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How to Fly Your Practice Over MIPS with an Advanced APM

While independent practices are uncertain with the upcoming changes to the regulations – yours might be exempt. The Merit-Based Incentive Payment System, aka, MIPS, has clear-cut criteria.

Only those clinicians who bill for Medicare Part B (otherwise known as the Physician Fee Schedule) -- or Critical Access Hospital (CAH) Method II payments assigned to the CAH -- can participate in MIPS.

Excluded from MIPS eligibility 

For 2017, there are three exemptions from MIPS:

  • Clinicians in their first year of Medicare Part B participation
  • Clinicians billing Medicare Part B up to $10,000 and providing care for up to 100 Part B patients in one year.
  • Clinicians participating in an Advanced APM who qualify for a 10 to 20% bonus payment.

Also, those who participate in the most advanced APMs may be qualifying APM participants (“QPs”). As a result, QPs are not subject to MIPS, will receive 5% lump sum bonus payments during 2019-2024 and a higher fee schedule update for 2026 and onward.

Easing MACRA/MIPS Administrative Burden 

Many independent physicians who qualify for MIPS are struggling with reporting requirements, revenue collection, and competition from larger practices and physician networks.

  • Practices believe they “will not have the technology, capital or staffing to sustain under the conditions [of MIPS,]” according to Black Book Market Research.
  • The burden of compiling quality metrics is the biggest burden MACRA brings. Physicians spend an average 15.1 hours every week processing quality metrics.

Start Preparing Now!

Forward-thinking organizations, such as WRS Health, already have the technology and management expertise in place.

Our systems and software provide ENT practices the valuable reporting and revenue cycle tools.

We will also provide the support needed to survive the upcoming changes.

Watch for MIPS updates

At this printing, MIPS is scheduled to take effect January 1, 2017. The department of Health and Human Services has until November 1, 2016 to publish the quality measures. However, what you’ve just read is the most recent and accurate information we’ve gathered to date. 

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