By Alex Tate
If I Don’t Report Medicare Will Ding Me?
Last year Medicare implemented the Merit-Based Incentive Payment System (MIPS). MIPS is a risk and an opportunity to add to your income. You should, at least know what is going to happen to your Medicare payments.
For most physicians, Medicare remains the largest single source of income, and while Medicare Advantage Plans are growing in membership, they still make up only a fraction of the Medicare population. However, depending on your location, and participation in Medicare Advantage Plans, you could find yourself exempt from MIPS based on your patient mix, so it is worth a quick check of your patient revenue sources, and number of patients before expending the time to learn MIPS submissions.
Additionally, most physicians, aside from the obvious specialties like pediatricians, and potentially OB/GYNs are still subject to MIPS, so unless you want to volunteer for a cut in your Medicare payments, best to get on top of what is required, and make submissions part of your routine.
Who is exempt?
In in 2017 you billed Medicare less than $30,000 and saw less than 100 Medicare patients, you are exempt from MIPS.
For 2018 dates of service, if you billed Medicare less than $90,000 and will see less than 200 Medicare patients, you will be exempt as well.
If you are not among the fortunate exempt physicians, to win, or at least have a chance to win, you have until March 21, 2018 to submit the requited data to Medicare. Don’t submit, and your 2019 Medicare fee-for-service reimbursement will be cut by 4%. Submission should be readily available through your CureMD EHR.
You may have heard that MIPS is going away, it’s not. Although Medicare is slowing down some of the phase in of MIPS, they are also increasing the point value of cost and quality metrics. Therefore, like other areas of healthcare – quality and cost have becoming more important in Medicare Fee For Service.
Medicare is being directed to implement ways of tying quality and cost to all its payments. Hospitals have their own methodology, and Medicare Advantage Plans are subject to a separate program. MIPS is the program for traditional fee-for-service payments.
So how are you doing in the Medicare Fee-For-Service Quality/Cost realm?
You can answer your own question by going to the Medicare Quality and Resource Use Reports (QRURs). Medicare regularly releases these reports (usually quarterly and then a more detailed report annually) in order to inform physicians of their results and compares those results to comparable physicians. QRURs are available at the Tax ID level and can be accessed via the CMS Enterprise Portal (portal.cms.gov).
Recently, Medicare held a webinar describing these reports and how they can be interpreted relative to your 2018 MIPS efforts. The webinar can be found at:
Some physicians have chosen to take an ostrich approach to MIPS, ignore it, and perhaps it will go away, of ignore it, and what happens happens. Not a good strategy, for while the economic hit is only 4%, it is 4% of your money, money that you earned. There is no good reason to surrender your income so easily, when you may already be meeting your MIPS requirement, with only a simple submission of data.
Alex Tate has served in various positions at leading health IT organizations for the past thirteen years. Most recently Mr. Tate served as Vice President at a leading EHR organization. He currently oversees product management and revenue cycle consulting for a number of organizations. Mr. Tate oversaw the development of many emerging products and held leadership roles across health-tech strategy, operations, service organization development, delivery and optimization. His ongoing collaboration with startups and academic research centers are paving the way for the development and commercialization of groundbreaking technologies like artificial intelligence, augmented reality, HCI and other initiatives for a future that offers the promise of transforming care delivery through cutting-edge technology and progressive methodologies.