MIPS Overview: What You Need to Know for the End of the Year

CMS presented the Final Ruling for the 2018 Quality Payment Program a few weeks ago. Here is what practices most need to know before the end of the year:

Are any of your providers exempt for reporting in 2018?
Practices should go to the website https://qpp.cms.gov/ to check each provider's participation status and enter the individual National Provider Identifier (NPI) number to check to see if a specific provider must report for 2017. Practices should do this every year as qualifications will change from year to year.
Is your entire practice exempt from reporting for the 2017 measures?

Practices in areas impacted by hurricanes or wildfires may receive an automatic exemption for MIPS reporting due to extreme and uncontrollable hardship. Exemptions are for areas in Florida, Georgia, Texas, South Carolina, Puerto Rico, the U.S. Virgin Islands and some counties in California. To get specifics for your locations, call CMS at 866-288-8292 or email them at QPP@cms.hhs.gov . Clinicians in the exempted areas who do not submit data will not receive a payment adjustment in CY 2019. Those who do submit will be scored on the submitted data. This policy will not apply to anyone in an APM.

What about Part B Drugs being included?
Payment adjustments (upward or downward) will affect Medicare Part B allowable charges for the 2017 reporting year. Practices that administer drugs in an office or clinic setting-and it can be attributed to your TIN/NPI-should be aware that the Medicare Part B drugs will be included for the purpose of applying the MIPS payment adjustment. If the eligible clinician (which includes mid-level clinicians) does not submit data for 2017, each eligible clinician will incur a negative 4 percent adjustment on the Medicare allowable charges in 2019.
Are you currently receiving penalties in your practice?
On your Explanation of Benefits from CMS, claim adjustment reason codes (CARC) and remittance advice remark codes (RARC) are used to report payment adjustments on individual eligible clinicians (EC) or group practice's Remittance Advice. These code sets are updated three times a year, so business offices should be looking at previous explanations to see if penalties affect PQRS, EHR Incentive Program and Value Modifier. For help in seeing those codes, reach out to IntrinsiQ Specialty Solutions' consultants.
How much does my provider/practice have to report next year?
The performance period will be a full year of data for both the Quality and Cost measures. Practices must report at least 90 days for Advancing Care Information and Improvement Activities measures. CMS encourages providers to submit data for the full year in all categories.
What does my practice stand to lose if we don't report?

  • For the performance year 2017 (payment year of 2019), the adjustment is -4% to +4%.
  • For the performance year 2018 (payment year of 2020), the adjustment is -5% to +5%.
  • For the performance year 2019 (payment year of 2021), the adjustment is -7% to +7%.
  • For the performance year 2020 (payment year of 2022), the adjustment is -9% to +9%.

Watch IPN Informs for more information throughout the next several months.
If you are interested in receiving help or have questions for our dedicated team of experts, email us at sales@intrinsiq.com or call 877-570-8721 x2.

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