If you’re a physician, chances are you’ve been hearing more and more about MACRA and/or the Quality Payment Program (QPP) and MIPS in your publication subscriptions for months.  It seems every day there are articles, studies, whitepapers, and loads of advice.  Yet still, halfway through the second year of the QPP, there remains a world of confusion.  How does the program work? What is the scoring methodology? How much do I stand to gain or lose?  Why am I wasting my time with this? Do I need to report? Am I even eligible?

Patient360 hears these questions each and every day – and our job, as a CMS Qualified Registry and Qualified Clinical Data Registry (QCDR), is to help practices by leading them through the maze.

When the QPP first arrived in 2017 most practices didn’t pay much attention.  With so many other priorities and patients to see, this “QPP” was a small blip on the radar.  In the spring of 2017, letters of eligibility went out to practice physicians who met the eligibility requirements to report MIPS.

However, in 2018, these letters will not be going out and the burden of knowing if you are eligible will fall on you/your practice. Practices and providers must look up eligibility status on the QPP site.  One might think, “hey, I was eligible last year, I guess I need to report again this year” – but not so fast. In 2018, eligibility exclusion thresholds have changed.  

For MIPS 2018, if a provider sees fewer than 200 Medicare patients or individually bills (i.e., charges) less than $90,000 to Medicare, s/he is exempt from MIPS.  

The BBA18 (Bipartisan Budget Act of 2018) made changes to MACRA intended to provide some relief to small practices and individual clinicians.  For MIPS, these exclusions included removing Medicare part B drug costs from MIPS payment adjustments and eligibility determination.  So even if previously eligible under the program, you might not be in 2018.  This means your practice cannot rely on CMS QPP eligibility status from 2017 and you can’t wait to hear from CMS. That letter will never arrive.

What to do? Visit the Patient360 website and click on the CMS Eligibility Checker Tool.  If you and your practice are eligible to report (meaning you will in 2020 incur a -5% penalty if you do nothing), be in touch with us! Our team guides clients through the process of obtaining and optimizing MIPS data for CMS submission. Along the way, Patient360’s consultants help you and your team understand which measures are best for your specialty and hope to optimize MIPS scoring.  It’s not too late to report your full 12 months here in 2018 but  get started now!

For more information on the QPP as well as Patient360 Registry and QCDR services, visit our website.  To discuss how to get started, contact Heather Renzi, Business Development Manager.