top of page

The Quality Payment Program/MIPS/APM's How Do You Begin? Part 2

Taking Care of Patient

As promised and I know you have all been waiting for part 2, here it is!

All physicians should understand that you will be able to pick your pace for participating in MIPS for the transition year. Please keep in mind that not participating in the quality payment program for this year will result in a negative 4% payment adjustment for 2019. There are 3 ways to participate; minimally, partially or fully. You can choose to participate minimally and still not have a negative payment adjustment.

Minimal participation is known as the test pace. There is a minimum amount of data that needs to be sent to CMS. You need to submit the only one of the following: 1 quality measure, or 1 improvement activity, or 4 or 5 required advancing care information measures.

If you would like to participate partially, you may commit to submitting 90 days of your 2017 data to Medicare. You can start anytime between January 1 and October 2, the performance data needs to be sent in by March 31, 2018.

If you would like to go all in with the MIPS program, you may choose to submit a full year of your data for 2017. This maximizes your chances of getting a positive payment adjustment for that period.

One important thing that needs to be understood is that the positive payment adjustment is not based on the amount of data you submit or the length of time submitted. It really is based on your performance in terms of how you do on those quality measures. You maximum your chances of doing well in the program if you submit more data because, in part, you have access to more measures that you could potentially submit to Medicare, some require more than 90 days of participation.

Elements of reporting for MIPS are in four categories and they will be weighted. Quality Performance Category is weighted at 60%. You must select 6 of about 300 quality measures with a minimum number of 90 days to be eligible for full payment. One must be an outcome measure. The scoring for Quality is 3-10 points on each quality measure based on performance against benchmarks, bonus points are also available. All data must be reported or you receive 0 points.

The Cost Performance Category is weighted at 0% for the first year and will not be tied into your reimbursement for 2019 nor figure into your final score at all. Physicians are simple not ready, nor do they have much experience with his category. The cost category in MIPS is the only category that requires nothing from you, Medicare gets all their information they need for this category from the claims data that they receive from you.

The Advancing Care Information is weighted at 25%. This category replaces Meaningful Use, but you will now have greater flexibility in choosing measures. In 2017 there are two measure sets for reporting, measures that you select are going to be based on the version of your certified EHR technology that you have, plus there are opportunities to earn bonus a score. Within those categories, you will receive scores based on this formula. Base Score (50%) + Performance Score (90%)+ Bonus Score (15%).

Improvement Activities Performance Category is weighted at 15%. This is where the physicians will attest to participation in activities that improve clinical practice. Clinicians can choose from 90+ activities under nine subcategories.

Calculating the final score under MIPS is determined as CMS multiplies the score for each performance category by the assigned weight of the category then CMS will add the weighted scores to derive a value between zero and 100. The final score equals the physician Quality Performance Category score X the actual Quality Performance Category weight, + the physician Cost Performance Category score X the actual Cost Performance Category weight + the physician Improvement Activities Performance Category score times the actual Improvement Activities Performance Category score X the actual Advancing Care Information Performance Category weight X 100.

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

Vital Profits is available for any billing help that you need. We can take on your whole account or customize our service to what you need. How is your AR doing? Please do not hesitate to contact us for help.

Featured Posts
Recent Posts
Search By Tags
No tags yet.
Follow Us
  • Facebook Classic
  • Twitter Classic
  • Google Classic
bottom of page