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Advocacy efforts improve reporting under the Merit-Based Incentive Payment System

Comments from physicians across the country prompted a number of positive changes to final regulations for the Medicare Accountability and CHIP Reauthorization Act (MACRA).

The Centers for Medicare and Medicaid Services (CMS) on Oct. 14, 2016, released final regulations for MACRA, which implements the Quality Payment Program that will transition Medicare away from fee-for-service and into pay for performance. The program includes two options for physicians’ participation–Merit-based Incentive Payment System (MIPS) or the Alternative Payment Models (APMs).

KMA and other medical associations provided comments about the challenges physicians face in understanding the requirements and being prepared to participate in the new Quality Payment Program. Those comments prompted changes such as including more flexibility for reporting measures and reducing the number of performance measures that physicians have to report in the categories of quality, practice improvement and advancing care information.  As a result, physicians may:

  • Avoid the 4 percent penalty completely by reporting one quality measure, one practice improvement activity or the required measures for advancing care quality in 2017;
  • Report fewer measures for at least 90-days to be eligible for smaller bonus payments;
  • Opt to report in all performance categories for the full reporting period (12 months); and be eligible for the 4 percent bonus

Other key changes include:

  • The low-volume threshold that exempts physicians from all performance reporting has been increased from $10,000 in annual Medicare revenue and fewer than 100 Medicare patients to $30,000 in revenue or 100 patients.  CMS estimates that this change will exempt 32.5 percent of physicians and other clinicians from the program
  • For 2017, the cost (resource use) category of the Merit-based Incentive Payment System (MIPS) has been reweighted to zero

If you have questions contact Lindy Lady, KMA Medical Business Advocacy Manager, at

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