{"id":7658,"date":"2018-01-03T11:51:18","date_gmt":"2018-01-03T11:51:18","guid":{"rendered":"http:\/\/www.medicalbillersandcoders.com\/blog\/?p=7658"},"modified":"2025-12-16T11:24:49","modified_gmt":"2025-12-16T11:24:49","slug":"latest-mips-altercations-will-impact-oncology-revenue-growth","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/latest-mips-altercations-will-impact-oncology-revenue-growth\/","title":{"rendered":"Latest MIPS Altercations!! Will It Impact The Oncology Revenue Growth?"},"content":{"rendered":"

Two years ago, The Medicare Access and CHIP Re-authorization Act of 2015 (MACRA) proposed to drive healthcare’s payment reforms for clinicians and other insurance services (government such as Medicare or commercial). It was intended to move from traditional fee-for-service payments to a new coordinated care model, though a little risk bearing. <\/span><\/p>\n

Following this, on May 9, 2016, the US Centers for Medicare and Medicaid Services (CMS) Quality Payment program published rules\/rewards which would employ the key features of the act: ‘the Merit-based Incentive Payment System (MIPS), which would apply to eligible clinicians that Medicare pays under the Physician Fee Schedule (PFS), as well as the incentives for clinicians to participate in Advanced Alternative Payment Models (APMs).’ <\/em><\/span><\/p>\n

The MIPS Model:<\/span><\/h2>\n

The purpose of MIPS is to support independent practices and its payments thereby improving patient care, and to decrease provider burdens. The payments differ on the basis of the organization’s capability to augment people, processes and technology for collecting and reporting data as per the MIPS measures; along with enhancing the clinicians’ performance to match up to the MIPS measures. <\/span><\/p>\n

The MIPS model administers bonuses or penalties to physicians depending on their performance with respect to other physicians on the basis of predetermined set of quality and value measures. The bonuses and the penalties focus on the base fee-for-service rates and the annual payment updates. This program changes the way Medicare pays physicians and therefore, it is imperative for physicians to understand the challenges and opportunities it poses.<\/span><\/p>\n

Oncologists’ Revenue Benefits?<\/span><\/h2>\n

Under the MIPS program, the oncologists will be reimbursed in a positive, neutral or negative adjustments based on an individual\/group practice.<\/span><\/p>\n

For better reimbursements, oncologists must ensure their practice is reporting for the PQRS system, Meaningful Use, Quality and Resource Use Report and Value-Based Payment Modifier as these scores will then be merged to a single MIPS score with Advanced Care Information (formerly Meaningful Use), Cost (formerly Value-Based Modifier Program), Improvement Activities and Quality (formerly PQRS). Physician<\/span> services data of 2017 must be submitted to CMS in 2018. <\/span><\/p>\n

CMS will then evaluate and begin reimbursements in 2019. ‘The MIPS score, ranging from 0 to 100, will be determined from quality activity (50% of score), electronic health record (EHR) use (25%), cost of care (10%), and clinical practice\u2013improvement activities (15%).’ <\/em><\/span><\/p>\n

Lower score will make oncologists receive a reduced fee schedule\/negative payment adjustment of 4% in 2019, whereas a high score will see an increase by 4% in 2019; all moving up to +-9% in 2022 and beyond. <\/span><\/p>\n

The MIPS program further consists of 19 oncology reportable process and outcome measures, under which 6 must be reportable measures and 1 outcome measure; if more are reported, highest scores are taken. The practices must also report a minimum of 20 cases, with 50% of patients qualified for each measure.<\/span><\/p>\n

Oncologists<\/span> to increase revenues can also report further for bonus scores based on public health and clinical data registry. Clinical Practice Improvement Activities account for 15% of MIPS composite performance score, while attesting 4 improvement activities for a minimum of 90 days; i.e. any quality data that has been reported for at least 90 days in 2017 is eligible for payment adjustment in 2019. <\/span><\/p>\n

If there is no reporting, there will be a negative payment adjustment in 2019; if minimal submission, there will be only an avoidance of negative payments; if there is partial submission, the practice earns neutral or small positive payment; and finally, if practices submit a full data of 2017, they can earn a moderate positive payment adjustment. All this could include documented chemotherapy plans and current medication\/medication reconciliation.<\/span><\/p>\n

MACRA is a complete change from the status quo. The authorized reporting and reimbursement mechanism\/program of MIPS for clinicians and physicians payments is certainly paving the way to becoming the game-changer at every stage of the healthcare system.<\/span><\/p>\n

The patient\u2019s insurance verification is one of the most important steps for you before the procedure. With channelized procedures, you can plan out your patient care. Medical Billers and Coders (MBC)<\/strong> is a medical billing company<\/strong><\/a><\/span> which can reduce your losses and also provides the systematized procedure of reducing the deductible loss.<\/span><\/p>\n

With over 18 years of experience and team of certified billers and coders create a Revenue Cycle Management <\/span>(RCM)<\/strong><\/a> for your oncology practice.<\/span><\/p>\n

FAQs<\/h2>\n\n\n
1. What is MACRA, and how does it impact oncology practices?<\/strong>

MACRA aims to move from fee-for-service to a value-based care model, encouraging better patient care and reduced provider burdens. Oncologists’ reimbursements under Medicare are influenced by the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).<\/p> <\/div>

2. What is the MIPS model and how does it affect oncologists’ payments?<\/strong>

MIPS evaluates oncologists based on quality, electronic health record (EHR) use, cost, and clinical improvement activities. Payments can be adjusted positively, neutrally, or negatively depending on how well a practice performs against these criteria.<\/p> <\/div>

3. How can oncologists improve their MIPS scores for better reimbursement?<\/strong>

Oncologists should report data on quality measures, EHR usage, cost of care, and clinical practice improvement activities. Reporting on at least 6 quality measures and 1 outcome measure, along with 90 days of improvement activities, can earn them positive payment adjustments.<\/p> <\/div>

4. What are the consequences of not reporting for MIPS?<\/strong>

If oncologists fail to report the required data, they will face negative payment adjustments in 2019. Minimal or partial submission can result in neutral or small positive adjustments, while full data submission can lead to moderate positive adjustments.<\/p> <\/div>

5. How can oncology practices optimize their revenue cycle management (RCM)?<\/strong>

By ensuring accurate coding, submitting timely reports to CMS, and utilizing services like Medical Billers and Coders, oncology practices can improve billing efficiency, reduce deductible losses, and increase overall revenue through proper reimbursement channels.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"

With over 18 years of experience and team of certified billers and coders create a Revenue Cycle Management (RCM) for your oncology practice.<\/p>\n","protected":false},"author":2,"featured_media":10754,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[9,357,12,144,163,815,53,27],"class_list":["post-7658","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-oncology-billing-services","tag-medical-billing-companies","tag-medical-billing-company","tag-medical-billing-services-2","tag-outsource-medical-billing","tag-outsourced-medical-billing","tag-outsourced-medical-billing-company","tag-physician-medical-billing","tag-revenue-cycle-management-2"],"yoast_head":"\nLatest MIPS Altercations!! Will It Impact The Oncology Revenue Growth?<\/title>\n<meta name=\"description\" content=\"The purpose of MIPS is to support independent practices and their payments thereby improving patient care and decreasing provider burdens.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.medicalbillersandcoders.com\/blog\/latest-mips-altercations-will-impact-oncology-revenue-growth\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Latest MIPS Altercations!! 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