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MIPS 2019 – Summary of the Biggest Changes to the 2019 Final Rule (vs. 2018)

By: Cal LaGroue

March 1, 2019

medical billing prices
 

MIPS 2019 is here. It may seem too soon, as some clinicians are still finishing their reporting for the MIPS 2018 performance year. However, the time has come. The Quality performance category requires clinicians to report a full year’s worth of data. So, the sooner providers start, the better.

To help you get going quickly, we’ve summarized the biggest changes to the MIPS 2019 Final Rule, as compared to 2018.

As this is the third year of MIPS, the requirements have increased, along with the potential penalties. The CMS is raising the stakes, so to speak. However, clinicians can still avoid negative payment adjustments without too heavy a burden. While the demands have technically doubled for 2019, providers still only need to score 30 out of 100 possible points to escape penalty. That’s certainly doable.

 

 

Check out our helpful chart below, which summarizes the biggest changes to MIPS for 2019.

 

Note: If this is your first year participating in the MIPS program, you’ll find tons of other helpful content on our website that will help get you up to speed.
Check out our: Value-Based Care Page || MIPS Page || MIPS 2018 Overview || MIPS 2018 Participation Guide

 


 

Major MIPS Changes for 2019 (versus 2018)

*red text = item is new or adjusted for 2019

 

Eligible Clinicians 2019


• Physicians, including doctors of medicine, osteopathy, dental surgery, dental medicine, podiatric medicine, and optometry; osteopathic practitioners; and chiropractors
• Physician Assistants

• Nurse Practitioners

• Clinical Nurse Specialists

• Certified Registered Nurse Anesthetists
• Clinical Psychologists

• Occupational Therapists

• Qualified Speech-Language Pathologists

• Qualified Audiologists

• Registered Dieticians & Nutritionists

Eligible Clinicians 2018


• Physicians, including doctors of medicine, osteopathy, dental surgery, dental medicine, podiatric medicine, and optometry; osteopathic practitioners; and chiropractors
• Physician Assistants

• Nurse Practitioners

• Clinical Nurse Specialists

• Certified Registered Nurse Anesthetists

 

Participation Requirements 2019


Providers must:
1) accumulate $90,000 in Medicare Part B allowed charges,
2) See more than 200 Part B patients, and
3) Provide 200 or more covered professional services to Part B patients

Providers must meet those minimums for two consecutive one year periods:
• October 2017 – September 2017, and
• October 2018 – September 2019

Participation Requirements 2018


Providers must:
1) accumulate $90,000 in Medicare Part B allowed charges, and
2) See more than 200 Part B patients

Providers must meet those minimums for two consecutive one year periods:
• September 2016 – August 2017, and
• September 2017 – August 2018

 

Payment Adjustment 2019


• MIPS-eligible providers stand to lose up to 7% of their Medicare reimbursements in 2021 for lack of participation.
• Participating providers stand to receive up to 7% in bonus Medicare reimbursements in 2021.

Bonuses: Small practices (of 15 or less clinicians) earn 6 bonus points IN THE QUALITY CATEGORY if they submit data for at least one Quality Measure.

Penalties: Providers need a final MIPS score of 30 to avoid a negative payment adjustment.

Payment Adjustment 2018


• MIPS-eligible providers stand to lose up to 5% of their Medicare reimbursements in 2020 for lack of participation.
• Participating providers stand to receive up to 5% in bonus Medicare reimbursements in 2020.

Bonuses: Small practices (of 15 or less clinicians) earn 5 bonus points if they submit data for at least one performance category.

Penalties: Providers need a final MIPS score of 15 to avoid a negative payment adjustment.

 

Performance Categories 2019


Quality – 45%
Promoting Interoperability – 25%
Improvement Activities – 15%
Cost – 15%

Performance Categories 2018


Quality – 50%
Promoting Interoperability – 25%
Improvement Activities – 15%
Cost – 10%

 


 
 

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).

Full Bio


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