Medical Billing Blog

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Medicare Updates for the New Year: 2018 Fee Schedule, MIPS, and More

By: Cal LaGroue


2018 Medicare Physician Fee Schedule
In November, the Centers for Medicare and Medicaid Services (CMS) finalized the 2018 Physician Fee Schedule. The most broadly relevant change is that to the payment Conversion Factor. The CMS has increased the payment rate by 0.41%. This change is the result of “the 0.5% update established under the Medicare Access and Chip Reauthorization Act (MACRA) of 2015, which has been reduced by 0.09% due to the misvalued code target recapture amount, required under the Achieving a Better Life Experience (ABLE) Act of 2014″.

Many other changes were also made in various fields, including Advanced Diagnostic Imaging, Telehealth, and Chronic Care Management. For more detailed information on the various changes, check out the CMS’ 2018 Physician Fee Schedule Fact Sheet by clicking below.

2018 Fee Schedule Fact Sheet


MIPS: Low-Volume Providers 2018 Adjustment
The CMS has increased the low-volume provider exemption threshold for 2018 from $30,000 (or 100 patients) to $90,000 (or 200 patients). This means that providers who treat less than 200 Medicare patients per year or have $90,000 or less in Medicare part B revenue per year are exempt from participation in MIPS. Exempt providers do not need to worry about facing financial penalties in 2020 for failure to participate in MIPS in 2018.

There will also be no voluntary opt-in benefit for low-volume (exempt) providers who wish to participate in MIPS. For more information, check out page 7 of the CMS’ 2018 QPP Final Rule Executive Summary by clicking below.

Executive Summary

What is MIPS? For an introduction to the Merit-based Incentive Payment System (aka MIPS), check out these blog posts from our archive:
MIPS: The Key Elements
Should I Participate in MIPS?


MIPS Reporting Options – Virtual Groups
There is a new MIPS participation option. With ‘Virtual Groups’, solo providers can band together in groups of 10 or less in order to share risk, improve cost, and provide better quality care. Virtual Groups can consist of medical providers from various locations and specialties, who wish to report together on MIPS.

For more information on Virtual Groups and how to form them, click below.

Virtual Groups Information


MIPS Assistance – New Program Available from Mingle Analytics
Last year, The Valletta Group formed an official partnership with Mingle Analytics. With Mingle, our clients gain access to the most knowledgeable and experienced consultants on MIPS and the Quality Payment Program. At The Valletta Group, we are committed to doing everything in our power to make sure our clients are prepared for any changes in the healthcare landscape. With this partnership, we stay true to that commitment.

This partnership allows our clients preferred access to the various tools Mingle provides. On that note, Mingle has launched a new and more affordable program for providers who would like extra assistance avoiding MIPS penalties. It’s called the “Essential Edition” and you can learn more about it by clicking the link below.

Mingle Analytics Options


The Valletta Group is committed to staying at the forefront of the healthcare and revenue cycle industries. The medical business (and regulation thereof) is constantly evolving. Providers deserve a medical billing company that adapts concurrently. Valletta is more than just a back-office biller. With front-end office training, industry guidance, and financial reporting/advice, Valletta is a partner and consultant to providers who want to successfully grow their practices.

Don’t fail to prepare your practice for the future. Simplify your life by securing your practice’s financials and acquiring on-call industry experts.

Contact Valletta today.

About the Author: Cal LaGroue

Cal has over a decade of experience in the Revenue Cycle Management industry. He serves as Board Secretary for the Healthcare Business Management Association (HBMA), the leading organization for Revenue Cycle Management professionals. He's also accredited by the HBMA as a Certified Healthcare Business Management Executive (CHBME).

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