May 12, 2017
2 min read

Merit-based Incentive Payment System letters in the mail, says AAFP

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Clinicians have begun receiving letters that will provide information about their 2017 participation status in the Merit-based Incentive Payment System, according to AAFP’s website.

CMS stated that the following health care professionals need to submit data to the Merit-based Incentive Payment System (MIPS):

  • doctors of medicine, osteopathy (including osteopathic practitioners), podiatric medicine, optometry, dental surgery, dental medicine, and chiropractors; physician assistants; nurse practitioners; clinical nurse specialists; certified registered nurse anesthetists; and group(s) including such clinicians; and
  • clinicians from the groups above that bill $30,000 or more in Medicare Part B allowed charges a year and provide care to more than 100 Part B-enrolled Medicare beneficiaries a year.

According to CMS, an online tool — — also lets health care professionals ascertain their participation status in MIPS for 2017 by entering their 10-digit National Provider Identifier. 

A blog on AAFP’s website encouraged eligible practices and members who receive a letter to review it and determine if they will report as individuals or as a group. The blog also advised clinicians practicing under multiple tax identification numbers to verify their participation status with each practice.

CMS’ website also provides guidance on the three ‘paces’ — test, partial, or full — that participating clinicians can choose from when entering data on their quality of care, cost for care delivery, participation in activities that improves their practice and use of Certified Electronic Health Record Technology from Jan. 1, 2017 through Dec. 31, 2017. A scoring method is used that accounts for what CMS stated are the weights of each performance category, exceptional performance factors, availability and applicability of the measures to the different groups of clinicians, group performance and the special circumstances of small practices, nonpatient-facing MIPS eligible physicians and those practices based in rural areas.

“The MIPS payment adjustment is based on the data submitted. The best way to get the maximum MIPS payment adjustment is to participate full year. By participating the full year, you have the most measures to pick from to submit, more reliable data submissions, and the ability to get bonus points,” CMS’ website states. “But if you only report 90 days, you could still earn the maximum adjustment — there is nothing built into the program that automatically gives a reporter a lower score for 90-day reporting.”

Health care professionals are encouraged to pick the reporting pace that works best for them, CMS’ website states.

According to CMS’ website, to be considered for a positive payment adjustment through MIPS in 2019, eligible physicians must send in 2017 data by March 31, 2018; physicians who don’t send in any 2017 data receive a negative 4% payment adjustment.

MIPS is a Quality Payment Program under the Medicare Access and CHIP Reauthorization Act. MACRA, which replaces the Sustainable Growth Rate formula, and was touted as changing how Medicare payments are tied to the cost and quality of care when HHS finalized the act last fall.

At the time of MACRA’s finalization, AAFP president John Meigs, Jr. stated, in part, that he was “pleased practices with low volumes of Medicare Part B patients are excluded in the first year and that family physicians will be able to move toward full participation without suffering penalties that will slow their progress” but said more work had to be done.

To that end, AAFP Board Chair Wanda Filer, MD, MBA, sent a letter to CMS administrator Seema Verna, MPH, earlier this month urging that the MIPS and alternative payment model be struck, as well as other recommendations that the Academy felt would simplify the implementation of MACRA. - by Janel Miller

References/Further reading:

Are you participating in MIPS this year? Check your mailbox

CMS' Quality Payment Program page (accessed 05-10-17)

Look for MIPS participation status letters in May (accessed 05-10-17)

Disclosure: Meigs is president of AAFP; Healio Family Medicine was unable to determine other relevant financial disclosures prior to publication.