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CMS Transforming Clinical Practices Initiative and The Southern New England Practice Transformation Network MIPS 2017 Overview 1/24/2017 and 1/27/2017 2
CMS Transforming Clinical Practices Initiative and
The Southern New England Practice Transformation Network
MIPS 2017 Overview1/24/2017 and 1/27/2017
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Agenda
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Source: CMS. “The Merit-based Incentive Program.” November 2016. PowerPoint presentation
Quality Payment Program (QPP) Tracks
Clinicians have two tracks to choose from:
OR
MIPSAdvanced
APMs
The Merit-based Incentive Payment System (MIPS)
If you decide to participate in traditional Medicare, you may earn a performance-based payment
adjustment through MIPS.
Advanced Alternative Payment Models (APMs)
If you decide to take part in an Advanced APM, you may earn a Medicare incentive payment for
participating in an innovative payment model.
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Adapted from: CMS. “The Merit-based Incentive Program.” November 2016. PowerPoint presentation
What Is MIPS?
MIPS Performance Category
Prior CMS Program
Replaces the Physician Quality Reporting System
(PQRS)
Replaces the Value-Based Modifier
(VBM)New Category
Replaces the Medicare EHR
Incentive Program (Meaningful Use)
Transition Year Weight
60% 0% 15% 25%
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Adapted from: CMS. “The Merit-based Incentive Program.” November 2016. PowerPoint presentation
When does MIPS Start?
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Source: CMS. “The Merit-based Incentive Program.” November 2016. PowerPoint presentation
Exceed low volume threshold: Medicare Part B clinicians who billed more than $30,000 AND
provided care for more than 100 Medicare Part B patients
(Sept 1, 2015- Aug 31, 2016)
Who Is Eligible In 2017?
PhysiciansPhysician Assistants
Nurse Practitioners
Clinical Nurse Specialists
Certified Registered Nurse
Anesthetists
Physicians include:• Doctor of medicine
• Doctor of osteopathy
• Doctor of dental surgery
• Doctor of dental medicine
• Doctor of podiatric medicine
• Doctor of optometry
• Doctor of chiropractic
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Source: CMS. “The Merit-based Incentive Program.” November 2016. PowerPoint presentation
Who Is Excluded In 2017?
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Source: CMS. “The Merit-based Incentive Program.” November 2016. PowerPoint presentation
MIPS Eligibility Decision Tree
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What Pace Should You Pick In 2017?
Don’t Participate
Do not report any data
Receive -4% payment adjustment
Test Pace
Report a minimum of 1 quality measure OR 1
improvement activity ORthe required advancing care
information measures for any time period
Receive a neutral or small payment adjustment
Partial Year
Report more than 1 quality measure AND up to 4
improvement activities ANDat least the required
advancing care information measures for 90 days
Receive a small positive payment adjustment
Full Year
Report a minimum of 6 quality measures AND up to
4 improvement activities AND at least the required
advancing care information measures for the full year
Receive a modest payment adjustment
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Adapted from: CMS. “The Merit-based Incentive Program.” November 2016. PowerPoint presentation
How should I report In 2017?
*If clinicians participate as a group, they are assessed as a group across all 4 MIPS performance categories
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Source: CMS. “The Merit-based Incentive Program.” November 2016. PowerPoint presentation
Individual Group
QCDR (Qualified Clinical Data Registry)Qualified RegistryEHRClaims
QCDR Qualified RegistryEHRAdministrative ClaimsCMS Web Interface (group of 25 or more)CAHPS for MIPS Survey
AttestationQCDRQualified RegistryEHR Vendor
AttestationQCDRQualified RegistryEHR Vendor CMS Web Interface
AttestationQCDRQualified RegistryEHR Vendor
AttestationQCDRQualified RegistryEHR Vendor
What are the data submission methods for 2017?
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Source: CMS. “The Merit-based Incentive Program.” November 2016. PowerPoint presentation
□ Determine eligibility status
□ Pick Your Pace for the 2017 Transition Year
□ Choose to report as an individual or a group
□ Review available data submission methods
□ Review the “Explore Measures” section on the QPP website for all three performance categories
□ Confirm your current EHR is certified under 2014 or 2015 standards
□ Review the 2015 Quality and Resource Use Report (QRUR) to see your practice’s cost performance
Preparing for MIPS – How should I start?
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Adapted from: CMS. “The Merit-based Incentive Program.” November 2016. PowerPoint presentation
□ CMS Quality Payment Program Website – https://qpp.cms.gov/
□ American Medical Association MACRA Assessment - https://apps.ama-assn.org/pme/#/
□ SNE PTN Payment Reform Resource Page -http://www.sneptn.org/clinicians/payment-reform
□ Office of the National Coordinator for Health Information Technology -https://chpl.healthit.gov/#/search
□ Quality and Resource Use Reports - https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Obtain-2013-QRUR.html
Resources to prepare for MIPS
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