Physician Practice

Explore eligibility requirements and scoring standards for the first year of MIPS

Physician Practice Insider, April 18, 2017

The 2017 calendar year marks the beginning of a new approach to physician payment through the Quality Payment Program (QPP), an initiative created by the Medicare Access and CHIP Reauthorization Act to revise the physician payment system previously updated through the Sustainable Growth Rate.

Clinicians in hospitals and provider-based clinics can choose from two pathways of participation in this program: an Advanced Alternative Payment Model or the Merit-based Incentive Payment System (MIPS). This new system will replace three previous Medicare reporting programs: Medicare meaningful use (MU), the Physician Quality Reporting System (PQRS), and the Value-Based Payment Modifier.

Most providers will participate in the QPP through the MIPS track, according to CMS, which will apply a positive or negative payment adjustment to the traditional standard fee paid according to the Medicare Physician Fee Schedule. This payment adjustment will be based on the clinicians’ total MIPS performance score, which is calculated from the following four categories:
 

  • Advancing Care Information (ACI)
  • Cost
  • Improvement Activities
  • Quality


Some of these categories bear a resemblance to programs previously used by Medicare. ACI, for example, replaces the MU program. The Cost category replaces the Value-Based Payment Modifier, and Quality replaces PQRS.

This article originally appeared on JustCoding. Members can log in to read the full, detailed article here.

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