Medical Billing Forum

Payments => Insurance Payments => Topic started by: johnpaul4691 on November 28, 2016, 06:09:23 AM

Title: Tell me more about MIPS?
Post by: johnpaul4691 on November 28, 2016, 06:09:23 AM
Tell me more about MIPS?
Title: Re: Tell me more about MIPS?
Post by: johncogger on November 28, 2016, 06:36:54 AM
Eligible clinicians will be evaluated based on 4 categories:

❂ Quality- based on the existing PQRS system

❂ Resource use: based on the Value based payment modifier model

❂ Advancing Care Information: which is similar to MU mandates

❂ Clinical practice improvement categories

Read more: https://goo.gl/DHRDIU (https://goo.gl/DHRDIU)
Title: Re: Tell me more about MIPS?
Post by: Michele on November 28, 2016, 07:05:05 AM
This is the new method Medicare is using to determine the amount providers will be paid.  Providers will be assigned a composite score based on the four areas listed in the previous post and their reimbursement will be dependent on that score.  It doesn't start until 2019 but it will be based on claim information from 2017 (only one month away).
Title: Re: Tell me more about MIPS?
Post by: Christy on January 26, 2017, 03:02:29 PM
ok, so for a LCSW who did not report PQRS in 2015:

This year she has a 2% fee reduction.

She sees only a handful of Medicare patients and definitely bills under $10,000 a year.

So is she MIPS exempt?  And if so, going forward how will her fee schedule be determined?
Title: Re: Tell me more about MIPS?
Post by: Michele on January 28, 2017, 03:31:30 PM
At this time mental health providers are exempt from MIPS until 2019 reporting year.  According to the Final Rule:

In 2017 MIPS applies to Clinicians who bill Medicare Part B using the physician fee schedule, including:
•Physicians (including psychiatrists)
•Physician assistants
•Nurse practitioners
•Clinical nurse specialists
•Certified registered nurse anesthetists