The Centers for Medicare & Medicaid Services (CMS) recently released the 2018 results for the Merit-based Incentive Payment System (MIPS)—the major quality reporting program for physicians under Medicare.
MIPS measures performance in four categories: Quality, Cost, Improvement Activities, and Promoting Interoperability (formerly Meaningful Use). A physician’s performance in each category rolls up into an overall composite score that translates to a payment adjustment (i.e., a bonus, penalty, or no change) that providers receive two years after the performance period. For example, a physician’s performance in 2018 will impact his or her Medicare payments in 2020.
The payment adjustments under MIPS could eventually have a significant impact on your revenue, which is why it’s a priority for ACEP to help you succeed in the program. In addition to working with CMS to simplify the requirements, ACEP provides our members with resources to ease the reporting process. Thousands of emergency physicians are now using ACEP’s Clinical Emergency Data Registry (CEDR) to meet the Quality Reporting requirements and participating in the Emergency Quality Network (E-QUAL) to meet the Improvement Activities requirements.
Thus far, the vast majority of MIPS participants have successfully met the requirements and have been eligible for a small bonus. In 2018, the second year of the program, over 98 percent of clinicians avoided a penalty. Since the penalties offset the cost of the payment increases, the pool for bonuses is very small. If you received a perfect score of 100 percent in 2018, you will only receive a 1.68 percent positive payment adjustment to your Medicare payments in 2020. To learn more about general 2018 MIPS performance results, check out CMS’ blog and infographic.
Any day we expect CMS to release its 2020 Medicare Physician Fee Schedule (PFS) proposed reg, which will include updates to MIPS. Each year, CMS raises the bar in terms of performance requirements, making it harder to receive a bonus. I recommend you log into CMS’ Quality Payment Program (QPP) website to check how you did in 2018 and understand how to improve your performance in the new reporting year. Note, if you have not gone to this site before, you will need to create a user ID and password. From there, you will be able to find out how you performed on each of the four MIPS categories, what your composite score is, and what positive or negative payment adjustment you will receive.
If you would like assistance accessing or interpreting your results, ACEP can help. Please contact me with questions. Also, if you believe an error was made in the calculation of your MIPS score, you can request a targeted review from CMS through the end of September. Click here for more details on the targeted review process.
Until next week, this is Jeffrey saying, enjoy reading regs with your eggs!