SUPPLEMENT

Making Sense of MACRA: Earning Bonus Points for MIPS

 

See if you're eligible for two new bonuses as part of MIPS.

Fam Pract Manag. 2018 Jul-Aug;25(4):29-30.

 Download in PDF format

The Medicare Access and CHIP Reauthorization Act (MACRA) established the Quality Payment Program (QPP) to shift Medicare payment from volume to value by creating two payment tracks. New provisions for the 2018 QPP performance period allow eligible clinicians (ECs) to earn bonus points in their final score of the Merit-based Incentive Payment System (MIPS) track.

This supplement provides information about the provisions and bonus points, which can help ease the burden for small practices and those practices with patients who have complex conditions.

SMALL PRACTICE BONUS

The small practice bonus allows ECs who submit data for at least one performance category to automatically have five bonus points added to their MIPS final score. The Centers for Medicare & Medicaid Services (CMS) defines a small practice as a practice which has 15 or fewer national provider identifiers (NPIs) billing under the same tax identification number (TIN). Since this determination is based on NPIs billing under the same TIN, it may include clinicians who are not otherwise eligible to participate in MIPS, such as clinicians in their first year of Medicare participation. Clinicians can find out if their practice is considered a small practice by accessing the MIPS participation status tool.

HIERARCHICAL CONDITION CATEGORY (HCC) BONUS

Any practice (small or large) that submits data in at least one performance category in MIPS can also earn up to five bonus points based on the complexity of their attributed patients. This bonus is based on the group’s average hierarchical condition category (HCC) score and the proportion of dual-eligible (having both Medicare and Medicaid) patients within the practice.

Access the full supplement.

 

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