January 06, 2017

ACR Clarifies ACI Options in MIPS

The following information is pertinent to radiologists participating in the Merit-based Incentive Payment System (MIPS). There are additional details not discussed below that apply to non-physicians and other non-radiologist audiences. The below article is intended for educational purposes only and should not be used as a guidance or legal document.

The Centers for Medicare & Medicaid Services (CMS) provides several different options for eligible clinicians to reweight the Advancing Care Information (ACI) performance category in the Merit-based Incentive Payment System (MIPS) to zero, effectively exempting the participant from reporting ACI. If reweighted, the full weight of ACI — 25 percent of the MIPS final score — would instead be reallocated to the quality category.

Automatically Reweighted to Zero Based on Medicare Data

Radiologists in either of the below categories will have ACI automatically reweighted to zero by the agency unless they deliberately choose to report. CMS will make the determinations for both categories based on claims data and notify participants of their status.

  1. Non-patient-facing (NPF): The agency will determine individual MIPS-eligible clinicians to be “NPF” if they have fewer than 100 patient-facing encounters during the corresponding NPF determination period. A group would be determined “NPF” if more than 75 percent of the individual clinician’s billing under that group’s tax identification number meet the NPF definition.

    CMS plans to conduct two separate queries using different 12-month segments of data every NPF determination period to identify NPF clinicians. The first query uses Medicare claims data from September 1, two years prior to the performance period to August 31 of the year prior to the performance period. This first query would enable CMS to calculate and provide early notification to clinicians of their NPF status every December. CMS will then conduct a second query using Medicare claims data from September 1 of the year prior to the performance period to August 31 of the year of the performance period to determine if any additional clinicians and groups are NPF while the performance year is in progress.

    For example, for the 2017 performance year (2019 MIPS payment year), CMS will initially identify eligible clinicians and groups that are considered NPF based on data from September 1, 2015 to August 31, 2016. Then, CMS will conduct another analysis based on data starting from September 1, 2016 to August 31, 2017 to identify additional NPF clinicians and groups.

    All MIPS-eligible clinicians who meet the definition of a non-patient facing MIPS-eligible clinician will be considered non-patient facing for the duration of a performance period. Furthermore, a clinician who identified as non-patient facing during the first eligibility determination analysis will continue to be considered non-patient facing for the duration of the performance period regardless of the results of the second eligibility determination analysis
  2. Hospital-based: Hospital-based MIPS-eligible clinicians are those who provide 75 percent or more covered professional services in the inpatient hospital (POS 21), on campus outpatient hospital (POS 22), or emergency room (POS 23) on-campus settings. The determination period for the “hospital-based” definition uses claims with dates of service from September 1 of the calendar year two years preceding the performance period to August 31 of the calendar year preceding the performance period. For example, for the 2017 performance period/2019 MIPS payment year, CMS will use the October 2016 data for Medicare claims with dates of service between September 1, 2015, and August 31, 2016.

Manually Apply to CMS

Radiologists who do not meet the aforementioned “NPF” or “hospital-based” definitions can apply to CMS every year to have the ACI category reweighted to zero if they successfully argue to the agency that they fall into one of the below three categories. The annual application process, forms and other details will be fleshed out by CMS in the future.

  1. Insufficient Internet Connectivity: MIPS-eligible clinicians in areas without sufficient broadband access, and who faced insurmountable barriers to obtaining sufficient Internet connectivity, can apply under this categorization. The FCC's National Broadband Map allows MIPS-eligible clinicians to search, analyze and map broadband availability in their area.
  2. Extreme and Uncontrollable Circumstances: According to CMS’ explanation in the final rule preamble, “extreme and uncontrollable” circumstances could involve natural disasters, transitional infrastructure changes, migration difficulties, product certification problems, and any miscellaneous issues with vendors and Certified Electronic Health Record Technology (CEHRT) that qualify as both extreme and out of the control of the clinician.
  3. Lack of Control over the Availability of CEHRT: MIPS-eligible clinicians who do not have influence over the health IT decisions of their workplace(s) can apply under the “lack of control over CEHRT availability” category. Those who practice in off-campus hospital facilities and other facilities where they do not influence the availability and use of CEHRT could apply under this categorization. A majority (50 percent or more) of a clinician’s outpatient encounters must occur in a location or multiple locations where the clinician does not have influence over health information technology decisions.

American College of Radiology (ACR) members who have questions about ACI should contact Michael Peters, ACR director of regulatory and legislative affairs, via email at mpeters@acr.org or by phone at 202-223-1670, extension 4546.