New must-have resource by AOA for MIPS providers

The AOA has resources, including the just-released 2021 MIPS Guidebook: A Road Map to Success for Doctors of Optometry, to help doctors protect their Medicare reimbursements—or even earn bonuses.

The AOA Quality Improvement and Data Committee and the AOA Coding and Reimbursement Committee provided guidance and input in developing the guide on the Merit-Based Incentive Payment System (MIPS).

“The guidebook contains most, if not all, of the information any practicing doctor of optometry might need to successfully report MIPS for 2021,” says Rebecca Wartman, O.D., member of the AOA Coding and Reimbursement Committee. “The guide reviews who is eligible, what quality measures are available for reporting, which Improvement Activities are available and what the rules are for Promoting Interoperability along with the Cost portion of MIPS. The guide breaks down how each section of MIPS reporting is counted and how the MIPS reporting could impact doctors’ reimbursements from Medicare in 2023.”

Adds Zachary McCarty, O.D., chair of the AOA Quality Improvement and Data Committee: “The 2021 MIPS Guidebook is the quick synopsis of what and how to report MIPS for both electronic health record and claims-based reporting. Each year it is updated to reflect the current state of the Quality Payment Program that has yearly rule changes along with the small tweaks to the program.”

Dr. McCarty notes an important change in the program. A Security Risk Analysis is still required, though not scored, he says. It must be performed after upgrading to the 2015 certified (Stage 3) version of your EHR, he adds.

Under the Medicare program, an overall MIPS score is calculated based on a doctor’s or practice’s performance on each of four performance categories: Quality, Cost, Improvement Activities and Promoting Interoperability. A final score determines if doctors receive a bonus, penalty or neutral adjustment in their Centers for Medicare & Medicaid Services (CMS) payables. “If your score is above the CMS-derived threshold, you will get a bonus,” the guidebook reads. “If your score is below the threshold, you will get a penalty (pay education).”

What’s at stake

Successful reporting can be the difference between bonuses and penalties for doctors. The Centers for Medicare & Medicaid Services projected $1.3 billion in Medicare charges for optometry for 2019.

“First, it is very important for doctors of optometry to successfully report to avoid a negative payment adjustment in 2023 for not reporting this year,” Dr. McCarty says. “That adjustment can be upward of 9% of Medicare reimbursements. The other reason to report is to help provide data on the quality care that optometry provides to all our patients. Medicare will publish this data on its Physician Compare website for consumers to review and in aggregate comparing performance between different specialties.”

Says Dr. Wartman: “If providers are eligible to participate in or successfully report MIPS (based on number of claims and dollar amount of claims to original Medicare and Railroad Medicare) and if providers fail to report measures or apply for an exemption to reporting, their Medicare and Railroad Medicare reimbursement could be reduced by as much as 9% for 2023. On the other hand, if a provider attempts to successfully report and follows the rules for reporting closely, they could receive a bonus and extra Medicare and Railroad Medicare payments over and above the normal Medicare reimbursement rates amounting up to a 9% increase.”

“MIPS reporting and the quality programs have been around for many years at this point (since 2017),” she adds. “Many of the quality measures have remained the same, so there are only a few changes to that portion of MIPS reporting. The Improvement Activities often fit nicely with the quality measure and are not difficult to achieve. The Cost portion does not require any effort on the part of the providers for eye care. The most difficult portion is Promoting Interoperability but thankfully, many of our Electronic Health Reports greatly aid in this section. EHRs also can make Quality Reporting quite easy. In my mind, there is little reason, assuming you and your practice qualify, not to report.”

Are you eligible to participate in MIPS?