2017 is the inaugural year for the Quality Payment Program (QPP). Most radiation oncologists will participate in the Merit-based Incentive Payment System (MIPS) program. MIPS replaces and consolidates previous Medicare quality initiatives (Physician Quality Reporting System (PQRS), Value-based Modifier (VM) and EHR Incentive (Meaningful Use) Program) into one comprehensive program. Based on an eligible clinician’s performance in three categories in 2017, their 2019 Medicare Part B reimbursement will be impacted. Since MIPS is a new program, 2017 is a transition year with an option to “Pick Your Pace”.
In preparation for MIPS, you need to answer the following questions:
Group vs. Individual Reporting
Pick Your Pace
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The academic university, community hospital or large multidisciplinary group practice is responsible for billing my physician services.
There are multiple paths to MIPS participation. In addition to the various “Pick Your Pace” options, there are additional nuances on MIPS participation based on how your Medicare billing is structured.
As a reminder, a National Provider Identifier (NPI) is used for identification purposes while a Taxpayer Identification Number (TIN) is used for tax purposes. All physicians have an NPI number. Depending on employment contracts, a clinician may have:
- Assigned their NPI to a Hospital TIN, Physician Group TIN, etc. for billing purposes, OR
- Maintained their NPI for themselves and bill Medicare on their own
In the first situation, the hospital or physician group bills both the professional component (PC), which covers the work done by the physician directly, and the technical component (TC), which covers the cost of the equipment, supplies and the work done by medical physicists and/or specialized support staff, such as radiation therapists.
In the second situation, the physician bills for the PC while the entity (e.g., hospital) bills for the TC. Physicians in this clinical setting would add a “-26” modifier indicating that they only provided the professional component for a particular service.
Last Updated September 12, 2017
Please check back regularly to see the latest updates. ASTRO is continually updating this site to reflect new and/or changing information from the federal government and other sources.
As always, each radiation oncology practice and its eligible clinicians are encouraged to review primary materials (statutes, regulations, agency interpretive guidance, etc.) and seek appropriate legal or other professional guidance for a comprehensive understanding of their obligations. The information on this website should not be construed as legal, coding or other professional advice, and ASTRO assumes no liability for the information contained herein.