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MIPS Reform – Should You Start Preparing Your PT Practice?

As it stands right now, your physical therapy practice is exempt from the merit-based incentive payment system (MIPS). However, by early 2019, you may be affected. If that happens, your billing will be impacted quite drastically. Essentially, MIPS would make it possible for you to enhance or decrease the amount of money you can earn from services based on how well you perform your duties. Even though these changes would not burden you seriously for a while, you may find it prudent to start reporting now. That option is open. This way, if/when it does happen, you will have experience with it.

Purely Voluntary

While it’s a good idea to participate in the MIPS program now, it is purely voluntary. Unlike other healthcare professionals who have had to start using the program for 2017, physical therapists and their practices have been granted a reprieve – for now. Many professionals in the physical therapy field, however, are strongly suggesting getting involved regardless.

Implement and Use an EHR

Whether you’re an individual or a practice, you should implement the electronic health record and use it, if you haven’t done so yet. There are a few EHRs that are certified for physical therapists. This makes choosing the right one very important. The biggest thing is to ensure that it works with Medicare as well as the MIPS program. It also needs to be certified through the Office of the National Coordinator.

Attach to a Registry

A merit-based incentive payment system should be a good thing for professionals and patients alike. The idea is to keep everyone honest, for the most part, and enhance service quality. An inherent issue of a new system like this is understanding it. Joining a registry certainly is not mandatory, but subscribing to one is a great way for you to get valuable information about your business and where you stand in the marketplace. Now in 2017, you can connect to the Physical Therapy Outcomes Registry. This resource works over time by providing you not only with private practice information, but storing data to manufacture ‘quality measures’. These will aid your business in the future, especially when it’s mandatory to participate in MIPS.

PQRS is Dead

Unfortunately, the system you were so used to is now dead. Time of death was January 1st of 2017. At that time CMS ceased the Physician Quality Reporting System. There is a bit of good news, at least for now – the FLR is still in use. Of course, if you were eligible for PQRS, you are still on the hook for 2017/2018 penalties. Many would think (and hope, of course) that if you qualified for PQRS then you would also qualify for MIPS. This is not the case. Even though the program consists of a lot of familiar elements from MU, PQRS, and VBM, working within those aren’t a guarantee.

Financial Implications

Now that you know what you’re up against, and you’re thinking about going ahead and getting yourself prepared, you want to know how this hinders your wallet. That’s perfectly understandable. It’s two-fold. First, you will see an annual adjustment to Part B of 0.5% through 2019. In 2026, that adjusts to +0.26%. Second, you’ll see a ‘value-based payment adjustment’, which is determined, plus or minus, on your final score. Annually, CMS will create a ‘performance threshold’. You need to earn that many points to stay even. Go above and you earn incentives. Go below, you incur a penalty. There will also be opportunities to earn an ‘exceptional performance’ bonus. The threshold will be set as an average of all those enrolled, making when you join more important to how your performance numbers may increase to achieve maximum benefit early. MIPS can seem like an overwhelming change that’s coming like a train in a tunnel. But take a deep breath, learn about it, discuss it with experts in the PT billing field, and see how you might use it to your advantage. Creative Commons Attribution: Permission is granted to repost this article in its entirety with credit to Jet PT Billing and a clickable link back to this page.

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