With the long-awaited issuance of the MACRA Final Rule, the Centers for Medicare and Medicaid Services (CMS) tried to soften the blow for small practices in the first year of the program. Depending on the 2017 data you submit by March 31, 2018, your 2019 Medicare payments will be adjusted up, down, or not at all. This flexible timeline casts a wide net and should get everyone to participate. Measurement under the Merit Based Incentive Payment Plan (MIPS), effective January 1, 2017, is to determine Medicare Part B reimbursement for the calendar year 2019.
The complex MIPS program combined three established payment programs:
If your practice bills Medicare, you need to report in 2017 to avoid penalties or get the incentive payments you are owed.
CMS estimates that only 4% of practitioners will be participating in Alternative Payment Models, so 96% of practitioners will have their Medicare Part B payments determined by MIPS performance, and that includes all physicians. Unless implementation is delayed, this means that within a few months, physicians must be prepared to succeed under the MIPS structure.
MIPS program penalties will result in a physician losing 4% of his or her Medicare Part B payments unless they succeed at transitioning to this new system. However, under the current structure, physicians can achieve a small, moderate, or high positive BONUS in Medicare Part B payments within the first year. The percentage of your Part B payment at risk (and your ability to experience a bonus) changes each year so that by 2022, you could experience a -9%, or +37% adjustment!