Neurosurgery Coding Alert

Stay on top of MIPS requirements for the best shot at optimal reimbursement.

As of Jan. 1, 2017, Medicare has made some fundamental changes to the way physicians report quality measures. These newly implemented changes will affect office staff, coders, and providers alike - requiring a cumulative effort from all parties in order to reach optimal reimbursement for the provider's services.

This reformed quality measure reporting system is known as The Merit-Based Incentive Payment System (MIPS). The MIPS initiative replaces the Physician Quality Reporting System (PQRS) as the new and improved mechanism by which you will report quality care.

Jennifer M. Connell, CPC, CENTC, CPCO, CPMA, CPPM, CPC-P, CPB, CPC-I, Owner of E2E Health Solutions in Victoria, Texas, further explains that "PQRS is one of four parts of the MIPS program. CMS took the three programs of PQRS, meaningful use, and value-based modifier program and combined them into one program. Clinical Practice Improvement Activities is a new set of measures."

History: MIPS comes as a result of The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Essentially, the passing of this law ended the Sustainable Growth Rate (SGR) formula, instead introducing a new and revised quality payment program. You can visit cms.gov for more information on MACRA.

Optimize Profits with MIPS Participation

The fine details are important, but, at the end of the day, every provider wants to know how they can maximize profits utilizing the newly implemented MIPS system. First and foremost, providers need to accurately report six neurosurgery-specific MIPS measures on at least 50 percent of all Medicare Part B patients (this increases to 60 percent as of 2018). Additionally, you should report these measures over, at minimum, a 90-day period. If you report more than six measures, you'll receive credit for the six highest-scoring measures.

Meeting all the necessary requirements on the first year of reporting can yield you a maximum of a 4 percent payment adjustment increase. On the contrary, failing to document MIPS could result in a maximum 4 percent negative payment adjustment. This payment differential of 4 percent will increase to 5 percent in 2018, 7 percent in 2019, and 9 percent from 2020 and beyond.

The underlying difference between MIPS and PQRS is that MIPS relies on a sliding scale scoring system, while PQRS relied on a pass/fail system. This new dynamic allows for providers to achieve a positive payment adjustment anywhere between 1 and 4 percent depending on their degree of reporting and participation.

Final note: If your practice has yet to make the transition, you've got until July 15, 2017, to meet the regular enrollment deadline for MIPS reporting in 2017. Assuming that you have begun reporting before this cutoff date, you'll want to make sure you are reporting on at least 50 percent of your Medicare Part B patients for a minimum of 90 days to be eligible for a 4 percent payment adjustment.

Step Wisely for Smooth MIPS Transition

Grasping MACRA as a whole might sound like a daunting task, but the switch from PQRS to MIPS is a seamless one if you take the right steps - the first of which involves choosing the most practical measures applicable to the neurosurgery specialty. With MIPS, you'll be required to report six measures across these five domains:

• Clinical care,
• Safety,
• Care coordination,
• Patient and caregiver experience, and
• Population health and prevention.

This has changed from PQRS's nine measures across six domains. With MIPS, there's no domain requirement; however, you will be asked to include one outcome measure and one cross-cutting (multi-specialty) measure as a part of your six documented MIPS measures.