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Summer Means MACRA/MIPS Fun

Summer Means MACRA/MIPS Fun
Image via qpp.cms.gov/mips/overview

When thinking about summer, what comes to mind? Warm beaches and cool pools? Family picnics and outdoor grilling? A vacation with the kids? Prepping and testing for MACRA and MIPS?

Chances are that getting ready for MACRA and MIPS is not one of your top-of-mind considerations when reflecting on summer activities. However, unless you are exempt in 2017 for low Medicare billings, this is the perfect time to be make sure you have all your MACRA ducks in a row to ensure your practice has all the technology and processes required to earn a positive payment adjustment – and avoid a financial penalty.

MACRA, stands for the Medicare Access and CHIP Reauthorization Act of 2015, which created the Quality Payment Program. The large majority of providers, unless they are participating in an Alternative Payment Model, will follow the program’s Merit Based Incentive Payment System (MIPS) track. In order to earn a positive payment adjustment from CMS (to be paid in 2019), providers have until October 2, 2017 to begin recording at least 90 days of quality data. For 2017, providers can avoid a negative payment adjustment by submitting one quality measure or one improvement activity for any time period in 2017. And finally, for those providers who do not have certified technology, and/or choose to do nothing in 2017, they are subject to a negative payment adjustment.

However, you don’t want to wait until the last minute, October 2, to start your 90 days-worth of tracking – only to find out that your system lacks some essential functionality, or that your software isn’t certified, or your EHR is configured incorrectly. If you haven’t already started, the time to get ready for MIPS is this summer, so you have plenty of time to fully review all the requirements, put the right technologies in place, train your providers and staff, and perform advanced testing.

Consider a few of these MIPS basics.

To earn a positive payment adjustment, you must show you provided high-quality, efficient care supported by certified technology. Providers must submit evidence-based and practice-specific quality data in four categories:

  • Quality measures
  • Improvement activities
  • Advancing care information
  • Cost

For 2017, 60% of the MIPS performance calculations are based on the tracking and reporting of up to six quality measures. Before officially starting a 90-day tracking period, practices must select appropriate quality measures from a total of 271 possible choices, configure their systems to automate the tracking process, and modify workflows so that the quality activities, including documentation, are incorporated into provider and staff workflows.

MIPS also requires most providers to complete up to four improvement activities and fulfill up to nine Advancing Care Information Objectives and Measures. The point here is that the prep work for MIPS is considerable, so don’t want to wait until the last minute to put your systems and processes in place.

We recommend that practices validate their MIPS readiness after putting their systems and processes in place. This entails testing with a small sample of patients, perhaps over a single day or week. After the test period, users can run real-time reports to verify that all the patients who qualified for specific measurement activities are actually displaying as expected.

If you’re not sure where to begin in the prepping process, consider taking advantage of one of Aprima’s MIPS training opportunities. Our MIPS Consulting Service provides customers with practice-specific education, including assistance verifying system configurations, selecting appropriate quality measures, and addressing any workflow challenges.

We are also offering a MACRA/MIPS Boot Camp on August 17 in advance of our 2017 Aprima User Conference. During the conference will are also leading a variety of educational sessions on MACRA and MIPS.

Finally, our support desk staff is always available to address your simpler MIPS inquiries.

Prepping for MIPS may not be as fun as an afternoon nap in a swaying hammock, or even catching fireflies, but it is a summer activity that will leave you with less stress in the fall and a sense of accomplishment – and hopefully the reward of a positive payment adjustment.

Neil Simon, Aprima COO


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