Medicare Changes – Overdue?

Medicare has some big changes in the coming two years – here are two big ones to keep an eye on and prepare for:

The End of Social Security Numbers as ID

Thanks to the Medicare Access and CHIP Re-authorization Act of 2015, they will be phasing out the use of Social Security Numbers in the Medicare ID#. You are likely familiar with the current use of the patient social security with a letter at the end (usually “A”). Starting in April of 2018, they will be issuing new “Medicare Beneficiary Identifier (MBI)” to their beneficiary. How will this look?

  • MBI will be 11 characters and made up of numbers and uppercase letters.
  • There will be a transition period from 4/1/18 to 12/31/19 where you can use either HICN or MBI.

Keep an eye out for any delays issued from CMS, but currently, the transition is set to begin on 4/1/18. With HIPAA such a focus for healthcare, it seems overdue to keep a patient’s social security number as secure as possible.

The End of PQRS

For a refresher on what PQRS is, you can read our blog post here. Don’t study too much though, because it is going away! It ends December 31, 2016 and is replaced with Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). This represents a shift from Fee-For-Service payments to “Value-Based” Payments.

  • Most practitioners will fall under the MIPs model rather than the APMs model.
  • The base Fee Schedule will raise by 0.5% per year through 2019, and beginning in 2019 you are eligible to receive positive or negative adjustments to that fee schedule based on your MIPs performance.
  • Contains broader exemptions for smaller providers. If your Medicare billing charges are less than $30,000/year and you see less than 100 Medicare patients/year, you will not be subject to MIPS. NOTE: Many of the published information on the MIPs exclusion for small providers show $10,000 yearly limit, however this has been amended to $30,000 after feedback.
  • First year providers do not participate.
  • As with PQRS, payment adjustments are reflected 2 years after initial data collection/reporting. Initial reporting in 2017 will be due/analyzed in 2018, and payment adjustments based on that data will show in 2019. This also means if you participated in PQRS through 2016, you should still receive your 2% incentive in 2017 and 2018.

There are great resources available for CMS here, and an informative visual guide here from CMS.

If you are a client of In Charge Office Solutions and are interested in participating, we can guide you where to find the 2017 measures that may be available for you to report on. Delaying even one year will result in no increase in payment until 2020, so it is best to start in 2017 if you are participating.

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