MIPS 2018 requirements

Everything You Need to Know About 2018 MIPS Reporting Requirements

Now that the Merit-Based Incentive Payment System (MIPS) 2017 submission period is closed, don’t think you can procrastinate and put MIPS on the back burner for the rest of 2018.

One of the biggest changes in 2018 is that eligible clinicians (ECs) must now report Quality and Cost performance category data to the Centers for Medicare & Medicaid Services (CMS) for a full 12 months, beginning in the first quarter of 2019—which means the performance period has already begun.

On top of the performance period changing in 2018, on April 24, CMS renamed the EHR Incentive Programs to Promoting Interoperability (PI) Programs for eligible hospitals, critical access hospitals (CAHs), and Medicaid providers. In addition, CMS renamed the MIPS Advancing Care Information (ACI) performance category to Promoting Interoperability (PI).

According to CMS, the program name change “moves beyond the existing requirements of meaningful use to a new phase of EHR measurements with an increased focus on interoperability and improving patient access to health information.”

To uncomplicate the complicated, let’s examine 8 frequently asked questions to help guide you through the 2018 MIPS reporting maze.

1. How Can I Check my MIPS 2018 Participation Status?

To ensure you receive the highest score possible for the 2018 Performance Year (PY), it’s important to check your participation status on the Quality Payment Program (QPP) website at www.qpp.cms.gov/participation-lookup.

Enter your 10-digit National Provider Identifier (NPI) number to view your MIPS participation status. If you find that you are included in the program, we recommend that you begin monitoring your reports within your EHR.

QPP Participation Status

Graphic Source: CMS Quality Payment Program

Individual or Group Participation Reminder: If you will participate in 2018 MIPS, you will need to decide if you will send in MIPS data as an individual or with a group. For more information on how to report as an individual or group, visit the QPP website.

2. How Can I Check my MIPS Preliminary Feedback for Performance Year 2017?

If you or your practice submitted 2017 MIPS data through the Quality Payment Program website, you can check your MIPS preliminary feedback. Sign in to the QPP website at www.qpp.cms.gov/login using the same Enterprise Identity Management (EIDM) credentials you used to submit 2017 data. CMS will post final feedback reports in July 2018.

MIPS-Timeline
Graphic Source: CMS Quality Payment Program

“The MIPS assistance First Insight provides to MaximEyes EHR customers is an invaluable service. It’s a huge time saver and stress reliever. First Insight knows exactly what needs to be done and how to do it efficiently.” – Holdrege Family Vision Clinic

3. What Are MACRA and MIPS?

MACRA is the Medicare Access and CHIP Reauthorization Act of 2015. MACRA ends the Sustainable Growth Rate Formula to determine Medicare payments, creates a new framework for rewarding providers based on quality, not quantity, and combines existing quality programs into one Quality Payment Program (QPP).

MIPS is the Quality Payment Program that combines meaningful use (MU), Value-Based Payment Modifier (VBM), and the Physician Quality Reporting System (PQRS) into one program for Medicare-eligible clinicians (ECs). A fourth category, Improvement Activities (IA), has been created specifically for MIPS.

Two participation routes are available for optometry and ophthalmology under the Quality Payment Program: MIPS or Advanced Alternative Payment Models (APMs). Almost all eye care software ECs will fall under MIPS rather than Advanced APMs.

MIPS-AdvancedAPMs-Description
Graphic Source: CMS Quality Payment Program

“MaximEyes EHR is significantly ahead of other key players when it comes to incentive program readiness and collecting MIPS data.” – Lowell Lebovitz, OD

4. Does MIPS Replace the Medicare and Medicaid EHR Promoting Interoperability Programs?

MIPS only replaces the individual ECs Medicare EHR Promoting Interoperability Program (formerly EHR Incentive Program), PQRS, and VBM. However, MIPS does not alter the CAH/Hospital-Based Medicare Promoting Interoperability Programs or the Medicaid Promoting Interoperability Program.

5. What’s Changed for MIPS 2018?

To reduce the burden on small practices (15 or fewer clinicians, which affects most eye care ECs), CMS has decided to keep many of the transition year policies in 2018 and include some additional changes to benefit these practices. These items include:

  • The 2018 performance period for the Quality and Cost performance categories is a full 12 months.
  • Individual MIPS ECs and groups are excluded from the program if they bill less than or equal to $90,000 in Medicare Part B allowable charges or see less than or equal to 200 Medicare Part B beneficiaries.
  • The performance threshold is now set at 15 points (an increase from the 2017 threshold of 3).
  • Payment adjustment ranges from -5% to + (5% x scaling factor not to exceed 3). The scaling factor is determined so the budget neutrality is achieved.
  • 5 additional bonus points will be added to the final score of small practices.
  • ECs can use the 2014 Edition ONC Health IT certified and/or the 2015 Edition ONC Health IT certified version of their EHR software. MaximEyes EHR is 2014 Edition and 2015 Edition ONC Health IT Certified. The 2015 Edition certification allows ECs who use MaximEyes EHR software to meet technology, capability, functionality, and security requirements.
  • 5 bonus points for complex patients based on a combination of the Hierarchical Condition Categories and the number of dually eligible patients treated.
  • Data completeness requirement is now 60%. Small practices not meeting data completeness will still be awarded 3 points.
  • All categories will be automatically reweighted to 0% of the final score for clinicians impacted by hurricanes Irma, Harvey, and Maria, and other natural disasters.

6. How is MIPS Scored?

MIPS calculates a Composite Performance Score (CPS) based on four performance categories that will affect your future Medicare payments: Quality, Cost (or Resource Use), Improvement Activities (IA), and Promoting Interoperability (PI, formerly Advancing Care Information or ACI).

Each category has different weights per reporting year. Many MIPS categories are based on existing CMS Promoting Interoperability Programs (formerly EHR Incentive Programs), such are PQRS, VBM, and meaningful use.

7. What Are the MIPS Performance Categories for 2018?


Graphic Source: CMS Quality Payment Program

On April 24, 2018, CMS renamed the MIPS Advancing Care Information performance category to Promoting Interoperability (PI).

Quality: 50%

  • 12-month performance period
  • Weight: 50%
  • 60% data completeness
  • Improvement scoring at the performance category level-up to 10 percentage points

Cost: 10%

  • 12-month performance period
  • Weight: 10% (increased from 0% to 10%)
  • Calculated by CMS through claims submission (no action required from the EC for calculation)
  • Includes Medicare Spending Per Beneficiary (MSPB) and Total Per Capita Cost measures— possible reweighting of this category to Quality if the case minimums are not met for either of the two measures
  • Up to 1 percentage point based on improvement scoring on statistically significant changes at the measure level

Improvement Activities: 15%

  • The performance period is still a minimum 90-day reporting period, but CMS allows you up to a full year to report those activities
  • Weight: 15%
  • Now 112 available activities

Promoting Interoperability (formerly Advancing Care Information): 25%

  • CMS renamed the ACI performance category to Promoting Interoperability (PI)
  • The performance period is still a minimum 90-day reporting period, but CMS allows you up to a full year to report those activities
  • Weight: 25%
  • 10% can be earned in the performance scoring for reporting to any single public health agency or clinical data registry
  • 5% bonus is added when submitting to an additional public health agency or clinical data registry not reported under the performance score
  • One-time 10% bonus for exclusive use of a 2015 Edition ONC Health IT Certified EHR

Read More About MaximEyes EHR Receiving the 2015 Edition ONC Health IT Certification.

2015 ONC Certified HIT

8. Where Can I Find CMS Resources for MIPS 2018 and Promoting Interoperability Programs?

MaximEyes EHR Makes Your Eye Care Practice More Successful

Focus Your Energy with MaximEyes Certified EHR Solutions

First Insight is committed to ensuring our optometry and ophthalmology EHR products comply with current certification and clinical standards. We will continue to adopt standards and functionalities that make it possible for eye care providers to safely and securely exchange EHR data.

With MaximEyes EHR, your relationship with us is just the beginning. We’ll get you up and running quickly without compromising patient care. In fact, we think the legwork is so important, we’ll help you create a plan of action and determine your potential return on investment. Request an online demo today.