The Future of Medicare Reimbursement -
The Merit-Based Incentive Payment System
The program is intended to be “budget neutral,” so there will be equal numbers of negative and positive adjustments. Both negative and positive adjustments are capped at 4% in 2019, 5% in 2020, 7% in 2021 and 9% in 2022 and beyond, while positive adjustments must be paid out in an amount equal to the total negative payment adjustments among all providers. Unfortunately, according to CMS’ own estimates, these negative adjustments are likely to disproportionately affect solo practitioners and those in smaller practices, with 86% of solo practices, 69.9% of practices of 2 – 9 eligible clinicians, 59.4% of practices of 10 – 24 clinicians, and 44.9% of practices of 25 – 99 clinicians likely to be penalized, with only 18.3% of practices of 100 or more eligible clinicians likely to be penalized in 2019.
Physicians scoring in the lowest quartile will automatically be adjusted down to the maximum penalty for the performance year. Physicians scoring at the threshold will receive no adjustment. Physicians scoring in the highest quartile are eligible for a potential positive payment adjustments up to the maximum outlined above. The highest performers will receive proportionally larger incentive payments, up to three times the maximum positive adjustment for the year. For years 2019-2024, the law establishes a $500 million bonus pool designed to provide additional incentives of up to 10 percent for “exceptional performers;” however, the law does not provide a definition of “exceptional performer.”
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