MACRA, MIPS & Your Money

Are you ready for Medicare MIPS (Merit-based Incentive Payment System) 2017 reporting?

  • With some effort you will qualify for an incentive payment.
  • Just because it appears easy does not mean that reporting is simple.
  • Miss some of the subtleties and your minimal action you will incur a four percent (4%) penalty of your allowable Medicare charges.
  • If your allowable Medicare charges are $50K per month that mistake could cost you $24,000 annually.

$24,000 . . .Ouch!  Let’s put that in terms that means something to you.

  • That’s a semester of tuition at a private college.
  • Or a nice contribution to a retirement plan.

  • Is your medical practice receiving a penalty for 2015 Medicare PQRS reporting?
  • Do you think it is likely that you will receive an incentive payment next year?
  • Are you prepared for MIPS reporting this year?
  • Are you using a CEHRT certified EHR?

If you answered “No”  or “I don’t know” to any of the questions you may need help. 

Will you report the minimum amount of data and receive no penalty…maybe.

  • Will you report the correct measures?
  • Will you report with enough patient encounters?

You could gain an incentive payment by reporting just a little bit more data.

  • Anything over three points will result in an incentive payment.
  • This year’s reporting in 2017 is a valuable dress rehearsal for 2018 reporting.

Contact us at today Or call us at (866) 701-1716.

What is the Merit ased Incentive Payment System?

It combines legacy programs into single, improved reporting program.


  • MIPS Moves Medicare Part B clinicians to a performance-based payment system.
  • Provides clinicians with the flexibility to choose the activities and measures that are most meaningful to their practice.
  • Reporting standards align with Advanced APMs wherever possible.
  • Four Quality Payment Program Categories
    • Quality
    • Advancing Care Information
    • Improvement Activities
    • Cost

Are Medicare Quality Payment Programs like MIPS here to stay?  Probably, the percentages for each category may change, but the basic structure of the program will probably remain.

Here’s why MIPS in some form is here to stay:

  • Like it or not, some form of Medicare quality payment program will probably survive with the goal of limiting the growth of federal healthcare expenditures to a sustainable level.
  • It is highly unlikely we will return to the pre Affordable Care Act (ACA) where Congress waived a magic wand and did not let the Sustainable Growth Rate (SGR) cuts to physician payments take place.
  • Why, because the growth in Medicare spending could not continue, and as a nation we cannot afford the growth in healthcare spending.

MIPS Eligibility

For 2017 most physicians and some other medical providers, Medicare payments will fall under the Medicare QPP MIPS program.

  • The program applies to Physicians, Physician Assistants, Nurse Practitioner, Clinical Nurse Specialist and  Certified Registered Nurse Anesthetists.
  • To be eligible for the Quality Payment Program, a clinician must bill more than $30,000 AND see more than 100 Medicare beneficiaries.
  • There are some organizations that fall under the APM model.  Here is a link to CMS to see if you qualify.

Who is excluded from MIPS?  Clinicians who are:

  • Newly-enrolled in Medicare
    • Enrolled in Medicare for the first time during the performance period (exempt until following performance year)
  • Significantly participating in Advanced APMs
    • Receive 25% of your Medicare payments OR
    • See 20% of your Medicare patients through an Advanced APM
  • Below the low-volume threshold
    • Medicare Part B allowed charges less than or equal to $30,000 a year OR
    • See 100 or fewer Medicare Part B patients a year.

Are you ready for MIPS 2017 Reporting?

In a recent 2017 survey conducted by KPMG-AMA concerning Medicare’s Quality Payment Program and MIPS they report the following:

  • Ninety percent (90%) of respondents indicated that they find the requirements of MACRA’s merit based incentive payment system (MIPS) to be slightly or very burdensome.
  • Only 51 percent of physicians expressed feeling somewhat knowledgeable about MACRA and the QPP
  • that twenty-three (23%),  or only one quarter of physicians that had begun preparing were well prepared for MIPS reporting.
  • Many providers were surprised by Medicare 2015 PQRS reporting requirements.  The number of reporting measures increased from three to nine and included the reporting of a cross cutting measures.
  • Some EHR vendors were not able to meet more stringent EHR certification and PQRS reporting requirements and exited the market leaving physician practices without a ready source of data.

MIPS Reporting Going Forward

  • Incentive payments are revenue neutral in that payment penalties fund incentive payments.  Clinicians being penalized will fund those being paid an incentive.
  • Reporting for 2017 has been relaxed.  A four percent (4%) incentive will be difficult to achieve.
  • Not reporting is a huge mistake.  Do not report any MIPS data and you will be subject to a four percent (4%)  penalty.

MIPS Reporting Preparation is the Key to Success

Once again, in case you missed it:

  • Is your medical practice receiving a penalty for Medicare PQRS reporting?
  • Are you preparing for more stringent Medicare MIPS reporting?
  • Are you prepared for MIPS reporting this year?




Penalty/Reward Medicare Payments -4%/+2%* -5%/+5%
Minimum Reporting Period 90 Days 12 Months
Quality Measure Weight 60% 60%
Quality Patients %Reporting 50% 60%
Advancing Care Information (ACI)
ACI Weight 25% 25%
ACI Reporting Period 90 Days 90 Days
Improvement Activities (IA) 15% 15%
Cost 0% 0%
Composite Score to Avoid Adjustment 3 points 15 points
Data Completion
*CMS final rule incentive adjustment


Contact us today Or call us at (866) 701-1716.

  • With some preparation you can earn an incentive.
  • The delay could cost you thousands of dollars.
  • If you have your hands full with daily billing functions, you probably need help with MIPS
  • If you were penalized in the past, not acting could be costly.
  • Fail to prepare … and prepare to fail.
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