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First Year MIPS Reporting Decision Could Mean Pay Increase

MACRA is not going anywhere. So whether you like it or not, you have an important decision to make. For the first year, you have to weigh your compliance options and pick the right one for your practice. Choose wrong, and you could be faced with a significant decrease in your future Medicare reimbursement.

For 2017, you have five options for MACRA compliance:

  • Option 1: Take part in an Advance Alternative Payment Model (APM). This options means you will receive a 5% bonus payment in 2019.
  • Option 2: Submit data in one of the three Merit-based Incentive Payment System (MIPS) categories for a minimum of 90 days. This allows you to give it a try, and you’ll avoid a future negative payment adjustment.
  • Option 3: Submit data in all three MIPS categories for a minimum of 90 days. This option could qualify you for a small future positive payment adjustment.
  • Option 4: Submit a full year of MIPS data. If you submit your MIPS data for all of 2017, you could receive as much as a 12% Medicare payment increase.
  • Option 5: Report no data. This would leave you with a 4% payment reduction for your future Medicare payments.

So as long as you report some data for at least 90 days for 2017, you won’t be penalized with a payment reduction for your 2019 Medicare Part B allowable charges. At the same time, if you decide to report the bare minimum, you could be missing out on the chance to qualify for a substantial Medicare revenue increase of up to 12%. It all depends on the option you choose.

In addition, keep in mind that the Centers for Medicare and Medicaid Services (CMS) doesn’t require you to choose your reporting option or even submit your 2017 data until March 2018. So you can collect your data throughout 2017 and then decide which option has the best outcomes for you and your practice. However, to increase your options, you should prepare now so that you can be sure to collect as much data as possible.

Take Aways:

  • You have five options for MACRA compliance for the 2017 performance period.
  • If you’re subject to MIPS and report only the minimum data, you won’t be penalized, but you may also miss out on a bigger positive Medicare payment adjustment.
  • If you report a full year of MIPS data for 2017, you could see has much as a 12% Medicare payment bump.

To ensure that you have all the information you need about this confusing topic so you can make the right compliance decision, check out Coding Leader's online training series on MIPS: Everything You'll Need to Master Quality Reporting (3-Part Series). And you can view all upcoming live online training sessions at