Breaking news: CMS simplifies MIPS in final rule - DoctorsManagement Breaking news: CMS simplifies MIPS in final rule - DoctorsManagement

Breaking news: CMS simplifies MIPS in final rule

CMS has made major changes to the Merit-based Incentive Payment System (MIPS) in its final rule, released just this morning. The final rule gives your practice many more options to avoid a negative Medicare payment adjustment in 2019, thanks to easier reporting requirements in 2017, according to an early analysis by The Business of Medicine.The MIPS final rule is a massive document with nearly 2,400 pages of regulation and CMS responses to stakeholder comments, but here are some high-level takeaways that cover the biggest changes from the proposed rule, which was released in July.

  1. Easier to achieve low-volume exemption. CMS has decided to make it easier for smaller practices to be exempt from MIPS participation if they have a low volume of Medicare Part B patients. Practices that have Part B billing charges of $30,000 or less, or that have 100 or fewer Part B patients, will qualify for the low-volume exemption from MIPS. This threshold was only $10,000 under the MIPS proposed rule, though the 100-beneficiary threshold remains the same. CMS will calculate whether practices qualify using claims data from Sept. 1, 2015 to Aug. 31, 2016 (dates before the 2017 MIPS reporting period), and claims data from Sept. 1, 2016 to Aug. 31, 2017 (during the 2017 MIPS reporting period).
  2. Easier ways to avoid negative adjustment in 2019. CMS had previously announced that four options would be available to give providers flexibility during the 2017 reporting period. The final rule spells out all the details, but the easiest option to avoid a negative adjustment is to do any one of three things (no minimum reporting period is specified):
    1. Report meaningful use measures in 2017 (meaningful use is now called the “advancing care information performance category”). Five measures are required, which is greatly reduced from the proposed rule (see below).
    2. Report at least one quality measure (based on the Physician Quality Reporting System or PQRS, which is now simply the “quality performance category”).
    3. Report at least one activity in the “improvement activities performance category,” which includes clinical practice improvement activities such as beneficiary engagement, care coordination, etc.
  3. Easier ways to possibly get a positive adjustment in 2019. Similar to the bullet above, if you go a step further on your reporting in 2017, you’ll not only avoid a negative adjustment but also potentially receive a positive adjustment. You will need to do any of the following:
    1. Report meaningful use measures in 2017 for a period of 90 days or longer.
    2. Report at least two quality measures under the quality performance category for a period of 90 days or longer.
    3. Report at least two improvement activities for a period of 90 days or longer.
  4. Meaningful use is much easier. The EHR meaningful use program is now called the “advancing care information performance category” as noted above, and the final rule requires a total of five measures reported to satisfy this category, down from 11 measures in the proposed rule.
  5. Cost category won’t count in 2017. MIPS consists of four performance categories, the three described above, and the fourth, which is simply called the “cost performance category” and replaces Medicare’s Value-Based Payment Modifier program. The cost performance category won’t be counted toward your MIPS score during the 2017 reporting period for MIPS, thanks to a change in the final rule. In the proposed rule, the cost category was weighted to account for 10% of your MIPS score. The cost category will still be calculated by CMS based on your claims data and will count toward your MIPS score in years 2018 and beyond.
  6. Advanced Alternative Payment Models (APMs) still in progress. Another way out of MIPS reporting is participation in Alternative Payment Models (APMs) that are determined to be “advanced” by CMS. For example, some orthopedists are participating in a bundled payment program called the Bundled Payments for Care Improvement (BPCI) initiative. This is an APM, but is not considered advanced by CMS, so participating providers are not exempt from MIPS. Some practices may be participating in the Medicare Shared Savings (MSS) Program, which has three tracks. Tracks 2 and 3 of the MSS are considered advanced APMs, so participating providers will be exempt from MIPS and receive a positive 5% Medicare payment adjustment in 2019. The final MIPS rule lists some of the advanced APMs, but not all, and CMS states in the final rule that it will separately release a longer list of advanced APMs before Jan. 1, 2017. The agency is still working to make these determinations.

Remember, the MIPS final rule not only represents a major piece of rulemaking, but it also contains many significant changes from the proposed rule. This preliminary analysis by The Business of Medicine shows that most of these changes will soften MIPS’ impact on providers, but this analysis is not complete and the rule is very complicated. Look for more comprehensive coverage in the November issue.

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