MACRA Readiness: Prepare for MIPS

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Want to check off your progress? Download and print a copy of this assessment.

MACRA Readiness:

Prepare for MIPS

Preparing for the Merit-based Incentive Payment System (MIPS)

MACRA begins in 2019 with a proposed initial performance period in 2017 for the Merit-based Incentive Payment System (MIPS), one of two payment tracks created under the MACRA. This list of questions outlines steps you can take today to help prepare for MIPS. (Want to compare the two payment models? Check out this comparison table.)

This assessment provides actions you can take today to help prepare your practice for the Merit-Based Payment System (MIPS). MIPS is one of two payment tracks created under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.

MIPS consolidates three existing Medicare quality programs into one new program and will incorporate elements from meaningful use (MU), the Physician Quality Reporting System (PQRS), and the Value-based Payment Modifier (VBPM).

You can begin preparing for MIPS by assessing your performance under CMS’s current quality programs. Answer the questions below to help you and your practice get ready for MACRA.

Download the Checklist

Want to check off your progress? Download and print a copy of this assessment.

Current CMS Quality Programs

1. Did you attest to Meaningful Use?

If yes, your next steps are:

  • Review Modified Stage 2 requirements and prepare for 2016 attestation.
  • Incorporate data collection into workflows.
  • Focus on improvement in objectives and measures for patient electronic access, coordination of care through patient engagement, and health information exchanges.
  • Resource: The Evolution of Meaningful Use: Today, Stage 3, and Beyond

If no, your next steps are:

  • Adopt Certified Electronic Health Record Technology (CEHRT).
  • Review Modified Stage 2 requirements and prepare for 2016 attestation.
  • Incorporate data collection into workflows.
  • Focus on improvement in objectives and measures for patient electronic access, coordination of care through patient engagement, and health information exchanges.
  • Resource: The Evolution of Meaningful Use: Today, Stage 3, and Beyond

2. Did you report to the Physician Quality Reporting System (PQRS)?

If yes (your practice successfully reported as a group or you successfully reported as an individual for 2015 with individual measures or a measures group), consider:

The PCMH/ACO Primary Care Core Measure Set was created by the Core Quality Measures Collaborative Workgroup in an effort to create a consistent set of measures to be used across public and private payers. With a harmonized set of measures, family physicians will see a reduction in administrative burden and measurement complexity and frustration. Clinical topics in the core set include: cardiovascular, diabetes, care coordination, prevention and wellness, behavioral health, overuse and utilization, and patient experience.

  • Of the measures you reported, ____ are included in the PCMH/ACO Primary Care Core Measure Set.                       

Your next steps are:

If no (you did not report to PQRS for 2015), your next steps are:

  • Select reporting option for 2016.
  • Review measure specifications and select measures to report.
    • Consider aligning measures with the PCMH/ACO Primary Care Core Measure Set.
    • Consider clinical conditions usually treated, types of care typically provided, setting where care is provided, QI goals for 2016, and other quality reporting programs already in use (example: MU).
  • Incorporate data collection into workflows.
  • Monitor measure performance throughout the year as part of your QI plan.

3. Have you reviewed your Quality and Resource Use Reports (QRURs)?

If yes (you reviewed your 2015 mid-year and 2014 annual QRUR and are aware of how your practice fared under the Value-Based Payment Modifier (VBPM)), make sure you have:

  • Obtained and reviewed the supplementary exhibits from your annual QRUR.
  • Developed a QI plan and incorporated the information provided from your QRUR and supplementary exhibits into that QI plan.

Your next steps are:

  • Use QRUR and supplementary exhibits to identify opportunities for improvement and incorporate into QI plan.
  • Develop QI plan and incorporate the information from QRUR into plan.
  • If you feel the information in your annual QRUR is incorrect, file an informal review. An informal review must be filed within 60 days of the release of the annual QRUR.

If no (you have not obtained your mid-year or annual QRUR and/or are  unaware of how your practice fared under the VBPM), your next steps are:

  • Obtain Enterprise Identity Management (EIDM) system account.
    • Ensure you have the correct role within the EIDM system to access your QRUR.
  • Download mid-year QRUR and annual QRUR, including supplementary exhibits.
    • If you feel the information in the annual QRUR is incorrect, file an informal review. An informal review must be filed within 60 days of the release of the annual QRUR.
  • Identify opportunities for improvement.
  • Develop QI plan and incorporate data from QRUR and supplementary exhibits into QI plan.
  • Resource: What You Need to Know About Medicare’s New “Quality and Resource Use Report” 
  • Understand implications of non-participation in CMS’ Quality Programs.
  • Resource: Medicare Incentives and You: Payment Adjustments(2 page PDF)

Now Optimize Your Practice Revenue

Consider billing for these services as a means to get reimbursed for work you are already performing.