decisionhealth Newsletters, Coder Pink Sheets - 2017 Issue 8 (August)
2018 Quality reporting proposed rule: CMS proposes higher MIPS performance — but excludes most small practices
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Article Overview
This article explains proposed Medicare Quality Payment Program changes for the 2018 performance year, with emphasis on how CMS would raise the bar for MIPS participation while expanding low-volume exclusions for small practices. It is intended for coders, billing teams, practice managers, and clinicians who need a broad understanding of proposed scoring, reporting, and participation changes across MIPS and related QPP components.
Why This Topic Matters
The proposals could affect whether clinicians must participate in MIPS, how performance is scored, and which practices qualify for exclusions or special exceptions. It is especially relevant for organizations evaluating compliance burden, reporting strategy, and potential payment exposure under QPP.
Article Sections
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Higher MIPS performance threshold and penalty changes
Discusses proposed changes to the minimum performance needed to avoid penalties and the related payment-year impact. The section frames the overall direction of CMS scoring policy for the performance year.
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Small practices get a boost
Covers the expanded low-volume exclusion and other proposed relief for smaller practices. It also introduces related exceptions and bonus treatment tied to participation choices.
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Other key proposals
Summarizes the main proposed updates across MIPS components, reporting requirements, scoring weights, and participation options. The section provides a broad view of how different parts of the program would change for 2018.
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Virtual groups on the horizon for 2018
Describes the proposed virtual group concept for small practices and how it would affect reporting structure. The section focuses on grouping eligibility and participation format.
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Risk under advanced alternative payment models (APMs) extended
Notes the proposed extension of advanced APM risk requirements into additional years. The section addresses the related Medicare revenue-based risk framework.
What You Will Learn
- How CMS proposed to change MIPS participation thresholds for the 2018 performance year
- What relief measures were proposed for small practices and low-volume participants
- Which broad MIPS categories and reporting periods were affected by the rule
- How proposed updates could affect ACI participation and CEHRT flexibility
- What the article says about virtual groups and advanced APM risk timing
Who Should Read This
- Medical coders
- Billing and compliance staff
- Practice managers
- Healthcare administrators
- Physicians and eligible clinicians
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