ASRA Fact Sheets Help You Navigate MIPS

Dec 23, 2016

ASRA's Practice Management Committee has developed two fact sheets designed to help ASRA members navigate the Merit-based Incentive Payment System (MIPS) component of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). 

Under MIPS, beginning January 1, 2017, Medicare will assess clinician performance in four categories: (1) quality; (2) cost; (3) clinical practice improvement activities; and (4) advancing care information (previously known as “Meaningful Use”). Medicare then will make positive, neutral, or negative adjustments to a clinician’s Part B fee-for-service payments in 2019 based on his or her performance in 2017. 

Because Medicare has deemed 2017 a “transition” year for MIPS, clinicians must only report data for a continuous 90-day period during any time in 2017 to meet reporting requirements. Medicare has established performance standards for 2017 that should allow most clinicians to avoid receiving a negative payment adjustment in 2017 so long as they report at least some MIPS data.

Medicare requires that clinicians submit MIPS data on quality measures, clinical practice improvement activities, and advancing care information measures for MIPS beginning in 2017. However, Medicare will not require clinicians to submit cost data and, instead, will calculate clinicians’ cost performance through evaluation of their administrative claims data. For 2017 only, cost performance data strictly will be for informational purposes and will not affect MIPS payment adjustments. Beginning in 2018, however, Medicare will incorporate cost performance into clincians’ overall MIPS assessment, and, therefore, clinicians who have relatively high treatment costs could have their Medicare reimbursement negatively impacted in in future years.

The fact sheets provide practice-specific quality measures, clinical practice improvement activities, and advancing care information measures, inclusive of the data submission method necessary for each measure or activity. These measures and activities are suggestions only, and providers may find metrics that are more appropriate and applicable for their practices based on the broader list of MIPS measures and activities. For more information on MIPS and MACRA, please visit Medicare’s website: https://qpp.cms.gov/ 

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