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MIPS in Action: Take action in 2017 to prevent Medicare payment reductions in 2019

The new Medicare Quality Payment Program, which includes the Merit Based Incentive Payment System or MIPS, has an implementation date of Jan. 1, 2019, but physicians must take action starting in 2017 to avoid payment reductions or have a chance of receiving payment incentives in 2019 of up to 4 percent.

This article is the last in a three-part series. Earlier you were provided with MIPS terminology and how to navigate MIPS regulations. In this final article, we share the details of a specific measure and the reporting requirements.

The tobacco use screening and cessation intervention is an example of a quality measure that may also be reported as a practice improvement measure by any physician specialty that decides to participate in MIPS as an individual.

First, physicians must choose and take action on one of the following options:

  1. Do nothing and receive a 4 percent reduction of Medicare payments in 2019.
  2. Avoid the 4 percent reduction in Medicare payments in 2019 by reporting one quality measure for one patient or one improvement activity measure in 2017.
  3. Report for a 90-day period anytime in 2017 to avoid a reduction in Medicare payments or earn a small incentive.
  4. Report for a full-year—Jan. 1, 2017 – Dec. 31, 2017—to earn up to 4 percent incentive.

Clinical Example: You made the decision to participate in MIPS and selected tobacco screening and cessation intervention—measure #226—as one of the six quality measure to report to Medicare. On Jan. 10, 2017, a patient is seen for acute sinusitis. You treat the patient for sinusitis and perform a tobacco screening and cessation intervention. Follow the step-by-step instructions below for proper reporting of the measure via claim submission.

  1. This measure applies to patients 18 and older who were screened for tobacco use one or more times within 24 months and received cessation counseling intervention if patient identifies as a tobacco user.
  2. Report the measure once per performance period (90 days or 12 months).
  3. Report the appropriate patient encounter (below) during the performance period CPT/HCPCS : 90791,90792,90832,90834,90837,90845,92002,92004,92012,92014,92521,92522,92523,92524,92540,92557,92625,96150,96151,96152,96160,96161,97165,97166,97167,97168,99201,99202,99203,99204,99205,99212,99213,99214,99215,99341,99342,99343,99344,99345,99347,99348,99349,99350,99385,99386,99387.99395,99396,99397,99401,99402,99403,99404,99406,99407,99411,99412,99429,G0438,G0439
  4. Report the appropriate Quality Date Code:
    1. Patient screened for tobacco use and received tobacco cessation intervention and identified as tobacco user: 4004F
    2. Patient screened for tobacco use and identifies as non-user of tobacco: 1036A
    3. Tobacco screening not performed for medical reasons (limited life expectancy, etc.): 4004F with 1P
    4. Tobacco screening or tobacco cessation intervention not performed reason not specified: 4004F with 8P

The patient encounter and the quality data code must be reported for the same date of service on the same claim. 

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