MGMA 2017: Falk's magic number avoids MIPS penalty

By reporting one quality measure for one patient over the course of a year, practices can avoid a negative Medicare payment adjustment in 2019.

ANAHEIM, California—For practices that haven’t started thinking about MIPS, it’s not too late to avoid a reimbursement penalty. Just remember the number three.

While they have missed the deadline that would allow them to collect data for a consecutive 90 days and earn a small positive payment adjustment, there’s still time to avoid a payment penalty under the new Medicare payment system. That was a recurring theme at the Medical Group Management Association's annual conference here this week.

Under the “pick-your pace option” during the first year of the Merit-based Incentive Payment System (MIPS), one of the two payment tracks under MACRA, there’s still time for physician practices to earn the three points needed to avoid a penalty, said Suzanne Falk, MGMA’s associate director of government affairs.

Under MIPS, clinicians can earn 0 to 100 points. Three points is the magic number to avoid a penalty and the loss of Medicare revenue, Falk said during a conference presentation.

There’s really no reason for anyone to get a penalty.

To avoid the penalty, practices must report one quality measure on one patient for the year and they still have time to do that, Falk said. That step alone gives them three points and they can avoid up to a 4% negative payment adjustment in 2019. Practices can pick from almost 300 measures.

FierceHealthcare caught up with Falk after the session and she shared these additional tips:

Focus on the quality measures, one of three categories in play in 2017 under MIPS. “Especially in this place in the year ... I would recommend people put a lot of their eggs in the quality basket,” she said. And it's a category where practices can capture enough data to avoid a penalty. (The other two categories are clinical practice improvement activities and advancing care information.)

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Don’t stop at one. As a backup, report more than one measure. Send in data on two measures (or more), in case there is a problem with the data you submit, she said. Zone in on the outcomes measures. So, a doctor could report on a measure for diabetes or falls for a patient seen during an office visit.

Report the data through your Medicare claims. Doing so is free, she points out. There are other reporting mechanisms, but they are not without expense. So, you can report one code on one claim. For the patient with diabetes, you might report that you did a foot exam or found poor control of hemoglobin A1c levels during the office visit. To do that, you add a code on the claim indicating you are submitting the data as part of your MIPS reporting.

Look carefully at the measures. The same measure can have different national benchmarks attached to it, she said, so look at that information before choosing. For instance, there are four different measures under adult kidney disease. See what measure best suits your particular practice.

Doctors who wanted to fully participate in MIPS and earn a small positive Medicare payment adjustment just faced an Oct. 2 deadline to begin collecting performance data for a 90-day period. But with that deadline gone by, practices should act to report one measure before the end of the year to ensure they don’t lose Medicare reimbursement.