Medicare Physician Payment

How to Report the Revised Fee-for-Service Option

Under the Merit-Based Incentive Payment System, CMS evaluates providers' 2017 performance based on reporting in three areas. CMS plans to add a fourth, resource use, in 2018.

• Quality (formerly PQRS)
• Advancing care information (formerly meaningful use)
• Resource use (formerly the value-based modifier)
• Improvement activities

Resources

• Help us ensure zero penalties for ophthalmology in 2019
• EyeNet’s MIPS Guide
• IRIS Registry user guide
• Implementing MIPS in Your Practice (recorded webinar)
• Glossary
• What's in MACRA, the law that changed Medicare
• MIPS: How fee-for-service works in 2017

Implementation Timeline

• January 2017 – CMS begins to evaluate physicians’ performance, based on the requirements outlined under the two Quality Payment Program options.
• January 2019 – Physicians receive first pay adjustment under the new system, based on 2017 performance.

Our Commitment to Your Success

The Academy's physician leaders are working with policymakers in Washington, D.C., to secure ophthalmologists' successful transition to this new system. In addition to our analysis following CMS' publication of the system's final configuration in October 2016, we continue to identify and address parts of the program that don't work for ophthalmologists. We're working with medicine, Congress and federal regulators to ensure the system supports you and your patients.

The Basics

• What CMS calls the new policy: Quality Payment Program
• Where it came from: Congress passed sweeping reform under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to replace the sustainable growth rate.
• What this policy does: It ties Medicare payments to quality and value.
• When it takes effect: Performance evaluation begins in 2017, with pay adjustments in 2019.
• Fee-for-service option: Merit-Based Incentive Payment System (MIPS), which combines existing quality-reporting programs with some new elements. Most ophthalmologists will likely have to use this option.
• Alternative payment model option: These new approaches to paying for the medical care of Medicare patients incentivize quality and value. Few qualifying models currently exist for ophthalmologists.