MIPS Mastery, Chapter 6

MIPS Mastery is a seven-part series on optimizing performance under the Merit-Based Incentive Payment System, originally produced by PYA.

How Will Individuals or Groups Receive Feedback on MIPS Performance?

CMS solicited feedback from the public on performance feedback data under MIPS. By law, CMS is required to provide confidential, timely feedback to Clinicians on the quality and resource use categories. CMS has proposed this initial feedback to Clinicians by July 1, 2017. 

The data will be provided similarly to how information was provided in the Quality and Resource Use Report (QRUR) under the VM Program. CMS plans on releasing data just one time during the first performance year, but acknowledges that data reporting may evolve as MIPS becomes more mature – potentially

What Happens if a Clinician or Group Does Not Report in a Timely Manner?

The failure of an individual Clinician or group to report required information relating to any category in a timely and compliant manner will result in a zero score for that category.

How Will Payment Adjustments Be Made?

A Clinician’s CPS determines his or her MPFS payments during the adjustment year (i.e., two years after the performance year). By statute, CMS must inform each Clinician of his or her adjustment factor by no later than December 1 of the year prior to the payment adjustment year (i.e., by December 1, 2018, for the 2019 adjustment year).

Payment adjustment factors range from -4% to +4% in 2019. Adjustment factor ranges for subsequent years max out at +/-9% by 2023. CMS assigns payment adjustments based on a Clinician’s CPS compared to the national threshold. Each year, CMS will set a threshold so that roughly half of Clinicians will rank above and approximately half will rank below it. Payment adjustments can be negative, neutral, or positive depending on your position relative to the threshold. For example, those that fall just below the threshold may only experience a -1% adjustment, whereas someone near the 99th percentile may earn the full 4% increase (plus a potential scaling factor). The payment adjustment amount will apply to any item or service furnished by a Clinician otherwise paid under Medicare Part B. This also includes co-payments, which will be adjusted by the payment adjustment amount.

Read Chapter 5

Read Chapter 7

Martie Ross, Principal with PYA Consulting