Thriving Under Medicare's Newest Pay-for- Performance Program: Making Sense of the Merit-Based Incentive Payment System And the Alternative Payment Models: Part I.

Abstract

This is the first in a three-part series of articles intended to guide medical practice managers through the maze of the innovative,'yet complex regulations that will affect the amounts paid to healthcare providers by Medicare for at least the next three years. The goal of this series is to provide information to help practices optimize their payment potential from Medicare in 2019 based on their actions toward compliance for some portion of 2017 and to prepare to expand these behaviors as required in future years. Although there-are two pathways for participation in these new pay-for-performance programs, the series focuses more on actions required in the Merit-Based Incentive Payment System (MIPS). Approximately 85% of clinicians submitting Medicare Part B claims will participate in MIPS. The remaining 15% could assume risk in return for larger incentives while carrying out improvement activities similar to the MIPS requirements in frameworks known as Alternative Payment Models.