MACRA and MIPS
This web page refers to MACRA/MIPS. If you want information regarding Meaningful Use, click here to be taken to the Meaningful Use homepage.
What is MACRA?
Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) replaces the current Medicare reimbursement schedule with a new pay-for-performance program that is focused on value, accountability and quality. MACRA enacts a new payment model that incentivizes health care providers for providing better care instead of more services. source
MACRA combines parts of the PQRS, Value-based Payment Modifier (VBM), and Meaningful Use incentive program into one single program called the Merit-based Incentive Payment System, or “MIPS”. source
What is MIPS?
The Merit-Based Incentive Payment System (MIPS) is the name of the new program that will determine Medicare payments and adjustments. Using a composite performance score, eligible clinicians may receive no Medicare Part B payment adjustment, a negative Medicare Part B payment adjustment, or a payment bonus.
The Composite Performance Score is based on four performance categories:
- Resource Use (Cost), which replaces Value-Based Modifier
- Quality, which replaces PQRS
- Clinical Practice Improvement Activities
- Promoting Interoperability, which replaces Meaningful Use
To learn more about each category, see the Guides section.
If your practice is not preparing for MIPS, you could face Medicare Part B payment adjustments in the future. If you’re planning on attesting for MIPS, make sure the certified EHR you use is certified for 2014 or greater, such as ONCOCHART. Remember, failure to attest for MIPS may lead to adjustments (deductions) from your Medicare Part B reimbursements in future years.
Do I have to participate in MIPS?
There is no opt out for MACRA, but in 2018, you are not subject to MIPS if:
- Your Medicare Part B allowed charges are less than or equal to $90,000 OR
- You see less than or equal to 200 Medicare Patients OR
To verify your eligibility for MIPS, please contact the Quality Payment Program Service Center at 1-866-288-8292 TTY: 1-877-715-6222. Hours of operation: Monday-Friday 8:00 a.m. – 5:00 p.m. EST
MIPS Pathways 2018
Eligible clinicians will have to submit data to MIPS which would ensure they do not receive a negative payment adjustment in 2020. source
- Submit Nothing – If MIPS eligible clinicians choose to not report even one measure or activity, they will receive the full negative percentage adjustment. source
- Submit a Partial Year – Eligible clinicians can choose to report to MIPS for a period between 90 days and up to an entire year. They must report more than one quality measure, more than one improvement activity, or more than the required measures in the advancing care information performance category in order to avoid a negative MIPS payment adjustment and to possibly receive a positive MIPS payment adjustment. source
- Submit a Full Year – For full participation in the quality performance category, clinicians will report on six quality measures. For full participation in the advancing care information performance category, MIPS eligible clinicians will report on at least the base measures. For full participation in the improvement activities performance category, clinicians can engage in up to four activities, rather than the proposed six activities. source
MIPS Performance Requirements
For the transition year 2018, the MIPS performance threshold has been raised to 15 points. source
MIPS Incentive Payments
No matter how well you perform with MIPS, you are NOT guaranteed a positive incentive payment. This is due to scaling/budget neutrality. Positive incentive payments cannot occur without there having been negative payment adjustments. source
MIPS tools – ONCOCHART
To learn how ONCOCHART can help you with the Promoting Interoperability and Quality categories, please click below.
- Promoting Interoperability
- Quality Measures
- How to use the ONCOCHART Promoting Interoperability (Meaningful Use) Calculator
- How to use the ONCOCHART Quality Calculator
These are the best practices you need to be implementing now regarding MACRA/MIPS!
- Make MIPS a Priority! – We know you’re busy caring for your patients, but MIPS isn’t going away. If you don’t successfully attest for MIPS, you’ll possibly be subject to future payment adjustments.
- Check early and check often – Don’t let attestation time be the first time you’ve looked at the ONCOCHART Advancing Care Information calculator and ONCOCHART Quality Measures calculator.
- Stay up to Date! – As a MIPS participant, you need to make it a point to always be running the latest version of ONCOCHART. If you’re not getting the update bulletin, contact ONCOCHART Technical Support so you can be added to the email list.
- Delegation – Make one or two employees responsible for keeping track of MIPS progress at your facility. These responsibilities should include checking the ONCOCHART calculators and the Unsatisfied Results report on at least a weekly basis. If this is done, you’ll be better equipped to resolve any issues sooner rather than later.
- Education – ONCOCHART Technical Support is here to assist, but you should educate yourself regarding MIPS.
- Responsibilities – As an ONCOCHART client, you have the necessary tools to record some of your MIPS data. If you don’t do the work, ONCOCHART can’t record the data. Attesting and submitting your data on time is ultimately up to you.
- Do more than the minimum! – It is the recommendation of ONCOCHART to submit more than the minimum amount of data. Submitting more data will possibly earn you more money, and it will also keep you familiar with how to meet the measures.
- CMS – Signup for the CMS email updates. They are valuable resources. You can sign up for these emails at the bottom of the Quality Payment Program homepage at qpp.cms.gov
For your convenience, here are some helpful CMS links regarding MIPS. Upon clicking one of the CMS links, you’ll leave ONCOCHART’s website and go to a website that is not operated by Bogardus Medical Systems, Inc. Bogardus Medical Systems, Inc and ONCOCHART are not responsible for the content or availability of linked sites.
- What is MIPS – CMS
- Education and Tools – CMS
- Quality Payment Program Overview Fact Sheet – CMS
- Webinars about the Quality Payment Program – CMS
- MIPS Overview – CMS
For a complete description of CMS-mandated “Costs & Limitations”, please visit: http://www.oncochart.com/costs-and-limitations.
Page last updated: 10/5/2018