CMS Releases MIPS Participation Status Lookup Tool
MedPAC Weighing Reform of New System
May 17, 2017 02:19 PM
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) addressed longstanding problems related to Medicare’s payment system for Part B services and replaced the beleaguered Physician Quality Reporting System (PQRS) with the Quality Payment Program (QPP) beginning with calendar year 2017. Under the QPP, Part B providers who are required to report quality measures select participation in either the Merit-based Incentive Payment System (MIPS) or the Advanced Alternative Payment Models (APMs). The majority of Part B clinicians are eligible only for the MIPS program.
While home health agencies and hospices have their own quality reporting requirements for Medicare, some operate palliative care programs that bill under Part B. These programs may be subject to the QPP reporting requirements (please see CMS’ MIPs Participation Fact Sheet for additional information). Given the complexity and the newness of the QPP program, some Part B participants are unaware or uncertain as to how the program requirements might impact them. In general, Part B clinicians (physician, physician assistant, nurse practitioner, clinical nurse specialist, certified nurse practitioner) are required to participate in MIPS if they:
Bill Medicare Part B more than $30,000 a year and
See more than 100 Medicare patients per year.
Clinicians that are new to Medicare in 2017 are not required to participate, and there are other exemptions that are identified in the Fact Sheet (referenced above).
To assist clinicians in identifying their MIPS participation status, the Centers for Medicare & Medicaid Services (CMS) recently released an interactive online lookup tool that is available here.
In related news, the Medicare Payment Advisory Commission (MedPAC) has been discussing the MIPS program as, despite its newness, many believe the program to be larger and more complex than necessary and unlikely to be fully successful at identifying high-value clinicians. As part of MedPAC’s review they have indicated that any ideas for fixing MIPS include eliminating all measure reporting by clinicians and replacing it with a set of CMS-calculated outcome and patient experience measures where assessing performance and adjusting payment would happen at an aggregate level. They currently have under review a potential redesign for the MIPS program, and it is anticipated that at future meetings the commission will continue to discuss a recommendation on reforming the system that will be conveyed to Congress. Additional information about MedPAC’s most recent discussion of the MIPS program is available here.