Daily Practice

MIPS: Physician or Group Billing

Latest in MIPS

July 2018 - CMS released final 2017 feedback and information on the 2019 payment adjustment. Have questions? Contact us!

Learn about the QOPI Reporting Registry for data submission and see the full 2018 quality measure list!

Reporting Structure

Three scenarios would qualify a radiation oncologist for the “Physician or Group Billing” model:

  • The physician bills for the professional component (PC) of a service while the entity (e.g., hospital) bills for the technical component (TC). Physicians in this clinical setting would add a “-26” modifier indicating that they only provided the professional component for a particular service.
  • The physician practices in a freestanding center in which a radiation oncology-focused physician group bills for the PC on their behalf.
  • A solo practitioner.

In this billing model, we assume that the eligible physicians will report MIPS data as individuals or as a group with other radiation oncologists. Therefore, this page is tailored to radiation-oncology specific measures and programs to satisfy MIPS participation. If an individual will report as part of a multispecialty group, please see the Hospital/University Billing page for personalized MIPS information.

Prior to proceeding, the eligible physician or group should have already determined that they:

  • Are eligible for MIPS.
  • Will report as an individual or as a group.
  • Want to participate in MIPS to avoid a negative 4 percent payment adjustment.
  • Meet the billing scenario described above.

View more information for a high-level program overview, including MIPS eligibility.

Quality

Star_Quality

The “Quality” Performance Category is a new iteration of the Physician Quality Reporting System (PQRS) in which eligible physicians will need to report on quality measures. This category weight is 60 percent of the Composite Performance Score (CPS). If the physician receives an exemption for the Advancing Care Information (ACI) category, then the Quality category weight is increased to 85 percent. In this setting, ASTRO envisions that radiation oncologists, whether reporting as an individual or a group, will report the Radiation Oncology Measures Set or select 6 measures from the complete CMS measures list.

Pick Your Pace
Measures
Reporting Method
Scoring

Improvement Activities

Checklist_IA

The “Improvement Activities” (IA) Performance Category is a new program in which eligible physicians attest to completing activities identified as improving clinical practice or care delivery likely to result in improved outcomes. This category weight is 15 percent of the Composite Performance Score (CPS). In this setting, ASTRO envisions that radiation oncologists, whether reporting as an individual or a group, will report on activities satisfied by ASTRO’s two programs: RO-ILS and APEx. If reporting as a group, at least one clinician in the group must perform the activity for the entire group to receive credit. Regardless of the Pace, each improvement activity must be completed for at least 90 consecutive days.

Pick Your Pace
Activities
Reporting Method
Scoring

Advancing Care Information

Computer_ACI

The “Advancing Care Information” (ACI) performance category is a new iteration of the EHR Incentive (Meaningful Use) program in which eligible physicians need to report on use of 2014 or 2015 certified EHR technology. The category weight is 25 percent of the Composite Performance Score (CPS). Similar to the previous Meaningful Use program, we anticipate the majority of radiation oncologists will be exempt from this category either because they are classified as a hospital-based physician or qualify for a hardship exemption. If an individual or group are exempt, then this category weight is reduced to 0 percent and redistributed to the Quality performance categories, thereby Quality would be worth 85 percent of CPS.

Exemption
Pick Your Pace
Measures
Reporting Method
Scoring

Disclaimer

 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.

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