It’s hard to plan very far ahead when you’re busy serving so many patients each day. But what you need to find time to do by March 31 will have a significant impact on how you’re reimbursed for Medicare payments in the coming years.

March 31 is only a month away — the last day for physicians and other eligible providers to submit the requisite quality performance data to CMS if you’re being measured and paid under the Merit-based Incentive Payment System (MIPS). MIPS merged and streamlined multiple quality programs and, along with eligible alternative payment models (APMs), are replacing payment for value over volume and repealed the old Sustainable Growth Rate (SGR) formula.

It’s not a complicated process and we at Advantum Health can help, but only if you act now. Otherwise, you’re facing a 4-percent penalty or a “negative payment adjustment” for each Medicare claim for 2019. And if you don’t do it for 2018, that’ll affect your 2020 reimbursements, and so on. A 4-percent reduction for 2019 is bad enough, but this penalty will grow in future years. It’ll definitely add up and could spell financial doom for your practice.

At Advantum Health, through our dashboards we track your activities against Key Performance Indicators (KPIs)…not only for typical RCM measures such as denial rates or days in Accounts Receivable but how you’re measuring up against Quality Payment Program (QPP) indicators. This is part of what we regularly share with each account to help them prepare for this looming deadline. However, information from CMS and our own sources indicate that a number of physician practices have yet to file all of the necessary data to CMS to avoid the 2019 penalties. We’re here to help, but you need to act quickly so sufficient resources are available to serve you.

In addition to information in this blog, I encourage you to contact me at so I or a member of our team can discuss your situation and implement a quick action plan to ensure you avoid the penalty.

Below is some additional information that may be of assistance as the industry begins to adjust to the MIPS value-based payment tracking and reporting.

Are you required to participate in MIPS?

You probably already know (and hopefully are well on your way to gather and submit your data), but click here to link to the MIPS Eligibility Tool and enter your NPI.

View performance scores for your 2017 claims data

If you’re an eligible clinician who submitted 2017 Quality performance data for MIPS via claims, you can now view your performance scores through the MIPS data submission feature. Reminder: claims data submission is only an option if you’re participating in MIPS as an individual (not as part of a group).

If you’ve already submitted quality data through claims, no additional action is required. Claims-based quality measures are calculated automatically by CMS based on the Quality Data Codes (G-codes) submitted on your 2017 claims. Simply log in at and view your calculated individual measures’ scores and category score for the 2017 “transition year.” But remember: scoring of claims data is subject to change monthly based on the processing of any additional 2017 claims and adjustments for up to 90 days after the end of 2017. So that’s cutting it very close to the March 31 submission final date.

Still time to submit 2017 claims

If you still have 2017 claims to submit for the quality performance category, submit them now. Claims are processed by Medicare Administrative Contractors (MACs) — including claims adjustments, re-openings or appeals — and must be received by the national Medicare claims system data warehouse (National Claims History file) by March 1 to be analyzed. The MACs can provide you with specific instructions on how to submit.

Resource quick links

To close out your 2017 submission and prepare for year two, we also recommend that you take advantage of the following free resources:

CMS Quality Payment Program site (includes participation status, ability to submit and manage data, etc.)
MIPS Extreme and Uncontrollable Circumstances Policy for 2017
QPP Year 2 overview
Email the Quality Payment Program at or call toll-free at (866) 288-8292
Failure to comply with the requirements by the deadline may have a negative impact on your bottom line that you can ill-afford. Let Advantum Health help you survive and thrive.

Kerri J. Wing, RN, BSN, MS, is director of clinical analytics for Advantum Health.