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MIPS 2018: What You Need to Know

Wednesday, January 31, 2018 9:00 AM

Expert Advice, Hot Topics, Billing, Coding & Compliance

Written by: Laurie Brown

Laurie Brown
Senior consultant

We hope your first MIPS experience last year went well. For ophthalmic practices that participated in MIPS in 2017, most anticipate avoiding penalties and are optimistic about the potential for receiving some level of bonus.

To help you do well this year, we’ve highlighted some of the significant changes to the MIPS program for 2018. They are:

  • Quality is to be reported for a full 12 months without a 90-day option. The advancing care information (ACI) and improvement activities (IA) measures can be reported for either 1) any 90-day period during the year or 2) the full year; your choice. There will also be bonus scoring of the quality and cost categories applied, related to improvement over past reporting (without penalty for underscoring compared to past performance).
  • The new penalty avoidance performance threshold is 15 points; last year the threshold was three points. We anticipate this new threshold being as achievable as the 2017 threshold was for most ophthalmic practices.
  • The exceptional performance bonus threshold for composite scores remains at 70 points. Additional bonus points can be used to help make up that score (i.e., extra points applied for being a small practice or being a practice with complex patients).
  • There is still the option to report as individuals or groups, along with a new addition of virtual groups (which needed to be declared to CMS by Dec. 31, 2017).
    Click here to listen to ASOA EyeTalks Radio's episode on MIPS and MACRA in 2018.
  • Cost factors into MIPS scoring in 2018, with ophthalmologists largely having no control over this category.
  • You are still able to use either 2014 or 2015 CEHRT EHRs to report your data in 2018, but it may be the last year for 2014 version eligibility. It’s probably the right time to think about upgrading to the 2015 version this year.

AAO’s IRIS Registry

AAO’s IRIS Registry has become the preferred MIPS program support platform for most ophthalmic practices. IRIS will reportedly increase its ability to report retina quality measures for 2018. There may even be a refractive surgery outcome measure added for 2018. IRIS is also expanding its list of IA measures available to report. In addition, it supports all 90 of the ACI measures. IRIS integrates with your EHR and allows you to monitor quality measures throughout the year through a MIPS dashboard. Using the IRIS Registry should greatly increase your efficiency with the MIPS program reporting. If you have not signed up with the IRIS Registry, we advise you to do so. The registry participation cost is included in your AAO membership dues. Understanding ophthalmology as it does, IRIS supports members well and will likely be the easiest reporting method for ophthalmologists to use. Note: CMS has a new portal for the same purpose, but it requires all data to be hand-entered.

Best Effort

With one year under our belts, MIPS is not so scary anymore. Our advice to clients remains the same: participate with your best effort that aligns with your practice focus and activities. Likely, you are already performing many AI and ACI measures and just may not be documenting them as MIPS requires, which can easily be fixed. You may also adopt some measures you feel will add to your quality of care and patient experience. These may even contribute to your overall competitive advantage. Ophthalmology practices that give the program their best effort are likely to land in the bonus threshold range. Generating sensible reporting for your practice is key; it’s just another cultural attribute in your mission to always do the best you can for your practice.

YOUR TURN: How did your first experience with MIPS go last year? Please leave your response in the comment section below. Thank you.

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