.
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