MIPS or APMs? Do You Know Which You Need?
By: Alanna Diffendal.

Electronic Health Records |RxNT
July 12, 2016
The Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (API) are new incentive programs the Center for Medicaid and Medicare Services(CMS) has proposed following the creation of the Medicare Access and CHIP Reauthorization Act (MACRA) program. The new proposal has narrowed down the amount of measure from 18 to 11, a much more reasonable amount.

Don’t know which path your practice should take? Well you are not alone. In order to determine which program to choose, the Physician’s Practice outlines what qualifiers you need to be aware before making a decision about MIPS or APMs. First, determine if your practice qualifies:

    1. Does your practice have $10,000 ≥ in Medicare charges AND 100 ≥ fewer Medicare patients annually?
      1. If the answer is yes, you can relax and take a deep breathe because you are exempt from MIPS participation.
      2. If the answer is no, than you qualify for MIPS or potentially APM
    2. Does your practice participate in an Accountable Care Organization (ACO), Clinically Integrated Network (CIN) or another entity of that applies and qualifies as a APM?
      1. If the answer is yes to both questions, then you qualify for not only MIPS but APMs as well
      2. If you answered yes to number one and no to number two, then you only qualify to participate in MIPS
      3. If neither but you participate in another APM entity, contact you entity’s administrators
For practices that qualify for MIPS, there are a few key points you need to know while preparing to meet MIPS, outlined Physician’s Practice. The most important information about APM is:

  1. Continue to attest for Meaningful Use (MU)
    1. By 2017, MU will transition to the Advancing Care Information (ACI) component of MIPS
  2. ACI
    1. Account for 25% of your MIPS score (100 points)
    2. A practice’s total points will determine their payment adjustments

    3. The “all or nothing” approach is gone and the scoring is split into “Participating” and “Performance
    4. To be considered a participating provider you need to:
      1. Complete a security risk analysis
      2. Actively engage with an immunization registry
      3. Report a numerator and a denominator for all remaining measures
    5. To be considered a performing provider you need to:
      1. Focus on Stage 3 of MU: Patient Electronic Access
      2. Coordination of Care through Patient Engagement
      3. Health Information Exchange objectives
    6. Removes "Clinical Decision Support" and "Computerized Provider Order" measures
    7. Simplifies "Health Information Exchange" and "Public Health and Clinical Data Registry" reporting to yes/no answers
    8. Requires a full calendar year reporting period
  3. Continue to participate in PQRS
  4. Monitor your profile on the Physician Compare site
Practices that qualify for APM because they are participating with an ACO, can select to take the APM path for their practice. The APM path includes:
  1. Transitioning to a new payment entity
    1. This is where the ACO, CIN or other entity that applies and qualifies as an APM come into play. Your APM entity ascertains the plan you should take
  2. Lump-sum incentives payments
    1. Participants will not be subject to MIPS adjustments
    2. Will receive one lump-sum incentive payment between 2019-2024
The EHR incentive laws have come along way since the start of these programs and continue to evolve.These laws are designed to reward physicians who have adopted new medical, documentation technology to ensure a reliable, interoperable healthcare network in the future. RxNT|EHR can help your practice meet the MACRA EHR incentive requirements. To learn more about how RxNT|EHR can help call us at 800-943-7968 option 3 or email us at Sales@RxNT.com

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