MGMA Asks CMS to Notify Physicians of MIPS Eligibility

Ken Terry

March 17, 2017

No sooner was Seema Verma installed as the new administrator of the Centers for Medicare & Medicaid Services (CMS) than she received a letter on March 15 from Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association (MGMA).

Gilberg wanted to know what had happened to the provider notification provisions related to the 2017 Merit-Based Incentive Payment System (MIPS), saying that the lack of this information was "generating considerable frustration and confusion" among physician groups.

According to the MGMA letter, CMS has failed to notify clinicians and group practices regarding low-volume threshold exemptions and certain providers' status as "non-patient-facing" clinicians. The agency has also not furnished approved lists of registry vendors that can help practices report data to CMS, the letter said.

In the final regulations for the Medicare Accountability and CHIP Reauthorization Act (MACRA) issued last October, CMS exempted between 53% and 57% of physicians and other clinicians from a potential 2019 penalty under the MIPS reimbursement system. Many of these were either new physicians or doctors who participated in advanced alternative payment models and were therefore exempt from MIPS. But 32.5% of clinicians who take Medicare, according to CMS, are excluded from MIPS because they don't have at least $30,000 in annual Medicare revenues.

The regulations specified that CMS would use a 60-day snapshot of Medicare claims data, from August 31 to October 31, 2016, to determine whether clinicians met this threshold or not, Gilberg told Medscape Medical News. CMS promised to tell the clinicians whether or not they were eligible for MIPS last December, he said.

To date, however, CMS has not done so. It has also not told certain kinds of hospital-based specialists, such as radiologists and anesthesiologists, whether they are considered "non-patient-facing." If they are, they don't have to meet all of the MIPS reporting requirements, Gilberg said.

CMS has also not indicated which "qualified registries" and "qualified clinical data registries" have been approved for use in MIPS. "Group practices planning to utilize these reporting mechanisms must either delay engagement or partner with vendors without a guarantee they meet CMS' qualifications," the letter noted.

"The absence of notification about who is exempt from MIPS also affects group practices' ability to plan their software investments," the letter pointed out. Right now, this is not mainly about upgrading to 2015-version certified electronic health records (EHRs), which don't have to be in place until next year. But some practices may have to decide, for example, whether to pony up the fees their EHR vendors charge for reporting data to CMS without knowing whether their clinicians are eligible for MIPS, Gilberg said.

If a clinician is unclear whether he or she is eligible for MIPS, that clinician could choose the minimum option under CMS' "pick your pace" approach. By simply reporting on a single quality or practice improvement measure, the clinician could avoid a penalty in 2019.

Complex Decisions

Asked why physicians and practices that are close to the threshold don't take this approach, Gilberg noted that other complex decisions also hinge on these notifications. For example, MGMA is getting calls from members who say their groups include providers with multiple tax identification numbers (TINs). Some are clearly eligible for MIPS, but others may or may not be. These groups are trying to create coherent strategies, but can't in the absence of notification, Gilberg said.

Under MIPS, clinicians can report either individually or as part of a group. Large multispecialty groups may report as a single entity. In that case, the $30,000 threshold would be quickly surpassed. But it may not make sense for some practices, such as ob/gyn groups, to have their clinicians report together, because most of them would not individually pass the threshold for Medicare income, Gilberg noted.

The MGMA is also concerned, he added, that when CMS finally sends the notices out, they'll go to clinicians in medical groups that bill and report under a single TIN. If doctors get letters saying they're not eligible for MIPS, many won't understand that the practice is reporting as a group and therefore they're not exempt from MIPS. They'll think they don't have to worry, and if the group gets a penalty, and it's passed to them, they'll be angry. MGMA has made this point to CMS, he added.

In response to an emailed query from Medscape Medical News, CMS said that it would issue the notifications to clinicians sometime this spring. When Gilberg was informed of this, he said, "It makes me laugh."

First CMS was going to release the information in December, he noted. "Now they're saying it's going to come this spring. But you won't know your eligibility until then. The longer this drags on, the less relevant CMS' 'pick your pace' approach is."

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