Specialty Measures for MIPS


Under CMS’ Quality Payment Programs, eligible clinicians are going to have to report on specific categories in order to be reimbursed for patients’ treatment under Medicare. Physicians can avoid a negative 4 percent Medicare Part B payment adjustment in 2019 by fulfilling 2017 quality reporting requirements for the Medicare Access and CHIP Reauthorization Act’s (MACRA) Merit-based Incentive Payment System (MIPS).

Practices familiar with the data reporting requirements under the federal Physician Quality Reporting System (PQRS) and Meaningful Use (MU), should have an easier time transitioning to the new MIPS system.

In 2017 and the 2018 Proposed Rule, Quality will consist of 60 percent of the total score for the performance period. Clinicians are asked to review and select the six measures that best fit their practice, as not all measures will be applicable to each specialty. For example, Specialty-Specific Measures for Ophthalmology are: * Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery * Age-Related Macular Degeneration (AMD): Counseling on Antioxidant Supplement * Adult Primary Rhegmatogenous Retinal Detachment Surgery: No Return to the Operating Room Within 90 Days of Surgery

Specialty-specific measures are typically created by specialty societies. The above measures were created by the American Academy of Ophthalmology. CMS has created a tool on one of their websites to help practices decide the measures they can use. The tool allows you to select by: High Priority Measure (Yes or No), Data Submission Method (Administrative Claims, Claims, CSV, CMS Web Interface, EHR or Registry) and Specialty Measure Sets (numerous choices like General Oncology, Radiation Oncology, Urology, Orthopedic Surgery, Neurology, Pathology – to name just a few). Typically, there are several measures to choose from, and practices have options in the measures they choose to report. The tool asks you to select six different measures to report from your specialty set and include one outcome measure.

Physicians are also being offered three options to submit for 2017 which can influence their potential payment adjustment opportunity – full reporting, partial reporting or a test option.

IntrinsiQ Specialty Solutions’ Quality Reporting Engagement Group can help you manage MIPS. For more information, email us at inside_sales_associate@intrinsiq.com or call 877-570-8721 x2.