MACRA Monday: Try this measure


If you haven’t started reporting quality data for the Merit-based Incentive Payment System (MIPS), there’s still time to avoid a 4% cut to your Medicare payments.

Under the Pick Your Pace approach being offered this year, the Centers for Medicare & Medicaid Services allows clinicians to test the system by reporting on one quality measure for one patient through paper-based claims. Be sure to append a Quality Data Code (QDC) to the claim form for care provided up to Dec. 31, 2017, in order to avoid a penalty in payment year 2019.

Consider this measure:

Limelight Video

Measure #112: Breast Cancer Screening

This measure is aimed at capturing the percentage of women 50-74 years old who had a mammogram to screen for breast cancer.

Eligible cases include patients 51-74 years of age on the date of encounter and a patient encounter during the performance period. Applicable codes (CPT or HCPCS) include 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0402, G0438, G0439.

To get credit under MIPS, be sure to include a QDC that shows that you successfully performed the measure or had a good reason for not doing so. For instance, CPT II 3014F indicates that screening mammography results were documented and reviewed. Code G9708 is an exclusion code for women who had a bilateral mastectomy or evidence of a right or left unilateral mastectomy.

CMS has a full list measures available for claims-based reporting at The American Medical Association has also created a step-by-step guide for reporting on one quality measure.

Certain clinicians are exempt from reporting and do not face a penalty under MIPS:

• Those who enrolled in Medicare for the first time during a performance period.

• Those who have Medicare Part B allowed charges of $30,000 or less.

• Those who have 100 or fewer Medicare Part B patients.

• Those who are significantly participating in an Advanced Alternative Payment Model (APM).

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