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    How MIPS affects ODs’ Medicare payments

    Optometrists who see Medicare patients are being graded on their performances, and this grade will affect their 2019 Medicare payments.

    Via the Quality Payment Program of U.S. Centers for Medicare & Medicaid Services (CMS), the Merit-Based Incentive Payment System (MIPS) begins to shift Medicare reimbursements away from fee-for-service payments and toward outcome-based medicine. This change rewards optometrists who are improving care and penalizes those who are not.

    Previously from Dr. Rogoff: How your practice can learn from successful companies

    Must you comply?

    Optometrists will need to comply with the MIPS program if they have:

    • Billed Medicare for more than one year

    • Billed more than $30,000 in allowable charges per year

    • Cared for more than 100 Medicare patients

    Throughout 2017, ODs must record quality data and how they are using technology to provide the best outcomes for patients. This data must be sent to CMS by March 31, 2018, and feedback will be given for the remainder of 2018.

    Depending on 2017 performance, an adjustment of Medicare payments will be made. These adjustments can be as high as a 4 percent increase or as low as 4 percent decrease.1

    Such adjustments in payments will continue through 2023.1

    Bryan Rogoff, OD, MBA, CPHM
    Dr. Rogoff is an independent corporate and private practice consultant specializing in best healthcare, business, and clinical ...


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