Analysis : Merit-Based Incentive Payment System

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Running a medical office probably leaves you with a lot to worry about. Although helping patients is paramount, the need for getting paid is also significant. That's why it is extremely important to understand how clinicians will be paid for their services. Read on to find out everything that you should know about the new MIPS alteration. You may or may not have heard, but MACRA, the Medicare Access and CHIP Reauthorization Act of 2015, repealed and replaced the Medicare Part B Sustainable Growth Rate ("SGR") payment model and will now offer a new value-based reimbursement system called lithe Quality Payment Program" ("QPP"). Under the QPP, doctors will be paid by means of either one of two tracks: •Advanced Alternative Payment…show more content…
Also, at the end of 2019, there will be an annual inflationary adjustment of +0.5%. The adjustment will then resume in 2026, at which time physicians will receive +0.25% annually due to inflation. At the end of every year, each clinician's MIPS score (out of a possible 100) will be posted for patients to see. Patients can then access their doctor's score and make comparisons with respect to national averages. Each year, CMS will set a performance threshold in terms of the number of MIPS points that will equate to a 0% adjustment over the following year. Those practitioners who exceed this rate will receive higher incentives, while those who fail to meet it will receive penalties. In 2018, clinicians who receive less than one-fourth of the set threshold will be given a 5% penalty. (The maximum incentive will be 15%.) For the current year, CMS has set a more lax threshold; those who receive at least 70 points will qualify to receive the exceptional performance bonus. For 2019, the CMS will use the median or mean ofthe MIPS score to determine that year's performance threshold. As time progresses, the program is designed to slowly increase the threshold, thereby allowing clinicians to more easily transition into the program. Those who rank poorly relative to the national average will receive a blow to their reputations, and, if a clinician does poorly enough, he/she may ultimately be forced out of the program.
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