Timing Matters for MIPS: Upgrade Now to NextGen 5.9/8.4
CARMEN SOTO | April 5, 2018


Timing Matters for MIPS: Upgrade Now to NextGen 5.9/8.4


Upgrading to NextGen 5.9/8.4 is one of the most important things your practice can do to be more successful in 2018. This version includes new functionality to boost staff productivity, improve patient care and increase revenue cycle efficiency. And NextGen streamlined the 5.9/8.4 upgrade process to minimize disruption, effectively saving time and money for busy practices.

Despite these major benefits, many practices still haven’t scheduled the upgrade. Anyone participating in the Merit-Based Incentive Payment System (MIPS) must upgrade by the beginning of 2019 to access new capabilities required for reporting. Bottom line, the longer a practice waits to upgrade, the greater the risk of leaving money on the table and incurring financial penalties.

Upgrade by October 1 for MIPS

The MIPS reporting deadline for 2018 is March 31, 2019. This means that to maximize 2018 reimbursement potential, practices should complete the 5.9/8.4 upgrade before October 1, 2018.

Upgrading by October 1 will enable practices to capture new data points that are required to report on full MIPS measures for an entire 90-day 2018 reporting period. This can benefit practices with a positive reimbursement adjustment of up to 15%:

  • Receive a 10% incentive (MIPS/ACI category) by using 5.9/8.4 for the entire 90-day 2018 reporting period.
  • Avoid a 5% penalty for non-reporting in 2018 (increases 2% each year, currently 7% in 2019).

All adjustments are applied two years after the determining performance year.

Upgrading to 5.9/8.4 now will also give your practice useful additional data to increase its success potential. You will be able to run regular reports to check performance on key measures, then make adjustments to improve results.

You can pick the best 90 days of the year to report.  Measuring across the longest possible time period gives you more potential reporting periods to choose from, and more opportunity to make improvements. You’ll also have more data available to analyze and decide whether you should report by clinician or by group based upon performance.

MIPS Eligibility

There is still some confusion about MIPS eligibility since requirements changed for 2018. MIPS reporting is required for any provider who meets the Medicare Part B Physician Fee Schedule requirements. There are just a few participation exemptions, including clinicians who are participating in the Medicare program for the first time, and clinicians who don’t meet established Medicare patient volume thresholds.

In year one of the program (2017), practices were eligible only if they had more than 100 Medicare patients and allowable Medicare charges over $30,000. In 2018 that threshold increased to 200 patients and $90,000 in allowed charges, so many more providers are exempt.

Because MIPS is specific to Medicare Part B providers, it has no impact on Medicaid providers unless they have enough Medicare volume to be MIPS-eligible.

Hardship Exceptions

Practices often ask what they should do if they can’t comply with MIPS reporting requirements because of unforeseen circumstances. There is a hardship exception to avoid negative payment adjustments under MIPS. To qualify for the exception, submit a Hardship Exception Application, citing one of the following reasons for review and approval:

  • Insufficient Internet Connectivity
  • Extreme and Uncontrollable Circumstances
  • Lack of Control over the availability of CEHRT

Clinicians in areas impacted by Hurricanes Harvey, Irma and Maria are automatically exempted from the Quality, Improvement Activities and ACI categories without having to submit a hardship application.

Measure Performance Regularly

Practices often make the mistake of waiting until the last minute to run reports – and sometimes don’t see that they’re failing in certain areas until it’s too late. That’s why it’s critical to regularly check performance throughout the year and make improvements along the way.

This is another reason to upgrade now: 5.9/8.4 has enhanced reporting and analytics capabilities for continuous measurement and improvement during the calendar year and reporting period.

Striving to achieve the best results possible is not only important for reimbursement purposes, but also for the reputation of your practice. MIPS scores are publicly available on the CMS Physician Compare Initiative site used by consumers to make choices about where they receive care.

Your 5.9/8.4 Partner

Any major upgrade is a complex project that can make or break a practice’s continued success.

That’s why we recommend partnering with an expert to ensure upgrades are done right the first time.

ITelagen has the experience and resources to help you navigate the entire 5.9/8.4 upgrade process. We will assign a seasoned project lead to ensure your upgrade stays on track from initial planning through post-go live. Our team of certified NextGen experts will assess your unique environment to understand how the new version may impact your templates and workflows, and recommend ways to optimize them for 5.9/8.4.

We will assess your training needs and develop a plan to ensure every staff member is prepared to confidently use the new version. And we will provide full support during the upgrade as well as in the crucial first days after it is completed.

Contact us to learn how ITelagen can help your practice successfully upgrade to NextGen 5.9/8.4.