MIPS: The True Cost of Pick-Your-Pace

Did it cross your mind that what would be the point of doing all the work getting ready for MIPS when CMS is offering “Pick Your Pace Options”?  If it did, you are not alone. Many practices stopped in their MIPS preparation tracks without completely understanding how much money they would be giving up by taking the penalty avoidance track. After all, CMS has made it very easy avoid the 4% penalty in 2019.

Understand how much incentive money you would be giving up by using the  One Patient, One Measure  option, before you make that decision. Download the MyMipsScore App to figure out what the numbers would like for your practice.

Submit Something Option entails that you - submit one measure, for one patient and you are penalty free. It's logical to think that if it’s so easy to avoid penalty, for a budget neutral program, hardly anyone would end up paying the penalty. Which means, diminished bonus potential (<1% by CMS estimates out of maximum potential of 4%) for you even if you go all out and get a MIPS score of 100. But the situation is not so grim as it seems at the outset.

Source: CMS - A Quick Start Guide to the Merit-based Incentive Payment System (MIPS) - for 2017 Participation

Source: CMS - A Quick Start Guide to the Merit-based Incentive Payment System (MIPS) - for 2017 Participation

Small Percentages Can Add Up to Big Numbers

Don’t be in a hurry to call quits on MIPS. There’s more to the bonus story. There is $500 million allocated for distribution among exceptional performers (MIPS Score 70 to 100). As per conservative CMS estimates, this might amount to <2% as opposed to 10% maximum potential, bringing the total positive payment adjustment close to 2.4%. At the face of it, 2.4% does look like a very small number, until you look closely. For instance, a practice that has 1 million in Medicare Part B payments has the potential to earn $23,790 as payment adjustments. That is NOT a paltry sum. [Understand how MIPS calculators work]

A Closer Look at Your Numbers

Numbers speak for themselves and need no further convincing. So, we have made some changes to the app. You can now utilize your 2015 Medicare Part-B payments to determine what is at stake for you. Based on the numbers, you can decide for yourself whether it makes sense for your practice to just submit one measure and avoid penalty, OR invest in earning the best MIPS score you can.

To estimate the financial implications of MIPS for your practice, just: 

1.       Download the MyMipsScore app from your app-store (Apple, Google, or Microsoft)

2.       Click on the MIPS Calculator button on top

3.       Enter your NPI

4.       Get an estimate of the payment adjustment amount based on your 2015 Medicare Part-B payments


Watch this 1 minute video

You can adjust the numbers to your 2019 Medicare Payment estimates, play with different MIPS score combinations and see how much you stand to gain or lose in different scenarios. You can also check your 2017 MIPS eligibility status on the CMS website from within the app. We highly recommend you do that, as eligibility status for some clinicians might have changed from 2015.

To find the potential bonus for your practice, add up the amounts for all the NPIs and then decide If this amount is it worth putting some effort towards.  [Contact us for a free analysis for group practices till Oct 2, 2017] 

2017 being the transition year to MIPS, has most lenient reporting requirements, and thus, is the best time to get started. You have almost nine months of data for 2017, which you can utilize to see where you stand today and 90 days left to make improvements to get the highest MIPS score possible. Starting now will help you identify the gaps in documentation, streamline your workflow, and figure out a strategy that best works for your practice. 


Get Ready for MIPS 2018

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