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Thriving Under Medicare's Newest Pay-for- Performance Program: Making Sense of the Merit-Based Incentive Payment
The Journal of Medical Practice Management : MPM
|July 27, 2018
Summary
This guide helps medical practices navigate complex Medicare regulations, focusing on the Merit-Based Incentive Payment System (MIPS) to optimize payments. It prepares practices for 2019 by leveraging 2017 compliance actions and future requirements.
Area of Science:
- Healthcare Management
- Medical Economics
- Regulatory Compliance
Background:
- New Medicare regulations significantly impact healthcare provider reimbursement.
- Understanding these complex rules is crucial for financial stability.
- The Merit-Based Incentive Payment System (MIPS) affects most clinicians.
Purpose of the Study:
- To guide medical practice managers through complex Medicare regulations.
- To help practices optimize Medicare payment potential for 2019.
- To prepare practices for future regulatory requirements.
Main Methods:
- Focuses on the Merit-Based Incentive Payment System (MIPS) pathway.
- Analyzes actions required for MIPS compliance.
- Considers Alternative Payment Models (APMs) as a secondary pathway.
Main Results:
- Approximately 85% of clinicians submitting Medicare Part B claims will participate in MIPS.
- Alternative Payment Models offer risk-based incentives for improvement activities.
- Guidance is provided for optimizing payment potential based on past and future compliance.
Conclusions:
- Medical practices must adapt to new pay-for-performance programs.
- Strategic compliance with MIPS is essential for maximizing Medicare reimbursement.
- Proactive preparation for regulatory changes ensures long-term financial health.