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by Antonio Arias, MBA, CHBME

A Case of the MIPS: Preparing for the Newest Quality Reporting System


Another year, another new healthcare development, another new acronym. This time it’s MIPS – the CMS’s new Merit-based Incentive Payment System, which will have its first performance year in 2017.

To catch you up to speed: On April 27, 2016, CMS released the proposed rule for MACRA which repeals the Medicare Part B Sustainable Growth Rate (SGR) reimbursement formula and replaces it with a new value-based reimbursement system called the Quality Payment Program (QPP). The QPP consists of two tracks: The Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs).

Under the new program, the current Medicare quality and value programs will essentially be integrated into composite “performance scores” for each participating clinician. The CMS will measure individual scores against its defined performance threshold; those doctors whose previous year’s average score equals that of the performance threshold will not have their medical billing payments affected, but those who fall short will see a negative adjustment. (On the upside, high performers can earn bonus payouts.)

If you’re hoping to avoid facing down MIPS, good luck: CMS is aiming to get as many Part B physicians into the program as possible – or at least that what it seems like, given that very few clinicians meet its exemption requirements. As such, it’s wise for physicians to brace for MIPS’ impact now to ensure high scores in 2017 and beyond.

Your MIPS score will measure your performance in four particular areas, each one weighted to a set value. Get the rundown on each element below.

50% Quality: The Physician Quality Reporting System (PQRS) and Value-Based modifier (VBM) Quality portion is the highest weighted MIPS area for performance year 2017 – so if you haven’t been reporting PQRS measures, now is the time to start.

Advancing Care Information (ACI, renamed from Meaningful Use) (25%): Meaningful Use isn’t behind us just yet. For performance year 2017, MU will be 25% of your MIPS score – meaning it will the second largest indicator of your reimbursement levels. You’ve likely already been engaged with MU for some time, but if not now is the latest moment for some to jump in: For eligible professionals attesting in Medicaid program, now is the last year to initiate in order to access MU incentives.

Clinical Practice Improvement Activities (CPIA) (15%): Here’s the newly introduced element of MIPS. To earn the maximum amount of this 15% category, practices should consider partaking in the Patient Centered Medical Home (PCMH) initiative: PCMH practices automatically receive the full 15 points.

Resource Use or VBM Cost (10%): Lastly, the smallest portion of your MIPS measurements will be determined by your VBM cost measures. You can worry a little less on this category compared to the other three; there’s no minimum reporting requirement involved since your VBM cost measures are calculated by CMS based on submitted Part B claims.

To keep your medical billing operation moving smoothly while you prep to make the most of MIPS, contact NCG Medical.

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by Antonio Arias, MBA, CHBME

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