Medicare Compliance & Reimbursement

Statistics suggest that practices are struggling to make a profit based on their Merit-Based Incentive Payment System (MIPS) wages, according to a Medical Group Management Association (MGMA) study.

An MGMA Stat poll shows that about 67 percent of medical practices must offset their Medicare pay with private payer income due to the less than stellar fee-for-service increases over the past two years. “Medicare fee-for-service payments are not keeping up with inflation or the cost of running a physician practice,” explains MGMA in a release on the poll results. “The Medicare conversion factor has remained essentially flat, only increasing +$.2348 since 2016.”

Another reason: The 2017 MIPS performance data did not boost incentive pay for many Medicare providers. Most practices fell short on their quality and value-based measures, and it amounted to many receiving an increase of less than 2 percent for the 2019 payout, MGMA suggests.

The industry group advises CMS to offer more Advanced Alternative Payment Models (APMs) that are a “win-win” for both patients and providers, instead of ramping up burdensome reporting requirements that don’t translate to better pay outcomes.

See the MGMA Stat poll results at www.mgma.com/data/data-stories/2019-medicare-reimbursement-rates.