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Preparing for MIPS: The Key Elements

By: Cal LaGroue

December 12, 2016

MIPS – Merit-based Incentive Payment System

MIPS is one of the latest developments in Healthcare. As MIPS approaches, The Valletta Group wants to make sure that its clients are fully informed. Below are some key facts about MIPS, including information about its implementation, like qualification and exemption details, as well as important dates and deadlines.

 

The following summary was provided by Cal LaGroue, Executive VP of The Valletta Group:


What is MIPS?

  • MIPS is a new program that combines parts of PQRS, VM, and the EHR incentive program into one single program in which Eligible Clinicians will be measured on four specific performance categories:
    • Quality (replaces PQRS)
    • Improvement Activities (new category)
    • Advancing Care Information (replaces Meaningful Use)
    • Cost (replaces Value-Based Payment Modifier)

When does, MIPS take effect?

  • As early as January 1, 2017
  • MIPS only affects Medicare claims.

How is my MIPS score determined in 2017?

  • Quality (60%), Advancing Care Information (25%), Improvement Activities (15%)
  • Your 2017 MIPS score affects your 2019 claims.

Am I an Eligible Clinician for participation?

  • Eligible Clinicians are physicians, physician assistants, nurse practitioners, clinical nurse specialists, and nurse anesthetists.

What are the 2017 exemptions from the MIPS program?

  • Newly enrolled clinicians during 2017
  • Low – volume providers
  • APM participant (Advanced Alternative Payment Models)

What do I need to do in 2017?

  • You have four reporting options to choose from in 2017. If you do nothing, you will receive a 4% reduction on Medicare Part B claims in 2019.

How do I know if I qualify under the low-volume provider exemption?

  • CMS will notify practitioners by December of each year, if exempt.

More information about MIPS


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).

Full Bio


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