This document provides a quickstart guide for Medicare providers to maximize bonuses and avoid penalties from the MIPS program. It outlines the 7 key steps to take which include determining eligibility, understanding the timeline and scoring, choosing appropriate quality measures to track, ensuring technology is qualified, developing a data collection strategy, and completing a HIPAA risk analysis. Following these steps is positioned as the least amount of work needed to earn incentive payments worth up to $100,000 per year.

1. The Quickstart Guide
to Help You
EARN THE
MEDICARE
BONUS &
AVOID THE
PENALTY
With the Least Amount
of Work Possible

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The Medicare Provider’s Quickstart Guide to Maximizing the MIPS Bonus
MIPS Program Overview 3
Step 1: Are You Qualified? 4
Important Qualification Consideration for Medicare Provider Groups 4
Step 2: Getting Started within the MIPS Timeline 4
Step 3: Calculating the Potential MIPS Penalty and Bonus 5
Step 4: Determine if Your Software (EHR) Is Qualified 6
Step 5: Determine Your MIPS Measures 7
Quality Measures 8
Cost 8
Improvement Activities 8
ACI (Advancing Care Information) 9
Step 6: Set Your MIPS Data Collection Strategy 10
Step 7: HIPAA Risk Analysis 11
Step 8: Monthly MIPS Report Review 11
Testimonials: What Our Customer Say About Mike Holtz and Access1 12
Next Step: Free MIPS Strategy Session 13
TABLE OF CONTENTS
ABOUT MIKE HOLTZ AND ACCESS1
My name is Mike Holtz and over the past few years, my team at
Access1 and I have helped dozens of Medicare providers earn
millions from the government in Meaningful Use bonuses.
And while the Meaningful Use program is finished, a new
government program, called MIPS (Merit-based Incentive-based
Payment System) is now available and could be worth $100,000
per year in incentive payments to qualified Medicare providers.
My team and I are on a mission to help as many Medicare providers maximize the MIPS
bonus and minimize the MIPS penalty with the least amount of work possible.

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MIPS is the first step toward Outcome Based Reimbursement vs. the
current Fee for Service system.
Rather than paying clinicians more based on the number of treatments, visits,
procedures and tests completed, the goal is to pay more for better outcomes that are
delivered with less time and cost to the patient and the system.
The Quality Payment Program attempts to make Medicare better by helping the
clinician focus on care quality and the one thing that matters most — making patients
healthier.
The Quality Payment Program ends the Sustainable Growth Rate formula and gives you
tools, models, and resources to help you give your patients the best possible care.
You can choose how you want to take part based on your practice size, specialty,
location, or patient population. MIPS tries to focus on rewarding clinicians who can
deliver a higher level of care with better and quicker outcomes at a lower cost.
It will penalize those who have poorer outcomes or have higher than average costs.
There is also incentive to improve the overall patient experience through better access,
communication and quicker and better care.
While the program is not perfect and is continually being modified to be better, it is the
playing field where clinicians currently work.
While this is currently only for Medicare, other major carriers are certainly watching.
MIPS PROGRAM OVERVIEW

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STEP 1: ARE YOU QUALIFIED?
You must answer YES to these 3 questions:
1. Are you a physician, physician’s assistant, nurse practitioner, Clinical Nurse Specialist,
or Certified Registered Nurse Anesthetist?
2. Do you bill Medicare Part B $90,000 or more per year?
3. Do you have 200 or more Medicare patients per year?
If you answered YES to the above questions, you are qualified. If you’re still not sure,
you can visit: https://qpp.cms.gov/ and enter your National Provider Identifier (NPI)
number to get an official answer from Medicare.
Important Qualification Consideration for Groups!
If you currently bill less than $90,000 in qualified Medicare Part B claims annually but
are part of a group that collectively is above that threshold you are in luck! You can
report as a group and reap the rewards of the QPP/MIPS program. Call us to verify
your eligibility.
STEP 2: GETTING STARTED WITHIN THE MIPS TIMELINE
CRITICAL MIPS TIMELINE DATES!!!!!
THE BAD NEWS--The transitional year of 2017 has passed so if you did not report, you
have missed the first opportunity. There is NOTHING YOU CAN DO to avoid the 4%
penalty in 2019.
The GOOD NEWS!!! The benefits (and penalties) are bigger this year than last. On the
following pages you will see how the percentages grow over the coming years.
The BIGGEST DEADLINE IS TODAY!!! As there is no grace period this year, your
measurements started on January 1st for most of the measures. Every day that
passes where you do not document appropriate data is costing you money. The
sooner you start the better your chances are at maximizing your financial bonus.
Chances are you are already doing the work. Be sure you document it properly! Even
doing SOME data capture will help but why leave money on the table? Let us help you
maximize your bonus with the least amount of work.
January 1, 2018 – LAST DATE to start data collection for 2018 qualifying year.

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Based on the level of reporting during the entire 2018 year, the clinician will either
be penalized 5% of all reimbursement or earn as much as a 15% bonus on all
reimbursement, or somewhere in between. That is a 20% difference depending on your
reporting.
To avoid 2019 and 2020 penalties of 4% and 5% and to maximize the bonus for
2020, you must get started today. It takes some time to get all of your best measures
selected and implemented before January 1.
We pledge to help you “eliminate all penalties and maximize your bonus….with the
least amount of work on your side.”
STEP 3: CALCULATING THE POTENTIAL MIPS PENALTY AND BONUS
Here’s what you need to know about the MIPS penalty and bonus.
There is a 2-year lag between the qualifying year and the adjustment year. So, what
you do in 2018 impacts your 2020 bonuses penalties.
Potential bonuses are 3x the potential penalties.
You need to earn a MIPS score of 100 to achieve the highest potential bonus.
The following chart shows the how the potential penalties and bonuses are being
phased in.
First, a little basic information:

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How much Medicare qualified billing is sent annually? $______________­­­_____________
How much in Medicare payments received annually? $____________________________
How many unique Medicare patients are seen annually? __________________________
What is the total annual billing (for all payors)? $__________________________________
What are your credentials (MD,DO,DC,DPM,NP,PA, etc)? __________________________
What is your specialty? ________________________________________________________
Who is your main contact in your office? _________________________________________
Are you a solo clinician or part of a group? If part of a group, please describe the
nature of your group, number of clinicians, etc. ___________________________________
______________________________________________________________________________
There is a 2-year lag between the qualifying year and the adjustment year.
The following chart shows a Medicare provider who bills $1M annually.
Qualifying
Year
Payment
Year
Annual
Billing Penalty Bonus 3X
Total Bonus
+ Penalty
Total 3x Bonus
+ Penalty
$1,000,000
2017 2019 4% $40,000 $40,000 $120,000 $80,000 $160,000
2018 2020 5% $50,000 $50,000 $150,000 $100,000 $200,000
2019 2021 7% $70,000 $70,000 $210,000 $140,000 $280,000
2020 2022 9% $90,000 $90,000 $270,000 $180,000 $360,000
2021 2023 9% $90,000 $90,000 $270,000 $180,000 $360,000
Totals $340,000 $340,000 $1,020,000 $680,000 $1,360,000
STEP 4: DETERMINE IF YOUR SOFTWARE (EHR) IS QUALIFIED?
Your electronic healthcare records (EHR) system must be certified by CMS (Centers
for Medicare Medicaid Services). Why? Because the entire MIPS reporting process
depends on accurate data being collected and transmitted to Medicare. In short, you
need to pick the right measures, collect the measures the right way, and transmit it the
right way for you to maximize your MIPS bonus and avoid the MIPS penalty.
Here are the questions you need to answer to determine if you EHR is MIPS qualified.
1. Is your software qualified?
a. What software are you currently using for billing/clinical documentation?
b. Do you know if it is certified?

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c. If certified, to 2014 cert standard or 2015 standard?
d. Are all measures that you need included in your software? If not, can they be
added for a reasonable cost?
e. Is your patient portal fully functional and being utilized?
f. Are you able to grant outside access to your reporting (for coaching)?
What happens if your EHR software is NOT certified?
Call us!
STEP 5: DETERMINE YOUR MIPS MEASURES
MIPS is the first step toward Outcome Based Reimbursement vs. the current Fee for
Service system.
Rather than paying clinicians more based on the number of treatments, visits,
procedures and tests completed, the goal is to pay more for better outcomes that are
delivered more quickly, with less time and cost to the patient and the system.
The program is made up of 4 components.

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QUALITY MEASURES — 50% OF SCORE
This set of measures replaces the older PQRS reporting system. The goal is to be able
to report 6 high quality measures for the reporting period. While we want the highest
possible percentage of positive results, we also want the highest possible number of
opportunities.
We want measures that can be answered a large number of times per day and in a
positive way. If need be, focus on other measures that are already being completed but
not documented.
1. Select a minimum of 6 and a maximum of 8 measures to track. (285 available)
2. If possible select measures that are low hanging fruit — Clinician is already
performing but perhaps not documenting.
3. Measures must be available in the clinician software. Not all measures are available
from every software.
4. One measure must be an outcome based measure if possible. If none is available,
then a high value measure must be selected.
5. Be cautious of measure reporting options. Some measures will translate to a higher or
lower MIPS value depending on how the measure is reported. Can the Certified EHR
Technology support reporting each measure in the most advantageous method?
6. Be prepared to move to new measures quickly if original choices do not result in
good numbers.
7. Measures top out each year. Be prepared to switch accordingly.
COST — 10% OF SCORE THIS YEAR (2018)
The COST measure (loosely) replaces the Value Modifier Program. This measure will
directly measure (through billing claims) the number of visits, number and types of
charges, cost of charges as well as the eventual outcome of the care. It will become
more and more important to closely monitor the coding used for billing. Generally the
more precise and less general coding will benefit the provider.
This applies to both CPT and ICD10 coding. It is appropriate to suggest providers start
evaluation of their coding practices well in advance of this measure becoming active.
IMPROVEMENT ACTIVITIES —15% OF SCORE
This is a new area for CMS. Improvement activities focus more directly on the patient
experience.
Options include things like expanding office hours, adding mid-level caregivers to
do telephone follow-up with patients, offering wellness clinics (nutrition, smoking
cessation, etc.)
Reporting of these measures is through attestation in most cases (i.e. Did you do these
things? Yes/No.) Clinician will need to retain documentation proving that the activities
were, in fact, performed. There are 93 measures to choose from.

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1. If either an individual practice or group of 2-15.
a. Report 2 Medium Value activities or
b. Report 1 High Value activities.
2. If part of a group of clinicians of 16 or more.
a. Report 4 Medium Value activities.
b. Report 2 High Value activities.
c. Some combination of above.
ACI (ADVANCING CARE INFORMATION) — 25% OF SCORE
This set of measures replaces the older Meaningful Use program. The measures vary
slightly depending on the level of certification of the CEHRT. The focus of these
measures is on use of electronic systems for patient information security, access and
interoperability.
Determine level of certification of CEHRT.
1. If Certified to 2014 Certification (ACI Transition Objectives and Measures)
a. Must complete 4 Required Measures (12.5%)
1. E-Prescribing
2. Security Risk Analysis (annually)
3. Provide Patient Access (Patient Portal)
4. Outgoing Patient Summary of Care
b. Additional Optional Measures to Maximize ACI Score (up to 12.5%)
1. Patient Specific Education Materials
2. Secure Messaging through the Portal
3. View, Download, Transmit through the Portal
4. Medication Reconciliation
5. Immunization Registry Reporting
6. Specialized Registry Reporting
7. Syndromic Surveillance Reporting
2. If Certified to 2015 Certification (ACI Objectives and Measures)
a. Must complete 5 Required Measures (12.5%)
1. E-Prescribing
2. Security Risk Analysis (annually)
3. Provide Patient Access (Patient Portal)
4. Request/Accept Summary of Care
5. Send Outgoing Summary of Care
b. Additional Optional Measures to Maximize ACI Score (12.5%)
1. Clinical Data Registry Reporting
2. Clinical Information Reconciliation
3. Electronic Case Reporting
4. Immunization Registry Reporting
5. Patient-Generated Health Data
6. Patient Specific Education
7. Public Health Registry Reporting
8. Secure Messaging
9. Syndromic Surveillance Reporting
10. View, Download, or Transmit Data

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PRACTICE GROWTH ASSOCIATION CONSIDERATIONS
Being part of or associated with items in C below can create special circumstances
for reporting requirements and exclusions. If the practice is growing, the impact of
participation is bigger.
1. Practice Overview
a. Is your practice growing/stable/shrinking over the next 2-5 years?
b. Is your patient population aging at a rate that will affect the percentage of
Medicare business in your practice?
c. Are you part of or associated with:
1. Rural Health Clinic.
2. CAH (Critical Access Hospital)
3. In a HPSA (Health Professional Shortage Area)
4. QCDR (Qualified Clinical Data Registry)
5. APM (Alternative Payment Model)
6. ACO (Accountable Care Organization)
d. Do you bill internally for your fees or do you use an outside agency?
One you’ve determined your MIPS Measures, you now need to create a MIPS Data
Collection Strategy. This is how you and your team will integrate your MIPS data
collection.
This involves some training of your staff to ensure they collect the MIPS measures you
determined in Step #5.
The goal is to make sure you collect your MIPS measure with every patient intake
operation. And to ensure that all of your intake methods (paper, tablet, computer, etc.)
have included the chosen MIPS measures!
NOTE: If your practice exports billing, the process of recording data is sometimes
much harder.
STEP 6: SET YOUR MIPS DATA COLLECTION STRATEGY

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While HIPAA risk analysis has been around for years, this is the first year that it has
become part of the MIPS requirements.
As noted above, the HIPAA risk analysis is part of the ACI (Advancing Care Information)
component of the MIPS score, which represents 25% of your overall MIPS score.
Over 90% of my clients do NOT have a current HIPAA risk analysis completed. I’ve
been brought into numerous client audits, and when (not if) Medicare audits your
practice, the HIPAA risk analysis is the first thing they examine.
My team and I work with the top certified HIPAA risk experts in the business and
can get you up to date as quickly as possible. This is not something you want to put
off, which is why I’ve listed this as a critical step to maximizing your MIPS bonus and
avoiding the MIPS penalty.
The last thing I want to see is my clients getting penalized for HIPAA risk violations and
forfeiting 25% of their MIPS score (and almost guaranteeing that the MIPS Bonus will
disappear).
STEP 7: HIPAA RISK ANALYSIS
At Access1, we create a summary report and review the MIPS measures every month.
We ensure that our clients are on track and that there will be absolutely no surprises
when the actual data is uploaded to Medicare.
This is the monthly “peace of mind” step to let you and your staff know that everything
is on track and functioning properly. If a problem is detected, the time to fix it is before
you officially submit your data, which happens in March, the following year of your
MIPS data collection (similar to filing your taxes with the IRS on April 15th).
STEP 8: MONTHLY MIPS REPORT REVIEW

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“We have worked with Mike at Access1 through EHR and now
MIPS. His knowledge, expertise and support are exceptional and
invaluable. We would be lost without him. I highly recommend
Access1 to any office in need of the services they provide. You
won’t be disappointed and, in fact, you can send me a thank you
card.”
Dr. Louis M. Sempek, DPM
Family Foot Care
“Mike has assisted our office with medical technology transitions
since Y2K. Utilizing Access1 services and their qualified staff
has allowed my office to focus on providing quality care to my
patients. Mike and his staff have always communicated with us in
a timely and effective manner. We look forward to continuing our
business relationship with Access1.”
Austin Corbett, MD
Rheumatology
Colorado
On behalf of all of us here at Central Utah Foot Clinic, I wanted
to take this opportunity to thank Mike and Joe at Access 1
for their outstanding help with our Meaningful Use and MIPS
compliance. While it’s all so confusing and frustrating to us,
they help you know exactly what information you need to be
compliant at the end of the year. We’ve been successful in not
receiving any penalties because of their great service.
Dr. Thomas Rogers, DPM
Central Utah Foot Clinic (Provo Office)
TESTIMONIALS: WHAT OUR CUSTOMERS SAY
ABOUT MIKE HOLTZ AND ACCESS1

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The Medicare Provider’s Quickstart Guide to Maximizing the MIPS Bonus
I’m trying to help as many Medicare providers as possible get the MIPS
bonus and avoid the MIPS penalty.
So, I’m offering a free 30-minute MIPS strategy session. On this session, myself or one
of my certified MIPS coaches will ask you a series of questions to diagnose the MIPS
status of your practice and prescribe a custom solution to get you the maximum MIPS
bonus.
At the end of our strategy session, I’m going to offer a done-for-you solution, where my
team will work with your team to ensure that you get the maximum bonus. You will get
ongoing monthly support, and we regularly check in with your team to give you your
MIPS status, so there will be no surprises at the end of the year.
In short, we make sure you get the maximum MIPS bonus.
The fee for this done-for-you MIPS solution is just $2,400. My clients will testify to
significant ROI when compared to the bonuses they receive plus the penalties they
avoid.
Now, if you decide not to work with us, that’s totally fine. The MIPS Quickstart Guide
and the strategy session results are yours to keep. No obligation. You can use the
checklist and the strategy session information to do it yourself.
In fact, if after our strategy session, you feel like I’ve wasted even one minute of your
time, I will send you a check for $100.
Now, in the entire time I’ve offered this, no one has taken me up on that guarantee, but
I want you to know that we’re serious about our mission to maximize our clients’ MIPS
bonuses. If we’re not doing our job right, your feedback will be worth 10x that $100 if it
improves our MIPS services in any way.
Here’s the catch.
If you haven’t started collecting your MIPS data using the right formula, there’s still time
to get this done.
NEXT STEP: FREE MIPS STRATEGY SESSION

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The Medicare Provider’s Quickstart Guide to Maximizing the MIPS Bonus
If you miss the critical dates I outlined above, you’re more than likely looking at a
penalty in 2020. However, we can still get you set up and ready to collect the right
MIPS data starting today, which will impact all of your 2020 bonus.
The MIPS bonus is a zero sum game. In other words, all of the MIPS penalties get put
in a pool that is used to pay the providers who earn the MIPS bonuses. These are not
my rules. These are the MIPS guidelines that Medicare will enforce.
I’m on a mission to get my clients the best MIPS bonuses they can get.
So, what I need you to do now, click the button below and schedule a free MIPS
strategy session. That will lock in your time with us, which is filling up quickly.
Just click the link below to schedule your strategy session today, and take the next
step toward maximizing your MIPS bonus and eliminating the MIPS penalties.
SCHEDULE YOUR STRATEGY SESSION
HTTPS://MIPSMETHOD.COM/MIPS-QUALIFIED-WALKTHRU