PQRS

Small Practices are Affected by MIPS Increased Thresholds

We recently heard about a small practice that had been faithfully submitting all the required “G” codes for the Quality Payment Program (QPP) only to discover that for 2018 they are excluded from MIPS because the low volume threshold increased from $30,000 in Part B allowed charges or 100 Part B beneficiaries to $90,000 in Part B allowed charges or 200 Part B beneficiaries. They were unsure about what they needed to do at this point and how it would impact their practice.

We recently heard about a small practice that had been faithfully submitting all the required “G” codes for the Quality Payment Program (QPP) only to discover that for 2018 they are excluded from MIPS because the low volume threshold increased from $30,000 in Part B allowed charges or 100 Part B beneficiaries to $90,000 in Part B allowed charges or 200 Part B beneficiaries. They were unsure about what they needed to do at this point and how it would impact their practice.

How Does the Physician Compare Website Affect You?

The physician compare website may not be working quite the way you think it is. Not all providers will have rankings showing up for them. Physician compare lists basic information, but quality measure information was not added until this year (2018) and not all quality measures are included in the Star Rating system. Additionally, patient surveys are also sent out and those are an additional rating.

PQRS Measures by Specialty (2016)

The PQRS program continues for 2016. CMS has recently began to publish a list of preferred measures by specialty. Keep in mind that these are preferred lists which means that there can be additional measures which apply.

The following are the CMS preferred 2016 Specialty Measure Sets:

The PQRS program continues for 2016. CMS has recently began to publish a list of preferred measures by specialty. Keep in mind that these are preferred lists which means that there can be additional measures which apply.

The following are the CMS preferred 2016 Specialty Measure Sets:

PQRS Measures for Behavioral Health (2015)

Performance Measurement Codes for Behavioral Health:

PQRS Measures for Behavioral Health (2014)

Performance Measurement Codes for Behavioral Health:

Combined Deskbook Resources

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In short, MIPS is the new Medicare payment incentive/penalty system which will begin in 2019. The Medicare Access and CHIP Reauthorization Act of 2015 (also known as the SGR repeal or 'doc fix') included the creation of a new pay-for-performance program called the Merit-Based Incentive Payment System (MIPS). In 2019, MIPS will replace the current PQRS, EHR, and VBM as we know it now.

Due to an error found in the logic, The Centers for Medicare & Medicaid Services (CMS) is providing guidance relating to measure CMS122 (Diabetes: Hemoglobin A1c Poor Control) included in the 2014 measure set for the Electronic Health Record (EHR) Incentive Program for Eligible Professionals. Version CMS122v3 of the measure was posted on CMS’s website on May 30, 2014. A subsequent posting of this measure in 2015 (CMS122v4) resolved this issue for the 2016 program year. 

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