MACRA vs MIPS

Demystifying MIPS for Your Behavioral Health Practice

For psychiatry specialists, MIPS has been a confusing acronym. It’s “Medicine for Psychiatry Service,” right? Well, in the sphere of CMS and healthcare reform, MIPS takes on a whole new meaning.

What exactly is MIPS? What is MIPS vs MACRA in the jungle of acronyms?

  • MACRA (Medicare Access and CHIP Reauthorization Act of 2015) was the largest change in how Medicare clinicians were paid.
  • MIPS is a sister program, the “Merit-Based Incentive Payment System” – and both are scheduled to take effect in 2017.

MIPS = Better Patient Care = Financial Incentives

MIPS’ overarching goal is to improve patient care. In the process, that will involve revamping payment structures and providing incentives for physicians. The government’s emphasis on healthcare information technology will shift as well.

  • MIPS will absorb three reform programs, namely Meaningful Use (MU), Physician Quality Reporting System (PQRS) and Value-Based Modifier (VBM).
  • MIPS changes how Medicare reimburses physicians. MIPS links fee-for-service payments with quality of patient care and value – instead of quantity.
  • With MIPS, the emphasis is excellence in patient care, supported by better-connected technology. Electronic health record (EHR) systems must be able to communicate – to share patient records.

Behavioral health specialists will appreciate this renewed focus on patient care. It’s all about being more available to patients when they need you.

Yes, you may be restructuring your office hours. It’s possible you’re already doing that to accommodate patients’ busy schedules. With MIPS financial incentives, you will be rewarded for your efforts.

Who is affected (or not) by MIPS

MIPS applies to Medicare Part B clinicians, including behavioral health/psychiatry physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists.

MIPS isn’t for everyone: Psychiatrists are exempt from MIPS reporting and payment adjustments for a particular year if:

  • It is their first year of Medicare enrollment;
  • They meet the “low volume threshold” of no more than $10,000 in Medicare billings and 100 Medicare patients
  • They qualify for the MACRA bonus for “advanced” alternative payment models (APMs)
  • They meet the definition of a partial qualifying APM participant and choose not to report under MIP.

MIPS may apply to clinical psychologists and clinical social workers starting with reporting in 2019 and payments in 2021.

That’s the flyover view of MIPS. Look to this site for more information to come about the nuts and bolts of MIPS and how it pertains to behavioral/psychiatry specialists.

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