What You Need to Know About MACRA and MIPS



To help offices prepare for MACRA and MIPs, the new payment system for Medicare Eligible Clinicians (ECs), we are sharing this guest blog from Nitin Rai, CEO of First Insight. Check out these quick facts, FAQs and industry resources to help guide you through the complicated process.

What is MACRA?

MACRA is the Medicare Access and CHIP Reauthorization Act of 2015 that was signed into law on April 16, 2015. In October 2016, the Department of Health & Human Services (HHS) released the Final Rule. MACRA:

  • Ends the Sustainable Growth Rate Formula to determine Medicare payments

  • Creates a new framework for rewarding providers based on quality not quantity

  • Combines existing quality programs (meaningful use, PQRS, VBM) into one new Quality Payment Program (QPP).

Two routes are available to providers under the new QPP: MIPS or Advanced Alternative Payment Models (APMs). A majority of optometry and ophthalmology practices will fall under MIPS and not Advanced APMs.

What is MIPS?

Merit-Based Incentive Payment System (MIPS) is a new Quality Payment Program that combines meaningful use (MU), Value-Based Payment Modifier (VBM) and Physician Quality Reporting System (PQRS) into ONE program for Medicare Eligible Clinicians (ECs). EPs (Eligible Professionals) are now called ECs.

When does MIPS begin?

MIPS begins January 1, 2017. ECs can choose to start collecting data at anytime in 2017 between January 1, 2017 and October 2, 2017. Performance data must be submitted by March 31, 2018. The final payment adjustments based on performance go into effect on January 1, 2019.

How is MIPS scored?

MIPS calculates a Composite Performance Score (CPS) based on four performance (4) categories: Quality, Advancing Care Information, Clinical Practice Improvement Activities and Cost (or Resource Use). Each category has different weights per reporting year. Many MIPS categories are based on existing CMS Incentive Programs such are PQRS, VBM and MU.

Does MIPS replace both the Medicare and Medicaid EHR Incentive Programs?

No. MIPS replaces the individual ECs Medicare EHR Incentive Program, PQRS and VBM. However, MIPS does not alter the CAH/Hospital-Based Medicare Incentive Program or the Medicaid EHR Incentive Program.

What are the MIPS exemptions for performance year 2017?

  • ECs in their first year of Medicare Part B participation

  • ECs billing less than $30,000 in Medicare Part B allowable charges OR providing care for less than 100 Part B patients

  • ECs participating in an Advanced APM

Pick Your Pace: Depending how much data you choose to submit, this can determine any payment adjustments to your 2019 Medicare Fee Schedule (i.e. penalties, neutral adjustments or incentives). The size of the payment adjustment will depend on how much data you submit and your quality results. For more information, download the CMS Quality Payment Program Overview Fact Sheet.

Industry Resources

Easy and quick implementation

First Insight offers a certified EHR that is MACRA READY: MaximEyes EHR complies with reporting requirements you need for the new Merit-Based Incentive Payment System (MIPS) to support increased outcomes. For more information, check out the First Insight website at www.first-insight.com.