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The Quality Payment Program/MIPS/APMs – How do you begin? Part-1

Taking Blood Pressure from a patient

Taking care of and making patients healthier is the main concern of clinicians. As a special gift, Medicare has devoted itself to help you focus on quality care! The MACRA final rule

has introduced, the Quality Payment Program (QPP) where clinicians either choose the MIPS (Merit-Based Incentive Payment System) or the APMs (Advanced Alternative Payment Models) track. It was published this past October and the new programs begin in 2017, with payment adjustments beginning in 2019. Most providers will be part of the MIPS program which combines elements of three programs whose performance period ended in 2016: PQRS, VM, and the Medicare EHR incentive program. I am sure many of you have already begun the work, however for some who really do not understand what the new programs are about, I thought I would do my best to explain what I know.

MIPS is comprised of four performance categories which include Quality (formerly PQRS), Cost (formerly Value-Based Modifier),Improvement Activities (this is new) and Advancing Care Information (formerly Meaningful Use). Performance will be measured for clinicians under these categories and a final score will be issued. For the first year, clinicians will be able to pick their pace and participate as minimally or as fully as they are able to. Data will then be received by CMS, who will then issue feedback to clinicians to let them know how they performed under the MIPS program. Higher scores will be associated with higher reimbursement in 2019.

Let’s look at how you can begin participating in MIPS. First, you must determine if you are eligible. Next you need to decide if you will be submitting as an individual or a group and lastly you must decide your method of submission and verify its capabilities.

As you prepare to partake, I would like to offer a few suggestions. Begin with considering your practice’s readiness and evaluate your ability to begin reporting data for the 2017 transition year. Then, review the Pick Your Pace options as to whether you would like to participate as a test, partial or full-year. Start selecting your measures and/or improvement activities. CMS has given clinicians increased flexibility to choose the improvement activities and measures, within the performance categories, that are most meaningful to their practice. You may choose one or more performance categories, the more you choose the more your reimbursement will be. Go to and click on explore measures. There you will find a list of specialties, unfortunately Podiatry is not yet listed, but you can find quality measures that apply to your specialty. Verify the information you need to report and review the specifications for any measures you will be reporting. As you care for and treat your patients during 2017, you will be tracking your data. Finally, you will take that captured data and submit it to CMS by March 31, 2018.

Hopefully every physician in our group, who is eligible, is prepared. The better prepared and the more you participate in MIPS, the more you will get paid.

For any technical support, or any other questions on these programs go to

Coming soon- Part 2 explanation of MIPS including more specific information on elements of reporting, length of participation, performance categories and scoring.

My company, Vital Profits, is available for any billing help that you need. We can take on your whole account or customize our services. How is you AR doing? Please do not hesitate to contact us. We are Sammy experts, we also use HealthFusion and Meditouch and are familiar with other systems. If you love your system you can still use it! Call us for a free practice analysis, consultation or just to connect! 855-848-2511.

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