How to Submit the Bare Minimum to Avoid 2019 MIPS Penalty

Under the new Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) rules, physicians submit data on their 2017 performance, and that data will affect their 2019 Medicare payment rates. TMA has compiled some easy steps you can take now to avoid the 4-percent Medicare penalty in 2019.

To implement MACRA, the Centers for Medicare & Medicaid Services (CMS) designed a new Quality Payment Program that has two paths: the Merit-Based Incentive Payment System (MIPS) and advanced alternative payment models (APMs). Although you don't submit data for the 2017 performance period until early in 2018, you may take the necessary steps now to avoid the 2019 MIPS penalty. Here's how.

For the first year, CMS offers a "pick-your-pace" approach to participation. In 2017, you may participate in an advanced APM or submit data under the MIPS program for a full year or for a partial year (90 days), or you may just test the system by submitting a minimum amount of data for any point in time to avoid a penalty. If you choose not to participate in any path in 2017, you will receive an automatic 4-percent pay cut on a per-claim basis to your Medicare Part B payments in 2019. 

CMS will exempt physicians from MIPS in 2017 if they are in their first year of Medicare Part B participation, part of an advanced APM, or are below the low-volume threshold of $30,000 or less in Medicare Part B charges or 100 or fewer Medicare Part B enrolled beneficiaries annually. CMS tells TMA it will soon add a website tool to help physicians determine if they are below the low-volume threshold and exempt from MIPS in 2017. TMA will notify physicians once the tool is made available by CMS. 

Bare Minimum Requirements

If you are not in an advanced APM and are not exempt from MIPS in 2017, you must complete at least one of the following bare minimum requirements to avoid the 2019 MIPS penalty:

Quality Category  

  • To submit the bare minimum for this category, you only need to report data on one quality measure for one patient for any point in time in 2017. TMA recommends physicians report on more than just one patient to ensure sufficient data is received by CMS. 
  • Review the list of 271 MIPS quality measures and select a measure that applies to you and your patients.
  • The most affordable and easiest way to submit the bare minimum for the quality category is through claims-based reporting. The process to report data on quality measures via claims should be similar to what it was for PQRS, except you will need to refer to 2017 MIPS measure specifications to obtain the most current data codes for the quality measure you choose to report. NOTE: Make sure you use only MIPS codes and not old PQRS codes.
  • Access the TMA guide for step-by-step guidance on how to select a quality measure and review measures specifications to obtain quality data code(s) that you will use on a claim form.
  • The deadline for claims-based reporting for the quality category for the 2017 performance period is Feb. 28, 2018, but you can fulfill this bare minimum requirement now. 

Improvement Activities Category  

  • To submit the bare minimum for this category, you only need to report that you completed one improvement activity for a minimum of 90 days in 2017. 
  • Review the list of 92 improvement activities, and identify at least one improvement activity your practice already does and will continue to do or which activity your practice could implement or engage in to receive credit for the first performance period.
  • The most affordable and easiest way to submit data on improvement activities is by attesting to participation via the CMS MIPS portal. This portal is not yet ready, but will be made available by January 2018. Once available, it is expected that all you will need to do is log in and attest to one activity on the list. 
  • The deadline for attestation for the Improvement Activities category for the 2017 performance period is March 31, 2018. 

Advancing Care Information Category  

  • To submit the bare minimum for this category, you only need to attest to meeting the four or five measures that are required for the base score. CMS will accept a minimum of 90 consecutive days of data in 2017. 
  • Review the list of up to 15 measures and two reporting options, and select your reporting option and number of measures required for the base score that corresponds with your electronic health record (EHR) edition.
  • For the measure requiring a yes/no response, the answer must be "yes." For numerator/denominator measures, you must report at least "one" in the numerator, meaning at least one patient per measure during the 90-day reporting period to meet the bare minimum requirements for the base score. 
  • Contact your EHR vendor to inquire about these requirements, whether you will be able to meet them through your EHR system, and to discuss fees for MIPS reporting.
  • The deadline for attestation for the Advancing Care Information category for the 2017 performance period is March 31, 2018.  

According to CMS, completing one of the above actions in 2017 will ensure you avoid the 2019 MIPS penalty. However, the more data you submit, the greater the potential for a higher performance score and bonus payment. If you decide to report more data in 2017 to shoot for a bonus payment in 2019, review the TMA MACRA Checklist to learn about requirements for full year or partial year participation. 

As always, visit the TMA MACRA Resource Center to stay up to date on the latest information. 

Action, April 3, 2017