How can ambitious providers get a better-than-modest adjustment to Medicare Part B claims in 2019?  On which performance areas should they focus to maximize their bonuses?

To earn the maximum 100 points in the new Merit-based Incentive Payment System (MIPS), you need to:

  1. Report for a full year on at least six quality measures (or a measure set) to ensure the maximum number of points;
  2. Report for at least 90 days on one to four improvement activities (depending on the activity, as well as the geography, size, and make up of your practice); and,
  3. Report for at least 90 days on the four or five (depending on the edition of certified software you’re using) required ACI measures to get half the points in that category, as well as report on high percentages in the performance and bonus ACI measures to earn the rest of the points for that category.

These three steps will yield the highest scores in individual categories and help earn bonus points for each area. Once providers have been scored across all areas, their total scores will be compared to each other and an adjustment to their 2019 reimbursements will be determined (see chart below).

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High scores relative to one’s peers in the clinical quality measures reporting area will best position a provider for a positive adjustment. The measures a provider chooses to report should be highly applicable to their practice panel. Due to the reductions in reporting requirements for the first reporting year, projections for 2017 predict that a total composite score of between 3 and 70 points will yield small adjustments of up to +1%. Total scores above 70 will be considered exceptional performance and could earn higher positive adjustments.

Let’s not forget that this whole equation must balance as the MIPS program is budget neutral, meaning the CMS 2019 reimbursement amounts in total cannot go up and this is a redistribution based on these new performance measures.