2017 is bringing about changes in the way physicians and medical practices are reimbursed by insurance companies. Physician Quality Reporting Systems, known in the industry as PQRS, was created by Medicare and Medicaid in 2006. However, in 2017, PQRS has become a part of new Medicare quality reporting program known as the Merit-based Incentive Payment System, or MIPS. This new reporting system is much more complex than the PQRS system and includes cost and improvement activity information as well as quality performance information.
The Medicare Access and CHIP Reauthorization Act of 2015, known as MACRA, created a new quality payment program, known as QPP, for Medicare part B. As of 2017, PQRS is no longer a reporting system used by Medicare. Under the new QPP, there are now two ways for providers to participate in quality improvement programs under MACRA. These two ways are:
MIPS
Advanced Alternative Payment Models (APMs)
MIPS: Measuring Success
Unlike the PQRS program, where success was based on the percentage of Medicare patients for which you submitted data, success in the MIPS program is more complex. Within MIPS, Physicians will be scored on the following 4 categories:
Quality (formerly known as PQRS)
Improvement Activities
Advancing Care Information (replacement for Medicare’s Meaningful Use Program)
Cost (replacement for the Value-Based Modifier)
This new method is meant to encourage physicians to perform higher levels of patient care. Annually, the four categories will be scored based on weights assigned to each category. Much like the PQRS, the payment-adjustment year will be two years following the data-collection year. Therefore 2019 will be the first year of payout on the new system.
MIPS: Penalties and Bonuses
The provider score will range from 0-100 and will be compared to performance thresholds set forth by the Centers for Medicare and Medicaid Services, or CMS for short. If providers score lower than the performance threshold, a penalty may apply. Penalty Information Includes:
On the bright side, providers who exceed the MIPS performance threshold can earn substantial bonuses. Much like the penalties, bonuses will be awarded on a sliding scale. At the least, the highest bonus will always match or exceed the highest yearly penalty, such as 9% in 2022. However, bonuses may be even higher, such as up to 3 times the maximum penalty levels, providing great incentive for providers.
On the bright side, providers who exceed the MIPS performance threshold can earn substantial bonuses. Much like the penalties, bonuses will be awarded on a sliding scale. At the least, the highest bonus will always match or exceed the highest yearly penalty, such as 9% in 2022. However, bonuses may be even higher, such as up to 3 times the maximum penalty levels, providing great incentive for providers.
