MIPS: How Will Your PQRS Decisions Impact Your VBM Score and Reimbursement?

In April of this year, Congress and President Obama approved what is commonly referred to as the “doc fix” bill. The bill repeals the Medicare Part B Sustainable Growth Rate (SGR) reimbursement formula and replaces it with the Merit-Based Incentive Payment System or MIPS. This new payment program will provide annual updates to providers starting in 2019, and will be based on performance scores in four categories: meaningful use of certified EHR, PQRS, Value-Based Modifier (VBM), and Clinical Practice Improvement. Unlike SGR, MIPS adjust payments are based on individual performance.

Here’s a projected MIPS Rulemaking timeline:

  • April 16, 2015 – MIPS legislation passed
  • July 8, 2015 – CMS solicits initial public comments on MIPS program
  • Sept 8, 2015 – CMS initial public comment period ends
  • By Dec 31, 2015 – CMS to release RFI seeking more comments
  • Estimated – July 2016 – Proposed 2017 MIPS rule
  • Estimated ~ Nov 2016 – Final 2017 MIPS rule

You can track the progress of the MIPS legislation here.

To learn more about MIPS, you can read our own Jim Tate’s white paper on the program MIPS…for the Rest of Us.

You can also check out SA Ignite’s recent article on the program – 10 FAQs About the Merit-Based Incentive Payment System (MIPS). Additionally, SA Ignite has created a free financial calculator to help providers understand the impact of the program. You can email SA Ignite’s CEO tom@saignite.com to request the calculator. Disclaimer: Use at your own risk and look for calculator updates as the rule progresses..

Last but not least, if you’re looking to stay on top of MIPS or get a question answered, you can join HITECH Answers and SA Ignite on our monthly webinar series,The ABCs of MIPS. This month’s webinar on Thursday will focus on PQRS and the impact on your VBM score and reimbursement.

Date: August 20 at 2 pm EDT/11 am PDT.
Registration Link
Topic: How PQRS Decisions Significantly Impact Your Value-Based Modifier (VBM) Score and Reimbursement

Learning Objectives:

  • Understand how the MIPS Value-Based Modifier (VBM) quality score depends upon your reported PQRS measures
  • Learn how the selection of PQRS measures and reporting method can significantly impact the VBM quality score
  • See quantitative examples of how PQRS decisions can have unexpectedly large impacts on the VBM quality score
  • Learn how to optimize your PQRS decisions to maximize your VBM quality score

If you’d like, check out our first two webinars on our YouTube channel or listen to the latest show at 8 am or 4 pm ET airing on our Internet radio station, HealthcareNOWradio.com.