Medicare Payments in 2017 & Beyond

Preparing your practice for the Merit-Based Incentive Program (MIPS)

The entire healthcare industry has moved to a “pay for performance”, merit-based model for physician reimbursement from Medicare and other payors.  It is vital to your bottom line that quality measures are being met, tracked and reported.  The first step is staying informed of government regulations as well as incentive (or penalty) based programs and how they affect physician reimbursement.  MIPS changes the old payment model so that:


  • Based on the MIPS score, Medicare providers may receive an upward payment adjustment, a downward payment adjustment, or no payment adjustment.
  • Doing the minimum will NO longer work; penalties are now assessed.
  • WHAT is reported and ADHERENCE to QUALITY GUIDELINES is now more important than just simply reporting something.

MIPS consolidates and further validates the quality and cost measurement mechanisms of the Meaningful Use (MU), Physician Quality Reporting System (PQRS), and Value-Based Modifier (VBM) programs.  Medicare Part B providers must participate in MIPS or incur significant penalties.


Components of the MIPS Score 2017- Year 1

MIPS 0 – 100 points

Quality Measure


MU-Advancing Care InformationClinical Practice ImprovementCost-Calculated but not assessed in 2017


The Merit-based Incentive Payment System (MIPS) annually generates a score out of 100 points for Medicare Part B providers using:

    a. Quality Measure Reporting,

    b. Meaningful Use / Advancing Care,

    c. Clinical Practice Improvement, and

    d. Cost/Resource Use.

What you need to know now:

1. Four tracks for practices to report in 2017:

  • Do Not Participate = -4%
  • TEST – Minimum Data ≤ 90 days = 0%
  • PARTIAL YEAR – Submit minimum data requirements >90 days = 0% to small +%
  • FULL YEAR –Submit required data, plus possible bonus data all year = 0% to +12% (more than 70 pts earned)

2. All Medicare Part B providers will participate in the program with only a few exceptions. Only three classes of Part B providers will be exempt: a) “alternative payment model” participants (for example, the Medicare Shared Savings Program), b) providers falling below a low-patient-volume threshold, and c) providers becoming Medicare Part B participants for the first time during a performance year.

3. The MIPS payment adjustments and penalties can be significant. The budget of the MIPS program (incentive versus penalty dollars) is designed to be budget-neutral. An annual threshold for the MIPS score will be set and CMS can adjust how many organizations receive incentives or pay penalties by adjusting this threshold.  There are no “safe” middle scores.

4. MIPS Scores will be publicly reported for consumer knowledge. Every provider’s MIPS score will appear on the Physician Compare website and consumers will see Medicare providers ranked in comparison to peers.


Healthcare Management Consulting (HMC) can help your practice maximize your reimbursement by assisting you in selecting the quality measures appropriate for reporting in your practice, reviewing and configuring your EMR for efficient and effective Meaningful Use and Clinical Improvement Activity capture, and analyzing your billing and claims workflow process.  Let HMC help you!  Call us at 941-378-8800 or email  

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