Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Merit Based Incentive Payment System

Maximizing MIPS Scores Through Chronic Disease Prevention

October 17, 2018 - The healthcare industry is moving beyond a “sick care” system and shifting to chronic disease prevention to lower costs and improve quality. However, the healthcare payment system is just catching up to the preventative care trend. Fee-for-service perpetuates a sick care model in which providers get paid for treating an illness and delivering services. With payment...


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Exploring Virtual Groups in the Quality Payment Program, MIPS

by Jacqueline LaPointe

Virtual groups enable independent physicians and clinicians in small practices to participate in Medicare’s historic push to transition to value-based reimbursement: the Quality Payment Program. The Quality Payment Program, or QPP,...

CMS Finds Errors in 2019 MIPS Payment Adjustment Calculations

by Jacqueline LaPointe

CMS recently announced that it is extending the targeted review deadline for 2017 Merit-Based Incentive Payment System (MIPS) performance feedback after the federal agency identified three errors with the scoring logic for the 2019 payment...

Developing a 2018 MIPS Reporting Strategy to Avoid a Penalty

by Jacqueline LaPointe

Eligible clinicians can avoid a financial penalty under the Merit-Based Incentive Payment System (MIPS) in 2020 by focusing their reporting on one of three performance categories: Quality, Improvement Activities, or Promoting...

How Can CMS Improve MACRA’s Quality Payment Program, MIPS?

by Jacqueline LaPointe

While providers commend CMS for replacing the Sustainable Growth Rate with MACRA and its Quality Payment Program, many still have some reservations about the Medicare program. After completing the first Quality Payment Program performance...

CMS Misses Chance to Move Physician Pay, QPP to Value, AMGA Says

by Jacqueline LaPointe

CMS recently proposed several changes to Medicare physician payments and MACRA’s Quality Payment Program to reduce medical billing and administrative burden. But initial reactions from medical group associations have not been...

Stakeholders Want Greater MIPS Participation for Higher Rewards

by Jacqueline LaPointe

Policymakers and industry groups are calling on CMS to include more Medicare providers in MACRA’s Merit-Based Incentive Payment System (MIPS). Five members of Congress, all of whom are part of the House GOP Doctors Caucus, recently...

EHR Costs, Staffing Still Trouble Small, Rural Practices in MIPS

by Jacqueline LaPointe

Financial challenges plaguing small and rural practices under legacy Medicare value-based purchasing programs are likely to persistent under the Merit-Based Incentive Payment System (MIPS), the Government Accountability Office (GAO)...

CMS to Waive MIPS for Providers in At-Risk Medicare Advantage Plans

by Jacqueline LaPointe

CMS recently announced that it advanced a demonstration that would waive Merit-Based Incentive Payment System (MIPS) requirements for eligible clinicians participating in at-risk Medicare Advantage plans. If approved, the Medicare...

91% of Eligible Clinicians Participated in 2017 MIPS Reporting

by Jacqueline LaPointe

Approximately 91 percent of all eligible clinicians participated in 2017 Merit-Based Incentive Payment System (MIPS) reporting, exceeding the CMS goal of 90 percent participation in the first year of the Quality Payment Program, the...

Provider Orgs Push for 90-Day MIPS Reporting Period in 2018

by Jacqueline LaPointe

Almost 50 provider groups are calling on CMS to reduce the Merit-Based Incentive Payment System (MIPS) reporting period from a full calendar to a minimum of 90 days during the 2018 performance year. Among the groups advocating for...

Only 37% of MIPS Quality Measures Deemed Valid by ACP

by Jacqueline LaPointe

The American College of Physicians (ACP) is calling for a “time-out” to assess and improve Merit-Based Incentive Payment System (MIPS) quality measures after finding few of the measures used to determine clinician performance...

Dissecting Merit-Based Incentive Payment System Reporting

by Jacqueline LaPointe

*UPDATE: CMS extended the MIPS reporting deadline to Tuesday, April 3, 2018, at 8:00 pm EDT, according to an email sent on March 29. Eligible clinicians participating in MACRA’s Merit-Based Incentive Payment System (MIPS) must...

MIPS Will Impede Value-Based Purchasing Transition, MedPAC Argues

by Jacqueline LaPointe

The Medicare Payment Advisory Commission (MedPAC) recently suggested that Congress repeal the Merit-Based Incentive Payment System (MIPS), arguing the new value-based purchasing program “impedes the movement toward high-value...

Should Congress Repeal the Merit-Based Incentive Payment System?

by Jacqueline LaPointe

As over 400,000 eligible clinicians prepare to submit data to the Merit-Based Incentive Payment System (MIPS) by the end of March, industry experts are urging policymakers and HHS officials to reconsider and even repeal MACRA’s most...

Login, Submit Data Early for MIPS Reporting Success, CMS Advises

by Jacqueline LaPointe

Eligible clinicians should log into the reporting system and upload 2017 performance data as soon as possible for Merit-Based Incentive Payment System (MIPS) reporting success, CMS recently suggested in an email. Eligible clinicians...

Clinicians, MedPAC Criticize the Quality Payment Program, MIPS

by Jacqueline LaPointe

Almost three-quarters (71 percent) of clinicians are “not very comfortable” or “not comfortable at all” with new measures under MACRA’s Quality Payment Program, and about 62 percent perceive the...

CMS Releases Quality Payment Program Data Submission System

by Jacqueline LaPointe

Eligible clinicians participating in MACRA’s Quality Payment Program can now start submitting their 2017 performance data on a new system on the program’s website, CMS recently announced in a press release. Medicare clinicians...

Orgs Argue MIPS Adjustments for Drug Payments Harm Patient Access

by Jacqueline LaPointe

Applying Merit-Based Incentive Payment System (MIPS) adjustments to Medicare Part B drug payments will restrict patient access to critical treatments, 11 medical societies recently told congressional leaders. The medical societies,...

The Pros and Cons of Quality Measure Choices In MACRA, MIPS

by Jacqueline LaPointe

Uprooting the fee-for-service payment system and changing the way clinicians provide care is no easy feat. With this in mind, CMS designed MACRA’s Merit-Based Incentive Payment System (MIPS) to gradually ramp up participation and...

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