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MGMA to Seema Verma: Release past due MIPS eligibility notifications

Three months into 2017 performance year, clinicians still in the dark about compliance, MGMA says.

Susan Morse, Managing Editor

In a letter to new Centers for Medicare and Medicaid Services Administrator Seema Verma, the Medical Group Management Association is urging for the immediate release of 2017 merit-based incentive payment system eligibility information to determine which practices are exempt.

Clinicians and group practices that bill $30,000 or less in Medicare charges or give care to 100 or fewer beneficiaries fall under the low-volume threshold and are exempt from MIPS. CMS has estimated that nearly one-third of clinicians would be eligible for an exemption.

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Yet three months into the 2017 performance period, CMS has left these providers in the dark about whether they must comply with program criteria, MGMA said.

"By CMS' own estimate, 32.5 percent of Medicare providers are exempt from MIPS in 2017 under the low volume threshold and, as such, at least 32.5 percent of Medicare providers are currently unsure whether they qualify for participation in MIPS," said Anders M. Gilberg, senior vice president, Government Affairs.

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In addition, CMS has failed to notify clinicians and group practices about their hospital-based or non-patient facing status, which carry modified reporting requirements.

"Transitioning to MIPS is a challenge involving upgrades to electronic health record software, reengineering clinical workflows to meet data capture and reporting requirements, contracting with data registries, and training clinical and administrative staff," Gilberg said. "Without basic information about eligibility, physicians and medical groups are significantly disadvantaged from positioning themselves for success in the program."

[Also: CMS offers insights on MIPS, APMs in MACRA's payment reform]

Further hindering group practices' success in MIPS is the absence of a final list of approved 2017 qualified registries and qualified clinical data registries, he said. Group practices planning to use these reporting mechanisms must either delay engagement or partner with vendors without a guarantee they meet CMS' qualifications.

"We urge CMS to expeditiously release these long overdue MIPS eligibility notices and approved vendor lists," Gilberg said.

Twitter: @SusanJMorse