What Chiropractors Need to Know About Medicare’s Quality Payment Program

///What Chiropractors Need to Know About Medicare’s Quality Payment Program

What Chiropractors Need to Know About Medicare’s Quality Payment Program

Are you planning to participate in Medicare's Quality Payment Program this year? The program is part of the Centers for Medicaid and Medicare Services' (CMS) effort to link reimbursement levels to quality of care, rather than volume. Although participation in the program may not be required for every chiropractor, you may want to evaluate the requirements to determine if you'll benefit from participation.

Participate in One of Two Payment Models

Medicare offers two tracks: the Advanced Alternative Payment Models (APMs) and the Merit-Based Incentive Payment System (MIPS). APMs offer Medicare incentive payments, while MIPS provide performance-based payment adjustments. If you expect to receive at least 25 percent of Medicare Part B payments from APMs and see at least 20 percent of your Medicare patients through advanced APMs, you'll want to participate in the APMs system.

Most chiropractors won't see the number of patients required for an APM, and many won't even meet the requirements for the MIPS, which include:

  • Caring for more than 100 Medicare patient this year
  • Billing more than $30,000 in Part B allowed charges

You are only eligible for MIPs participation if this isn't the first year you've seen Medicare patients.

How Does MIPs Reimbursement Work?

Both the amount of data you submit and your quality scores factor into your reimbursement. If you're eligible for MIPS, but choose not to participate, you'll receive a negative 4 percent payment adjustment. Under the previous Medicare reporting system, negative payment adjustments were as high as 9 percent. If you make an effort to submit at least some information, your payment level won't be affected. Submitting just one quality measure or one improvement activity is enough to avoid the negative payment adjustment, according to CMS.

Your payment adjustment may not change, or you may earn a small percentage increase if you submit 90 days of data. Chiropractors who submit an entire years' worth of data will benefit the most and can expect to see a moderate positive payment adjustment.

The information you submit will be used to determine payment adjustments for 2019. After CMS receives your data, it will offer feedback and inform you of your negative, neutral or positive adjustment. In 2019, payment adjustments will be capped at plus/minus 4 percent, but will increase to plus/minus 5 percent in 2020, plus/minus 7 percent in 2021 and plus/minus 9 percent in 2022.

The MIPs reporting system takes into account quality, improvement activities, cost and advancing care information. Quality accounts for 60 percent of your rating and is based on up to six quality measures, such as functional outcome assessment and pain assessment and follow-up. Medicare will use the information you provide to not only determine your payment adjustment, but also help patients choose chiropractors based on their scores.

When Must Data Be Submitted?

There's still plenty of time to submit Medicare data for 2017. As long as you begin collecting data by October 2, you can participate in MIPS. Data collected must be submitted no later than March 31, 2018.

Whether you're eligible for MIPS or not, you'll want to keep up with changes to the payment system. As quality becomes an increasingly important reimbursement metric, expect more changes in the future, even for lower volume practices.


Quality Payment Program: The Quality Payment Program Overview Fact Sheet


Chiropractic Economics: Medicare’s Quality Payment Program Has Arrived


By |2018-10-18T17:22:41+00:00June 8, 2017|Chiropractic Marketing, Marketing|Comments Off on What Chiropractors Need to Know About Medicare’s Quality Payment Program