MIPS continues to be a major risk, with practices who do not participate subject to a 5% penalty. This webinar covers: Rule clarification and changes that have occured since January 1st. Measure clarification and changes that have occured since January 1st. Your measure calculations may be changing as a result. Where your practice should be at this point in the year. How we can help support unique workflows and provider documentation.

1. Insight19
MIPS MID Year
July 12, 2018

2. Where To Focused
Agenda
What’s New
Recap Current 2018

3. Providing professional services for 13 years.
150+ employees, headquartered in Miami, Florida.
National footprint (Alaska to Florida).
Served over 20,000 doctors, mid-levels, nurse practitioners.
EHR and PM system agnostic.
Clients ranging from solo-practitioners, multi-specialty, FQHCs,
universities, IPAs, and more.
Care Optimize

4. What’s New
CMS has released MIPS Performance Feedback Reports and Final MIPS Scores for MIPS
Year 2017
Includes:
 2017 MIPS Performance Final Score for an individual clinician, group
or APM entity
 2019 Merit Based Incentive Payment Adjustments
 Detailed scoring and performance of each categories
 ER Utilization for attributed Medicare Beneficiaries

5. 2017 Performance Reports

6. 2017 Performance Reports
Quality:
• Measure-level scores, including performance and/or bonus points
• Benchmark information
• Performance Rates
• Numerator and denominator values
• Access to measure specifications
Advancing Care Information:
• Measure-level performance scores
• Numerator and denominator values
• Access to measure specifications
• Indicator of special scoring considerations, such as reweighting to
0% due to an approved hardship exception
Improvement Activities:
• Weight of each submitted activity
• Scores for each submitted activity
• Access to activity specifications
• Indicator of special scoring considerations, such as full
credit in the category for participation in the Improvement
Activity study
Cost: (informational only)
• Measure-level scores
• Measure-specific details such as the number of eligible
cases or episodes, and the average cost per episode
• Access to measure specifications

7. What’s New
MIPS Participants can request a targeted review if they believe there are errors
in the final report
Reports will be available on Physician Compare starting in late 2018
Benchmarks for 2017 Quality Measures must be recalculated based off 2018
EC

8. To Access Your Report
These scores can only be obtained using your Enterprise Identity
Management (EIDM) account
Clinicians, groups, ACO’s and NG ACO’s and authorized representatives
will be able to access reports
Submitting Entities – EHR / Registry will not have access to the Final
Scores
EIDM User Guide(www.cms.gov)
https://portal.cms.gov/wps/portal/unauthp
ortal/home/

9. 2017 Reminders
2017 Performance 2019 Medicare payments
Performance Categories
Quality (60%)
Advancing Care Information (25%)
Improvement Activities (15%)
Cost (0%) – no impact
Potential Adjustments -4% to +4%
Exceptional Performance
Threshold 70 or above

10. Eligible Clinicians
> $90,000 in Medicare Part B
>200 beneficiaries
Categories
Quality (50%) 1 year
Promoting Interoperability (Formerly ACI) (25%) 90 days
Improvement Activities (15%) 90 year
Cost (10%) 1 year
Expectational Performance
Threshold 70 points both years
Minimum Submission 15 points (increased from 3 points) / 60%
Bonus Points
Registry Bonus: +5%
Improvement Bonus: +10% Quality Score
End to End: +6 to Quality
2015 Edition Bonus: +10 pts PI
CEHRT submission: +6 pts
Additional Measures: +6 pts
ACI bonus for select IA: +10pts
Small Practice Bonus: 5 pts to overall
Complex Patients: 5 pts to overall

11. Topped out Measures
(max 7 PTs)
#21 Perioperative Care: Selection of Prophylactic Antibiotic-
First or Second Generation Cephalosporin
#23 Perioperative Care: Venous Thromboembolism (VTE)
Prophylaxis (When Indicated in ALL Patients)
#52 Chronic Obstructive Pulmonary Disease (COPD):
Inhaled Bronchodilator Therapy
#224 Melanoma: Overutilization of Imaging Studies in
Melanoma
#262 Image Confirmation of Successful Excision of Image
Localized Breast Lesion
#359 Optimizing Patient Exposure to Ionizing Radiation:
Utilization of a Standardized Nomenclature for
Computerized Tomography (CT) Imaging Description
PI Cert 2014 CEHRT permitted and 2015 CEHRT bonus created
Potential Adjustments -/+5%

12. Low Volume Threshold
Determination
Two 12-month segments of claims data
The first determination period was based on Part B claims from 9/1/-8/31
2017 MIPS: September 1, 2015 – August 31, 2016
2018 MIPS: September 1, 2016 – August 31, 2017
The second determination period was based on Part B claims from 9/1-8/31
2017 MIPS: September 1, 2016 – August 31, 2017
2018 MIPS: September 1, 2017 – August 31, 2018
Must exceed threshold in both periods

13. Considerations
Only MIPS EC during the qualifying year will receive adjustments regardless of
individual or group reporting.
Adjustments will only apply to Medicare Part B reimbursements
Group’s final scores will be applied to all MIPS Eligible Clinicians that bill under that
TIN during the performance year
EC’s who bill under multiple TINS will reciece separate final scores / adjustments for
each TIN/NPI combination
EC’s who receive scores in 2017 and bill under new TIN in 2019, CMS will apply the
payment adjustment associated with the NPI’s final score that was billed under 2017
performance period
Multiple scores for a NPI will take the highest score

14. Improvement Scoring –
What is used to determine?
Group > Individual in same TIN Individual score compared to group score for
TIN/NPI
New TIN but submitted Individual before Individual score compared to prior score
Multiple score in previous year and new TIN Individual score compared to highest previous
scores
No prior group score Averages from prior reported individuals in group
Starting in 2018 a Improvement Percent Score is Added to the Quality Performance
Category

15. Where to focus for 2018?
 If previously submitted, review 2017 report – this will give base for categories
unable to predict and prior performance to compare
 Decide method for submission
 Determine measures for tracking and review for updates to 2018 requirements
 Decide if you will be using 2015 or 2015 Cert EHR
 Tracking performance – Reminder Quality, Cost, IA full year! PI 90 continuous days
 Don’t forget Base Measures for ACI

16. Least to Do Without Penalty
Report 15 points from IA/Quality or combination of categories

17. DON’T FORGET!
August 1, 2018 through December 31, 2018
Advancing Care Information Hardship Exception Application
Window Opens
December 2018
Performance Year 2018 Eligibility Finalized
January 2, 2019 through April 2, 2019
Submission Window Opens for Performance Year 2018
You may submit and update your data any time while the
submission window is open.
March 2019
CMS Web Interface Submission Window Ends for
Performance Year 2018

18. Thank you
Megan.Halligan@CareOptimize.com
www.careoptimize.com

19. CMS Resource Library
Year 2 Overview
Payment Adjustment Fact
Sheet
Targeted Review Fact Sheet
Targeted Review User
Guide
EIDM Account Set Up
Physician Compare Initiative
QPP Participation Status
Hardship Exception
Resources

20. Questions:
What are transition vs non-transition/regular measures?
In 2018, there are two measure set options for reporting
PI Measures: 2015 CEHRT
Security Risk Analysis (Base)
e-Prescribing (Base)
Provide Patient Access (Base)
Send a Summary of Care (Base)
Request/Accept Summary Care (Base)
Patient Specific Education
View, Download or Transmit (VDT)
Secure Messaging
Patient-Generated Health Data
​Clinical Information Reconciliation
Immunization Registry Reporting
Clinical Data Registry Reporting
Syndromic Surveillance Reporting
Electronic Case Reporting
Public Health Registry Reporting
PI Transition Measures: 2014 CEHRT
Security Risk Analysis (Base)
e-Prescribing (Base)
Provide Patient Access (Base)
Health Information Exchange (Base)
View, Download, or Transmit (VDT)
Patient-Specific Education
Secure Messaging
Medication Reconciliation
Immunization Registry Reporting
Specialized Registry Reporting
Syndromic Surveillance Reporting