Educational Series: Tips to Help you Succeed – Part 2

Have you started on MIPS & MACRA? By: Stephanie Thomas, CANPC

Have you started on MIPS & MACRA?
Avoid getting a negative 4% payment adjustment from Medicare and START NOW!

What is the Quality Payment Program?
The Quality Payment Program implements provisions of the Medicare Access and CHIP Reauthorizations Act of 2015 (MACRA) and improves Medicare payment to focus care quality for patients. This combines and replaces three separate Medicare related programs with a single system where Medicare providers can be paid more for higher quality of care. Most of the measures are clinician-oriented, ensuring that physicians are being rewarded for what matters more to them and their patients.

Who participates in the program?
You are part of the MIPS track of the Quality Payment Program if you:
* Bill Medicare Part B more than $30,000 as an individual clinician
* Provide care for more than 100 Medicare Part B patients during the determination period and are a Physician, PA, NP, Clinical Nurse Specialist or Certified Registered Nurse Anesthetist.

Who DOES NOT participate in the program?
You do NOT participate in MIPS if you are in your first year as a Medicare provider, below the low-volume threshold listed above, or are above the threshold for significantly participating in an Advanced APM.

When does it start?
You can choose to start anytime between January 1,2017 and October 2, 2017.
How Will the Quality Payment Program Affect Payments?
* If you decide to participate in an Advanced APM, you may earn an incentive payment through Medicare Part B.
* If you decide to participate in MIPS, you will earn a performance-based payment adjustment- up, down or nothing- based on the data you submit.

The first payment adjustments based on performance in 2017 go into effect on January 1, 2019
In 2017, you can assess your readiness and decide how and when you will participate in MIPS.

Your options are:
* Submit the minimum amount of 2017 data required to Medicare and avoid a negative payment adjustment
* Submit a minimum of 90 days of 2017 data to Medicare to earn a neutral to positive payment adjustment
* Submit up to a full year of data to earn a positive payment adjustment.


Do you qualify for a hardship exemption? Visit the Quality Payment Program Website at to find out more.