Increase your reimbursement by 9%*
Meet your HIPAA, OIG & MACRA/MIPS Requirements
In April 2016, the Department of Health and Human Services (HHS) detailed how it proposed to implement the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). As expected, the law dramatically impacts the way Medicare payments will be made as the healthcare industry shifts from fee-for-service to value-based care.
*Full participation with compliance and reporting can generate up to 9% with the potential for even more
Clinicians have four MIPS options for reporting during the transition period*
Clinicians who do not submit any 2017 data would receive a negative 4% payment adjustment.
Clinicians who submit a minimum amount of 2017 data will avoid a downward payment adjustment.
Submit a Partial Year
Clinicians who submit 90 days of 2017 data may earn a neutral or small positive payment adjustment.
Submit a Full Year
Clinicians who submit a full year of 2017 data may earn a moderate positive payment adjustment.
Frequently Asked Questions
What is MIPS and am I required to participate in it?
MIPS (merit-based incentive payment system) is a government initiative that streamlines previous reporting into one program. MIPS take the place of PQRS (physician quality reporting system), MU (meaningful use) and VPM (value based modifier). It is designed to reduce duplicative reporting and incentivize care that focuses on improved quality outcomes.
Qualified MIPS providers that do not meet one of the three exclusions may receive a 4% negative adjustment in 2019 if they fail to report any MIPS measures in 2017.
Are there any exceptions to the MIIPS reporting requirement?
There are three exceptions to MIPS reporting:
Less than 100 unique Medicare patients see in the calendar year
Less than $30,000 in Medicare payments received for services provided in the calendar year
New Medicare provider
What is the MIPS timeline?
MIPS reporting began January 1, 2017 and any payment adjustments (positive or negative) will be reflected in your 2019 Medicare payments. In 2017 MIPS reporting can occur for the entire year, for 90 days or sporadically throughout the year. Registry reporting may allow full year reporting even if not implemented until mid-late 2017.
What happens to PQRS and Meaningful Use?
For Medicare patients, PQRS and MU programs have sunsetted. All reporting will be via MIPS approved registries. If you report quality or meaningful use for insurance programs other than Medicare, that reporting should follow the guidelines provide by that payer.
What is registry reporting?
A registry is a third party vendor that collects clinical data from your electronic health record and submits it to Medicare on your behalf. Use of a registry for reporting eliminates that need to include measures on your claims (paper or electronic).
Where can I find a registry?
Your electronic health record vendor has entered into agreements with one or more reporting registries that have been approved by CMS. You will need to contact your vendor for additional information.
We have been informed that the AOA More registry has been approved for the following EHRs:
Compulink Eyecare Advantage
Crystal Practice Management
Will I qualify for an Advanced Payment Model (APM)?
The qualified payment models for 2017 include:
What are the reporting categories?
Reporting categories for 2017 include:
Advancing Care Information (25%)
Improvement Activities (15%)
The cost category is not reportable in 2017.
Where can I find the measures?
The measures for all specialties can be found at:
Can you assist me in identifying measures?
CS Eye (Compliance Specialists, Inc.) can meet with you to review the measures specific to your specialty, allowing you to choose reporting that makes sense to your practice.
How will I know I am doing everything I can to capture appropriate reporting?
As part of the MIPS Assurance Program, CS EYE staff will review your system set-up and reporting following implementation of the registry.
Where can I get help?
Help is available through the MIPS Assurance Program offered by CS EYE. Assistance can also be found from:
Centers for Medicare and Medicaid Services (CMS)
What happens if I don’t report?
For MIPS providers not meeting one of the three exceptions, failure to report any measure will result in a 4% negative adjustment in 2017. Reporting required measures for the full year may result in up to a 4% positive payment adjustment in 2017. Limited reporting (one or more measures) will result in no change in your Medicare payments. Payment adjustment percentages will increase in future years.