Which Reimbursement Path Will Doctors Favor Under Medicare's New Payment System?

It won’t be the new Merit-Based Incentive Payment System (MIPS) that’ll attract most doctors under the so-called “doc fix” law that replaced Medicare’s notorious sustainable growth rate (SGR) formula, an official with a physician managed care organization predicts.

The Medicare Access and CHIP Reauthorization Act of 2015 offers providers a choice of two reimbursement paths beginning in 2019.

For one, physicians and other Part B medical professionals may choose to be reimbursed under MIPS, a “fee-for-service plus quality link” in which Medicare payments will be adjusted based on performance measures to be developed over the next few years.

MIPS will replace the current group of incentive payment programs: the Physician Quality Reporting System, Value-Based Payment Modifier, and Electronic Health Records Meaningful Use Incentive Program. Each year, there’s the potential to either gain or lose a percentage of payment, starting with 4 percent in 2019 and growing to 9 percent in 2022.