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MIPS for Pathologists

Background

The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) repealed the broken Medicare sustainable growth rate (SGR) formula and established new payment pathways for physicians. To implement MACRA's reimbursement reforms, the Centers for Medicare & Medicaid Services (CMS) developed the Quality Payment Program which includes:

  • the Merit-Based Incentive Payment System (MIPS), as a modifier for fee-for-service payments beginning in 2019.
  • Alternative Payment Models (APMs).
It Pays to be in the Know. Learn the nuances to comply with the Centers for Medicare & Medicaid Services’ Quality Payment Program so you can maximize your bonus potential and avoid penalties.

Ensuring Pathologists Participation in QPP

The CAP has engaged with Medicare officials to mitigate the negative effects of new and evolving reporting requirements for pathologists and laboratories. Through a strategy developed by the Council on Government and Professional Affairs and Economic Affairs Committee, the CAP advocates to ensure pathologists can participate in the Quality Payment Program. The CAP also provides resources and updates on Medicare payment reform to its members as the CMS implements and administers MIPS and APM programs.

Improvement Activities

We have developed a resource to help pathologists participating in MIPS determine which Improvement Activities to attest to in 2018. Clinicians need to attest to Improvement Activities, which represent 15% of a pathologist’s MIPS score, in order to receive credit in this category. 

MIPS Eligibility Look Up Tool

Individual pathologists and group practices can now check their eligibility for the 2018 MIPS performance year by using the QPP Participation Lookup Tool as the CMS will no longer send out eligibility letters to physicians.

The CMS updated its QPP Participation Lookup Tool so that pathologists can check if they are eligible as a MIPS participant or if they are a Qualifying APM participant. Previously, pathologists had to check their MIPS eligibility and APM status separately keeping in mind that the APM status took precedence over their MIPS eligibility.

To use the tool, pathologists can enter their National Provider Identifier (NPI) to find out both at the same time if they need to participate in MIPS in 2018 and if they are reporting as an APM or an eligible MIPS participant clinician.

Pathologists can also check 2018 MIPS clinician eligibility at the group level and APM Predictive qualifying physician status at the APM entity level. In order to determine group eligibility, clinicians need their Enterprise Identity Data Management (EIDM) and Taxpayer Identification Number (TIN) credentials. Here are the steps to use the tool:

  • Log into the QPP website with your EIDM credentials
  • Browse to the TIN affiliated with your group
  • Access the details screen to view the eligibility status of every clinician based on their NPI
  • Download the list of all NPIs associated with your TIN, including eligibility information for each NPI

MIPS Calculator

Use our MIPS calculator to help estimate future Medicare payment adjustments based on your practice data and project how MIPS will impact your practice's finances. Note this tool is for informational and estimation purposes only.

Learn More About Medicare's Quality Payment Program

MIPS Educational Webinars

The CAP is pleased to offer a MIPS education webinar series led by experts who will review components of the program concerning pathologists.

Maximize Your MIPS Bonus Potential

Diana Cardona, MD, FCAP

Watch the recording

Download the slides

Which Path is Right for Your Practice?

Emily E. Volk, MD, MBA, FCAP

Watch the recording

Download the slides

Pathologist Improvement Activities Under MIPS

Diana Cardona, MD, FCAP

Watch the recording

Download the slides

2019 Final Medicare Policy and Payment Changes

W Stephen Black-Schaffer MD, FCAP
Donald S. Karcher, MD, FCAP
Emily E. Volk, MD, MBA, FCAP

Watch the recording 

Download the slides

Quality Measures that Will Improve Your MIPS Score

Diana Cardona, MD, FCAP

Watch the recording 

Download the slides

Steps to Take Before Reporting MIPS Data

Tuesday, January 8, 2019, 3 PM ET
Emily E. Volk, MD, MBA, FCAP

Register Now

CAP Resources

AMA Resources

CMS Resources

Check your practice's readiness for MIPS

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