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Medicare Incentive Payment System: An update for MIPS in 2019

Cybil G. Roehrenbeck, JD (croehrenbeck@polsinelli.com) is a Shareholder in the Washington, DC offices of Polsinelli, PC. Mary B. Tobin, JD (mtobin@polsinelli.com) and Neal Shah, JD, MPH (nshah@polsinelli.com) are Associates in the Chicago offices of Polsinelli.

On April 14, 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law.[1] MACRA provided a permanent repeal of the Sustainable Growth Rate (SGR), which had previously prompted an annual recalculation, an often mandated decrease requiring Congressional intervention in physician and other clinician payment under Medicare Part B.[2]

The 2015 law also included a new value-based system for determining Medicare Part B payment, namely, bonuses for increased quality and decreased cost, as well as penalties for failure to accomplish the same. Beginning in 2017, certain eligible Medicare practitioners participated in one of two MACRA tracks: as a participant in an Advanced Alternative Payment Model (AAPM) designated by the Centers for Medicare & Medicaid Services (CMS); or, in the Medicare Incentive Payment System (MIPS), which requires reporting on a number of quality and cost measures, as well as compliance with certain information security and other requirements.[3]

Clinicians or groups who qualify as MIPS-eligible are required to participate in the program in 2019 or may face a 7% penalty on 2021 Medicare reimbursement.[4] 2019 will be the third year that eligible clinicians participate in MIPS and, unlike 2017 and 2018, this year is not considered to be a “transition” year by CMS. CMS made changes to the rules governing the 2019 MIPS participation year in the Medicare Physician Fee Schedule Rule for 2019 (final rule), published November 1, 2018. The rule makes some significant modifications to the MIPS program, including changes to the criteria to qualify as a “MIPS-eligible” clinician and updates to the four key MIPS performance categories of Quality, Cost, Advancing Care Information (ACI) requirements for electronic health records (EHRs), and Improvement Activities.

This article reviews areas where you or your administrative staff may need to update your compliance protocol to ensure complete and successful MIPS participation in 2019.

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