At this point everybody involved in billing Medicare for doctors administrations ought to know about the new Quality Payment Program (QPP) that will be effective for payment in the year 2019 based on information submitted in 2017. The proposed rules for the new framework were laid out keeping in mind the inflating healthcare expenses and changing payer requirements.

The final regulatory compliances that will oversee the new framework were issued recently, and radiology practices will profit by preparing early as possible to capture the information they should report under the new system.

Radiologist to report Information under MIPS

Most radiology practices will report their information under the Merit-based Incentive Payment System (MIPS), and this arrangement blueprints the different means you have to follow with a specific end goal to expand your 2019 Medicare repayment. Physicians that are individuals from an Accountable Care Organization (ACO) may have the choice to report as an advanced Alternative Payment Model (APM) through that system, however regulations indicate that a large portion of the current ACOs won't qualify or just somewhat qualify. So, MIPS have all the earmarks of being the most reasonable of the two choices for overall radiologist.

Under MIPS there are four parameters for performance:

  • Quality
  • Advancing Care Information (ACI)
  • Clinical Practice Improvement Activities (IA)
  • Cost factors

Of these, the biggest segment is Quality. For 2017 the Quality Performance Category is worth 60% of the aggregate points needed to expand your score under MIPS in light of the fact that the cost category won't be in effect for the initial years of MIPS and its 10% value has been reallocated to Quality.

For 2018, Quality is expected to return to 50% of the aggregate score and after that diminished to 30% in 2019. So, the upcoming two years, for both Radiologists and radiology medical billing company would be to streamline all the MIPS parameters for smooth transition.

Increasing the score through MIPS

Most radiologists are expected to be delegated as non-patient facing (NPF) with the end goal of deciding the prerequisites to boost their score under MIPS, which will decide the measure of their positive or negative Medicare fee schedule modification. Classification as NPF will enable a radiologist to be exempted from the ACI part of MIPS and it will decrease the IA reporting prerequisites. Teams with some patient-facing radiologists will need to explore group reporting under MIPS.


The Merit-Based Incentive Payment System (MIPS) is slowly being analyzed and engrossed by the healthcare community. This system, passed into law by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), will be in total effect for physician reimbursement in 2019, however those payment adjustments will be determined by performance in various categories for services rendered in 2017. Procedures governing the application of this law have now been finalized and updated radiology practices can begin to prepare to comply with the new system. They can also align with radiology billing and coding services as they already have the know-hows and the man-power to tackle any type medical industry changes.

Published By - Medical Billers and Coders
Published Date - May-04-2017 Back

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