June 7, 2019
<section><h2><h2>MIPS 2019: 6 Things You Should Know </h2></h2><p><p><span style="color: black;">The Merit-Based Incentive Payment System (MIPS) is part of the Medicare Quality Payment Program and is designed to tie payments to quality and cost-efficient care, drive improvements, increase the use of technology and reduce the costs.</span></p><p><br></p><p><span style="color: black;">MIPS also aims to simplify quality reporting by consolidating several programs into one, including the Medicare EHR Incentive Program for Eligible Clinicians, the Physician Quality Reporting System and the Value-Based Payment Modifier.</span></p><p><br></p><h2><strong style="color: rgb(0, 57, 166);">Please read these six facts you should know about MIPS. </strong></h2><p><strong style="color: rgb(0, 57, 166);">At the end, we’ll ask you to attest that you’ve read this information. </strong></p><p><br></p></p></section><section><h2><h2>The MIPS timeline includes four important milestones.</h2></h2><p><ul><li><strong>January 1, 2019: </strong>Performance period begins and runs through the calendar year.</li><li><strong>March 31, 2020: </strong>The deadline for submitting data to CMS.</li><li><strong>Summer 2020: </strong>You’ll receive your final MIPS score and payment adjustment information.</li><li><strong>January 1, 2021: </strong>CMS will start prospectively applying your payment adjustment to each claim. </li></ul></p></section><section><h3><h2>Four MIPS performance categories will determine your final score.</h2></h3><p><p>Clinicians and practices will report across four reporting categories for a final MIPS score of 100 possible points.</p><p><br></p><ul><li><strong>Quality Performance: </strong>Clinicians will report on six quality of care measures, either as individuals or as groups.</li><li><strong>Cost: </strong>This category measures the total cost of care. It’s calculated by CMS based on claims data.</li><li><strong>Improvement Activities: </strong>Clinicians choose a combination of high- and medium-weighted <span style="color: rgb(43, 41, 41);">activities</span>.</li><li><strong>Promoting Interoperability: </strong>Clinicians must report on base-score measures to receive credit.</li></ul></p></section><section><h3><h2>Clinicians who <u>are not enrolled</u> in an ACO will be scored across all four of the MIPS reporting categories.</h2></h3><p><ul><li><strong>Quality: </strong>Accounts for 45% of your overall MIPS score. You’ll need to report on at least six quality measures for a full calendar year. At least one of them must be an outcome measure or a high-priority measure. You may also choose to report a specific specialty measure set identified by CMS.</li></ul><p><br></p><ul><li><strong>Cost: </strong>Accounts for 15% of your overall score. It’s based on the calendar year’s administrative claims, so you don’t need to submit any cost data. CMS will analyze your claims and give you a score based on the full calendar year. Measures include Medicare spending per beneficiary and total per capita cost.</li></ul><p><br></p><ul><li><strong>Improvement Activities: </strong>Accounts for 15% of your score. You must report for a minimum of 90 days and select a combination of medium-weight activities or high-weighted activities.</li></ul><p><br></p><ul><li><strong>Promoting Interoperability: </strong>Accounts for 25% of your score. You must meet the base measures and report for a minimum of 90 days.</li></ul></p></section><section><h3><h2>Clinicians who <u>are enrolled</u> in an ACO will be scored across three MIPS categories.</h2></h3><p><ul><li><strong>Quality: </strong>Accounts for 50% of your overall MIPS score. Your quality performance score will be based on the quality measures that your ACO reports with its GPRO submission.</li></ul><p><br></p><ul><li><strong>Improvement Activities: </strong>Accounts for 20% of your overall score and will be automatically assigned to you based on the ACO. No additional reporting is necessary.</li></ul><p><br></p><ul><li><strong>Promoting Interoperability: </strong>Accounts for 30% of your overall score. You’ll need to report on it at the practice or individual level. The data is aggregated and weighted to get a single ACO score that applies to all eligible clinicians in the ACO. </li></ul></p></section><section><h3><h2>Promoting Interoperability is a key category.</h2></h3><p><p>To report this category, your practice must use 2015 Edition <span style="color: rgb(43, 41, 41);">Certified </span>EHR Technology (CEHRT).</p><p><br></p><p>This category is split into four different objectives. You must score at least 100 points to get full credit for the category:</p><p><br></p><ul><li>e-Prescribing: 10 points (with10 additional bonus points available)</li><li>Health Information Exchange: 40 points</li><li>Provider-to-Patient Exchange: 40 points</li><li>Public Health and Clinical Data Exchange: 10 points</li></ul><p><br></p></p></section><section><h3><h2>Your final score will determine your payment adjustment.</h2></h3><p><p>Your MIPS final score will be compared to the MIPS performance <span style="color: rgb(43, 41, 41);">threshold</span> to determine whether you’ll receive a neutral, negative or positive payment adjustment.</p><p><br></p><ul><li><strong>If you score fewer than 30 points in the MIPS program: </strong>You’ll receive a negative payment adjustment.</li></ul><p><br></p><ul><li><strong>If you score 30 points: </strong>You’ll get a neutral payment. No negative or positive payment adjustment will be applied to your Medicare reimbursements.</li></ul><p><br></p><ul><li><strong>If you score 30 – 74 points: </strong>You’ll earn a positive payment adjustment.</li></ul><p><br></p><ul><li><strong>If you score 75 points or higher: </strong>You’ll earn a positive payment adjustment and a bonus adjustment.</li></ul><p><br></p><p>All payment adjustments will be prospectively applied to each claim beginning January 1, 2021.</p><p><br></p><h2><strong>For more information about MIPS</strong></h2><p>Contact the New Jersey Innovation Institute at 973-642-4055 or <a href="mailto:qpp@njii.com" target="_blank" rel="noopener noreferrer">qpp@njii.com</a>.</p></p></section>
