2018 MIPS Changes
April 16, 2018
Written by Sharon Phelps
Whew!! 2017 MIPS Submission is completed and it is time to begin planning for 2018 MIPS. Some of you may be well down this road while others have been completely occupied by 2017 until now. No matter where you may be, here is a list of the important 2018 changes.
- Low Volume Exemption. These values increased significantly! To exceed the thresholds, you need to see at least 200 Medicare patients AND have billed at least $90,000 in allowable Medicare Part B charges.
Important note – the Balanced Budget Act of 2018 tweaked which Medicare Part B charges are used to determine the allowable charges. Effective starting in 2018, CMS will use only Part B “service” charges rather than “items and services.”
Action Item – If your volumes fall BELOW either the patient or the allowable charges threshold, you can choose to voluntarily participate but will NOT assess a negative penalty if you do NOT participate.
If your volumes EXCEED both the patient and the allowable charges threshold, you will be assessed a negative 5% payment adjustment if you do NOT participate.FAQ – How do can you check your eligibility status for these thresholds? By using the CMS Participation Status tool – https://qpp.cms.gov/participation-lookup. We anticipate the Participation Status tool will be updated very soon! Look in the first paragraph to ensure it states the Participation Status tool is for the 2018 Performance Period.
- Neutral Score. The neutral point has increased to 15 points in 2018. As long your 2018 final score is 15 or greater, you will not receive a negative adjustment if exceed the exemption thresholds.
- Cost category. This year, the Cost category will account for up to 10 points of your final score. This category is calculated from patients attributed to you by CMS and you do not need to report any additional data. The actual process they use to calculate these measures can get pretty intense so here are the measures with a link to more in-depth information.
The two measures being calculated in this category are:
- Medicare Spending per Beneficiary – attributed based on service volume during hospitalization.
- Total per Capita Cost – attributed based on primary care service volume.
You will likely have multiple questions on this category as it had no weight in 2017. We will be providing more information on this category in the future. CMS will be providing data on cost for informational purposes in your 2017 Final Feedback report due out by July.
- Participation levels.
- Quality category – quality reporting will cover the full year
- Advancing care information – report for a minimum of 90 days
- Improvement activities – report for a minimum of 90 days or as specified for the individual activity
Those are the big items. If you want to see the nitty gritty detail, here is a summary of all the changes in the 2018 Final Rule:
https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/QPP-Year-2-Final-Rule-Fact-Sheet.pdf
Please contact us if you have question or would like to arrange a one-on-one conversation with one of our QPP experts to help you design your 2018 action plan.
Email the QPP Help Desk at qpp@cms.hhs.gov or call the QPP Service Center at 1-866-288-8292.
You are also welcome to visit our Mountain-Pacific QPP website for more MIPS details.
You can also use the “Leave a Reply” section below, and one of our subject matter experts will get back to you.
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CMS QPP Website
HTS MIPS Services
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