Outpatient Care

MIPS impacts how doctors get paid. Are you ready?

The April 2015 signing by President Obama of the Medicare Access and CHIP Reauthorization Act (MACRA) effectively changed the healthcare game for individual clinicians working in physician practices. The MACRA legislation repeals the existing Sustainable Growth Rate (SGR) reimbursement formula and replaces it with a new Quality Payment Program (QPP) with two tracks: The Advanced Alternative Payment Models (APMs) and the default Merit-based Incentive Payment System (MIPS). A new Medsphere resource takes a closer look at MIPS, which will subsume existing EHR incentive programs.

While the popular misconception is that MIPS has replaced Meaningful Use, this is far from the case. How, then, are things different with MACRA and MIPS? The biggest change is that MIPS effectively alters performance measures for payment reimbursement related to EHR use as outlined via four categories:

  • Quality
  • Advancing Care Information (ACI)
  • Clinical Practice Improvement Activities (CPIA)
  • Resource Use

The Centers for Medicare & Medicaid Services (CMS) measures physician performance in each category and compares it to a predetermined national performance threshold. Data is then used to make adjustments to Medicare Physician Fee Schedule (MPFS) payments, creating incentives for those who score above the national threshold and penalties for those who score less.

Do you know what you need to know to ensure high scores, proper reimbursement and incentive payments? 

Click on MIPS to access Medsphere's resource and learn more about the new federal regime.

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