You Haven’t Missed the MIPS Boat! Jump Onboard to Avoid a Penalty

Haven’t thought about the Merit-based Incentive Payment System (MIPS) or what data to submit? Don’t worry, there is still time to avoid the 4% negative payment adjustment on your 2019 Medicare Part B claims.

With just about three weeks left in the 2017 Transition Year, eligible clinicians that have not begun to plan for reporting data to the Centers for Medicare and Medicaid Services (CMS) should consider taking the following steps to avoid a payment penalty:

  1. Determine eligibility – enter your 10-digit NPI into the MIPS participation status lookup tool, which will tell you if you are required to report data to CMS in 2017 or excluded from reporting.
  2. If you are eligible for reporting in 2017, consider either:
    1. Report claims-based data on the Documentation of Current Medications in the Medical Record quality measure (Quality ID 130) between now and December 31st, 2017
      1. Patients who have had their medications reconciled should have HCPCS code G8427 added to their claim form (CMS-1500 form or electronic CMS-1450 form)
      2. Patients who did not have their medications reconciled should have HCPCS code G8428 added to their claim form (CMS-1500 form or electronic CMS-1450 form)
        • Claims data will be submit to CMS directly, no additional reporting needed to satisfy the reporting requirements
        • We recommend reporting on at least 20 patients to provide a buffer should patients be excluded or ineligible for the measure, which would put the clinician in jeopardy of being considered a non-reporter if they reported on fewer patients
        • Measure specification sheet (Select 2017_Measure_130_Claims)
    2. Attest to the Improvement Activity of completed annual registration in your state’s Prescription Drug Monitoring Program, must be registered for at least 6 months (IA_PSPA_5)
      1. Many states now require clinicians to register for and utilize the Prescription Drug Monitoring Program
      2. Be sure to have supporting documentation to demonstrate your registration as well as use and consultation of the system
        • Data submission, attesting Yes, may occur on the CMS Attestation Portal (to be made available in early January 2018) or via a qualified registry or qualified clinical data registry (QCDR)
        • Must complete attestation between January 1st, 2018 and March 31st, 2018 to avoid a payment penalty
  3. If you are excluded from reporting in 2017, be sure to keep a screenshot of the MIPS participation status lookup page to demonstrate your exclusion from the program
    1. Eligible clinicians with less than $90,000 in Medicare Part B claims and who care for fewer than 200 Medicare beneficiaries annually will also be excluded from reporting to MIPS in 2018
    2. Check the MIPS participation lookup page again during the first quarter of 2018 for an updated status for the 2018 performance year


Still unsure about the MIPS program or how to avoid a payment penalty? Contact us for personalized support by clicking the button below.