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What Your Optical Practice Needs to Know About MIPS

Posted by Jeff Rezabek on Oct 12, 2016 2:19:00 PM

Can you believe that there are only a few more months until we ring in the New Year? Unfortunately, instead of solely focusing on capitalizing on expiring vision plans, eyecare professionals now have to concentrate on the important changes that will affect the way their optical practice receives Medicare payments in 2017.

In 2017, The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and its two-track structure will be put into action to reduce overtreatment by lumping healthcare professionals into two flexible payment tracks. Since most of the medical community will fall into the Merit-based Incentive Payment System (MIPS), this post will highlight some of the key things you need to know about MIPS so far. The final MIPS rules are expected to come out in November.

5 Questions to Help You Better Understand MIPS

What is MIPS?Five questions to help your optical practice understand MIPS

The Merit-based Incentive Payment System (MIPS) combines the Physician Quality Reporting System (PQRS), Value Modifier (VM), and the Medicare Electronic Health Record (EHR) Incentive Program together into one new system.

Who has to participate?

In the first couple of years, only a select number of clinicians will be eligible to participate in MIPS. These participants include:

  • Physicians (Includes Doctors of Optometry)
  • Physician Assistants
  • Nurse Practitioners
  • Clinical Nurse Specialists
  • Certified Registered Nurse Anesthetist

Following year two of the introduction of MIPS, other healthcare professionals may find themselves becoming a MIPS eligible clinician.

Who doesn’t have to participate in MIPS?

While most of the medical community will find that they meet the criteria for MIPS participation, there are a few who won’t participate in MIPS. These include:

  • Professionals participating in their first year of Medicare Part B
  • Clinicians who are below the low payment threshold of collecting Medicare billing charges less than or equal to $10,000 and provide care for 100 or fewer Medicare patients in a single year
  • Qualifying APM participants who have a certified EHR and are more susceptible to normal financial risks or qualify as a medical home model

It’s also worth mentioning that while you can participate in MIPS at a group or individual level, MIPS does not apply to hospitals or facilities.

How will MIPS be measured?

Eligible Participants will be given a Composite Performance Score that is based on four categories. These categories include quality, resource use, Clinical Practice Improvement Activities (CPIA), and Advancing Care Information (ACI). Quality makes up 50% of the Composite Performance Score.

How do payment adjustments work?

MIPS has a two year look-back system for payment adjustments with the first adjustment starting in 2019. Based on the Composite Performance Score, eligible participants can receive a positive, negative, or neutral payment adjustment. The payment adjustments will start at 4% in 2019 and will climb to 9% by 2022.

For a deeper dive into MIPS, view the MIPS training slide deck from the Centers for Medicare and Medicaid Services.

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Topics: Optometrist, Industry Pulse

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