Tips for avoiding a payment penalty in 2018 for MIPS

Minimum reporting requirements for the Merit-based Incentive Payment System (MIPS) track of Medicare’s Quality Payment Program (QPP) have been raised somewhat for 2018. Previously, independent physicians had only to report on one measure to meet the qualifications. For 2018, however, physicians must earn a minimum of 15 points to avoid a payment penalty.

The American Medical Association (AMA) has published a list of tips for independent physicians so they can earn incentives and avoid the payment penalty. The AMA tip sheet points out that the general formula for determining an independent physician’s score within a performance category is: “Points earned by physician / total possible points within the performance category x performance category weight = Earned points.” It adds that “A physician’s four performance category scores (as well as any bonus points) will then be added to determine a physician’s final score.”

Smaller practices of 15 or fewer clinicians can meet the performance threshold and avoid a payment penalty by:

  • Reporting one high-weighted Improvement Activity
  • Reporting one medium-weighted Improvement Activity and 1 Quality measure
  • Reporting six Quality Measures
  • Reporting Advancing Care Information base score and one Quality measure

Tips for larger practices of 16 or more clinicians to meet the performance threshold and avoid a payment penalty for 2018 include:

  • Reporting two high-weighted or four medium-weighted Improvement Activities
  • Report two medium-weighted Improvement Activities and four Quality measures
  • Report Advancing Care Information base score and two Quality measures

The AMA points out that, in developing these tips, it assumes “the quality measures reported meet the data completeness requirement (60% of all eligible patients and report each measure for a minimum of 20 patients) and that the practice is scored on the all-cause hospital readmission measure.”

2018 reporting impacts the independent physician’s 2020 MIPS payment. Following these tips now can help the healthcare provider qualify for incentive payments and avoid a penalty.