MIPS – Revisiting the Penalties

Last year we did a blog post “I’ll Just Take the Penalty”.  What has changed or will change about the penalties?

The first answer is – not a lot.  MACRA and MIPS are here to stay, and unless Congress changes the law, MACRA is going to separate providers into the “Haves” and “Have Nots.”  If you’re a MIPS eligible provider and you don’t earn your required MIPS score, your future reimbursements will be cut by 5-9%. If you score above average, you will see your reimbursements increase.

Do you HAVE to participate?

If your Medicare reimbursement is less than $90,000 per year you do not have to participate and will not see your Medicare reimbursement cut under current 2018 reporting year requirements.  To be sure, check this out: https://qpp.cms.gov/participation-lookup

What if you have to participate but choose not to do so?

  • 2020 reimbursements will be reduced by 5% (based on not reporting for 2018)
  • Future reimbursements will decrease if you continue to not participate.  By 2022 (based on 2020 reporting) your reimbursements will be reduced by 9%
  • Your Quality Score will be 0 on the CMS Physician Compare website.  Don’t let anyone fool you – seniors use the Internet!

What is gained by participating?

  • Avoiding the penalty (see above)
  • Potential additional reimbursement – currently up to 5% and will grow to up to 9%
  • Good scores on Physician Compare
  • Some insurance companies are now using MIPS or similar scoring for provider contracting and entrance to preferred provider listings.
  • Better patient care – as painful as MIPS may seem, many of the measures are directly related to ensuring your patients receive preventative care.

Is there an easier way?

Like they told you in medical school, “if it were easy everyone would do it.”  But it doesn’t have to be that hard. Some steps you can take to get headed in the right direction:

  • Make sure you’re using a 2015 Certified EHR.  It is required by 1/1/2019, and you have to wonder about your vendor if they’re not already certified.
  • Learn about the tools in your EHR for Quality Measures, Promoting Interoperability and Practice Improvement Activities.  If your EHR support team can’t help you this, it is another red flag.
  • Educate yourself on MIPS – https://qpp.cms.gov/mips/overview
  • Use a MIPS Checklist to get ready and check your progress.