AOA MORE protected $1 million in Medicare payments—here’s how it could help you

Eligible physicians must sufficiently report Medicare's Quality Payment Program data to avoid a penalty—and optometry's clinical registry can help, already protecting over $1 million in reimbursements since the program's inception.

In each of the two years since the Centers for Medicare & Medicaid Services (CMS) launched the Merit-based Incentive Payment System (MIPS), AOA MORE (Measures and Outcomes Registry for Eyecare) has helped protect a minimum of $562,800 and $594,000 in payments to doctors of optometry, based on 2017 and 2018 MIPS reporting, respectively. Significantly, those figures come as CMS makes sweeping, year-to-year changes not only to MIPS reporting requirements but also who's eligible to participate even in the current CY2019.

With the data submission period for 2019 MIPS attestation Jan. 2, 2020, through March 31, 2020, there's ample time for eligible physicians to avoid the payment penalty. To avoid the 7% penalty assessed on 2021 Medicare payments, eligible physicians must earn at least 30 points in their overall 2019 Merit-based Incentive Payments System (MIPS) score, and doctors can do this by reporting any combination of the following in the MIPS Guidebook:

• Report six measures in the Quality category;
• Report two medium-weighted or one high-weighted activity in the Improvement Activities category; or
• Report the required measures in the Promoting Interoperability category

That's where AOA MORE, a no-cost AOA member benefit, can be of assistance. Supporting each of the three MIPS categories above, AOA MORE can help doctors of optometry achieve those 30+ points. Even if doctors' EHR system isn't integrated with AOA MORE, both Improvement Activity and Promoting Interoperability points can be earned once enrolled in AOA MORE. The only other MIPS category, Cost, is evaluated separately through administrative claims data.

"While the reimbursements protected through the program are reason enough to participate, AOA MORE's value goes far beyond the bottom line. AOA MORE is the resource that gives optometry our edge in assessing and advancing best-in-class patient care," says AOA President Barbara L. Horn, O.D.

"Through AOA MORE, we have the data and insight to help continuously improve on the care we are delivering and accurately report it. Every AOA member doctor should be participating for their practice and their patients."

Are you participating in MIPS?

Each year, CMS has changed the minimum threshold for Medicare doctors required to participate in MIPS. Although CMS still exempts clinicians from MIPS if it's their first year of Medicare Part B participation, if they're participating in an Advanced Alternative Payment Model or if they're below the low-volume threshold, that latter exemption was once again redefined. For 2019, doctors may be excluded from QPP if they meet at leastone of the following:

• Submit ≤ $90,000 in Medicare Part B allowable charges; or
• Care for ≤ 200 Medicare patients per year; or
• Perform ≤ 200 covered professional services (e.g., 92004, 92133, 92020); or
• Are a Qualifying APM Participant and Partial Qualifying APM Participant.

Clinicians meeting any one exemption may choose not to participate and accept the traditional Medicare PFS. That said, doctors who meet certain requirements can opt into MIPS and have the potential to earn incentives.

"The great thing about opting in is you can go the entire year calculating to see if you're performing well within MIPS and you don't have to make a decision about opting in until the end of 2019," notes Jeff Michaels, O.D., AOA Quality Improvement and Registries Committee member, in AOA's MIPS 2019: Big Changes in the Rules webinar. "In the first months of 2020, you can add up all your categories and if you did well you can submit data to CMS, opting in and getting the bonus."

Not sure about your participation status? Access the CMS participation lookup tool.

Are you using AOA resources?

The AOA offers step-by-step checklists and webinars that can explain what participating doctors must accomplish to avoid a payment penalty, including AOA's 2019 MIPS Guidebook: Road Map to Success for Doctors of Optometry and AOA's 2019 MIPS Quality Measures for Optometrists. Visit AOA's 2019 MIPS/QPP information page for a complete resource roundup and links to helpful information.

As an additional member benefit, the AOA will provide up-to-date 2019 MIPS attestation tutorials, print resources, webinars and office-hour sessions—January through March 31, 2020—ahead of the 2019 MIPS reporting deadline.  

Also, MIPS participating doctors can find advantages using the AOA member benefit registry, AOA MORE.