American Society of Plastic Surgeons
For Consumers

How to Avoid a Penalty in 2018

Are you exempt from MACRA? MACRA allows physicians to be excluded from reporting if you meet one of the following criteria:

  • See less than 200 Medicare Part B patients per year
  • Have less than $90,000 in Medicare Part B allowed charges per year

If you are exempt you will not receive the 5% penalty in 2020 and you are not eligible to receive the incentive. You must check every year to determine your status in the program.

One of the biggest changes between 2017 and 2018 for providers who participate in MIPS is that the threshold for avoiding a negative payment adjustment is jumping up from 3 points in 2017 to 15 points in 2018. This means that in order to avoid the -5% payment adjustment on your Part B payments for 2020 you will need to earn at least 15 points out of a possible 100 points in your MIPS composite performance score in 2018.

If you are not exempt from the MIPS program and simply want to avoid the -5% payment adjustment you will have several options including:

  1. Submit 6 quality measures that meet data completeness criteria
  2. Earn 100% in the Improvement Activities category (attest to 4 medium weight, 2 high weight, or 2 medium and 1 high weight activity)
  3. Meet PI base score and submit one medium-weighted improvement activity
  4. Meet PI base score and submit one quality measure that meets data completeness

If you are in a small practice (15 or fewer clinicians) you can earn 15 points if you:

  1. Submit a small amount of data for 5 measures
  2. Attest to 2 medium weight or 1 high weight Improvement Activities