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    MIPS questions every practice should answer

    To succeed under the Meritbased Incentive Payment System (MIPS), physicians must embrace transforming how their practice does business to succeed with value-based pay. While government regulators have made MIPS participation easier in 2017, allowing physicians to ease into the program via a “pick your pace” plan, in 2018 physicians will have to fully participate, and could face reimbursement penalties if they don’t.

    The proposed 2018 rule for MIPS is proof that Medicare’s focus on value-based pay is not going away. “I think you have to accept the fact that this is reality and make your battle plan from here,” says Owen Dahl, FACHE, CHBC, a practice management consultant based in Texas. But diving headlong into MIPS before taking a hard look at what is required and performing a cost-benefit analysis would be a mistake, healthcare consultants say. Here are some questions that physicians should answer to prepare for MIPS.

     Am I exempt?

    The first step physicians in solo and small practice should take is to learn whether they even have to participate in MIPS. In 2017, physicians with 100 or fewer Medicare patients and $30,000 or less of Medicare charges are exempt from the program. That exemption expands in 2018, to 200 patients and $90,000 or less in charges, if the proposed rule is approved.

    Physicians should visit the Quality Payment Program website (https://qpp.cms.gov/participation-lookup) and use their National Provider Identifier to check whether they are exempt in 2017, says Elizabeth Woodcock, MBA, CPC, FACMPE, a healthcare consultant in Atlanta, Georgia. 

     What level of participation makes sense for my practice?

    A good financial and practice management strategy means evaluating potential programs on a cost-benefit basis, Woodcock says. Under MIPS in 2017, doctors can either receive a payment penalty, which maxes out at 4%, or a bonus that can reach as high as 12%. Physicians will fall along that spectrum based on their performance. The key is whether competing for this bonus—or avoiding the penalty—is worth it.


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