By Teri Thurston, Billing & Coding Advisor, PECAA
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable Growth Rate (SGR) formula, that would have resulted in a significant cut in payment rates to optical physicians. MACRA requires CMS to establish an alternative incentive program, referred to as the Quality Payment Program. This program provides two pathways to participate, the Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment models (APMs). The majority of physicians continue to participate under MIPS.
The first two years of MIPS were implemented gradually to reduce burden and provide flexibility in how physicians could participate. In November, CMS released the Final Rule for year 3 of the Quality Payment Program (QPP), revising payment policies under Medicare Part B for the 2019 calendar year. Year 3 continues to focus on simplification, reducing burden and meaningful quality outcomes for patients while streamlining reporting for optometry doctors.
Low-volume Threshold to Participate
To qualify under the MIPS track you must meet all three of the low-volume threshold criteria as an individual.
- Bill more than $90,000 a year in allowed Medicare Part B service charges
- See 200 Medicare beneficiaries a year
- Provide more than 200 covered professional services.
If you meet all three criteria you will be automatically enrolled and required to participate for 2019. Utilizing 2015 CEHRT will also be required starting January 1, 2019 for full year reporting.
Excluded from Participation:
You are automatically excluded from MIPS if you enrolled in Medicare for the first time in 2018, or if you do not meet all three above criteria.
For 2019 you may opt-in to participate if you meet at least 1 of the above low-volume threshold criteria. For example, if you billed 200 professional services, but did not see 200 Medicare patients or bill $90,000 in charges you may still participate. If you wish to opt-in simply report your data to CMS by one of the reporting methods (or submission types) for 2019. Caution, if you do not wish to participate be sure to not inadvertently submit claims data to Medicare. This has the potential to enroll you into the program. Once you opt-in you must participate.
To check your participation status, go to https://qpp.cms.gov/participation-lookup and enter your 10-digit Nation Provider Identifier (NPI).
Click here to read about MIPS performance measures and more.