Physicians and small medical practices may have difficulty keeping up with all the changes being implemented by the Centers for Medicare and Medicaid Services, or CMS. In an ongoing effort to modify care management programs and improve patient outcomes, CMS is slowly pushing the transition towards a value-based healthcare system.
CMS has implemented a quality payment incentive program, referred to as the Quality Payment Program, which rewards value and outcomes. The Merit-based Incentive Payment System (MIPS) which is divided into four parts (Cost, Quality, Promoting Interoperability and Improvement Activities).
Steps of Quality Payment Program Participation
Beginning in 2018, MIPS-eligible clinicians may participate in MIPS individually or as a group.
- Participate as an individual: MIPS eligible clinicians participating as individuals will have their payment adjustment based on their individual performance. An individual is a single clinician, tied to a specific Taxpayer Identification Number.
- Participate as a group: MIPS eligible clinicians participating in a MIPS group will receive a payment adjustment based on the group’s performance. Under MIPS, a group is a single Taxpayer Identification Number with 2 or more MIPS eligible clinicians, as identified by their National Provider Identifiers (NPI).
Determine Quality measures related to your specialty. These factors have been categorized into efficiency, intermediate outcome, outcome, patient engagement/experience, process and structure measures, with some tagged as high priority or bonus eligible. Most providers will be required to report on six quality measures of which many choose to use the specialty-specific measures defined by CMS.
Review Improvement Activities measures. For 2018, your practice will have to attest to the fact that you completed two to four out of the 112 available activities. A minimum of 90 continuous days will need to be reported for this category for 2018, but there may be special considerations available for certain practices.
Report on efforts at Promoting Interoperability. This area examines the meaningful use of certified Electronic Health Record technology. Certain exclusions and exceptions are available for 2018 for clinicians limited by certain circumstances.
There is no data submission required for the Cost category as CPS utilizes available Medicare claim information.
Collect data related to each of the applicable categories. Possible data submission methods include Qualified Clinical Data Registry, Qualified Registry, Electronic Health Record, Claims and CMS Web Interface. Each reporting method requires a minimum amount of all-payer patient visits or Medicare patient data to meet data completeness requirements.
Receive feedback from CMS, and assess your level of performance as compared to your available historical benchmarks from any previous year submissions.
CMS will make an MIPS payment adjustment if practice data is submitted by the official deadline of March 31.