How to avoid a MIPS penalty: a step-by-step guide

Sabra_Sullivan.jpgBy Sabra Sullivan, MD, PhD
Chair of the AADA’s Council on Government Affairs and Health Policy

If you know that you or your practice must participate in MIPS for 2017 and you want to simply avoid the 4 percent penalty (penalty will be applied in 2019), all you have to do is report one quality measure on one patient before Dec. 31, 2017. This can be done relatively easily regardless of whether you use an EHR or paper records. If you plan to report via claims, view the example below.

Here is how you can report one measure to avoid the 2019 payment penalty:

  1. Review the MIPS quality measures for dermatology.  Try the Academy's quality measure selection tool to help you find the best quality measures for your practice. You can also view a table of all 2017 MIPS measures.

  2. Find one measure that is relevant to your practice and complete it on one patient before Dec. 31, 2017. Document that you completed the measure in your patient record. (Note:The AAD strongly recommends you report one measure on at least 20 patients as an insurance policy in the event of submission issues or inaccuracies.)

  3. Report that you performed this measure through ONE of the following methods:
    a. DataDerm, the Academy's clinical data registry: Sign up now! Members using paper records can still use DataDerm to avoid the penalty.
    b. EHR vendor: contact your EHR vendor
    c. Claims (only a small subset of quality measures are reportable through claims; there are no dermatology-specific quality measures reportable through claims): visit CMS' Quality Payment Program website, or call 1-866-288-8292 for more information. See the example below to learn how to complete a claims form.

  MIPS claim example
Click here to download a high-resolution PDF of this claims-based reporting example. (This example, adapted from the AMA, is not for official use.)

How to report via claims

Although MIPS reporting can be done through claims, it is highly encouraged that physicians report via registry or electronic health record (EHR) to increase reliability, reduce errors, minimize having to report extra codes, edit data if needed, better track physician performance, and strengthen the opportunity for upward payment adjustments. Additionally, you should note that the results will be public, showing dermatologists reporting non-dermatology quality measures—the only measures reportable via claims.

If claims-based reporting is the only option, the image at the right offers step-by-step instructions on how to select a claims-based quality measure and complete the claim form. The example illustrates how to complete the claim form for Measure 130: Medication Reconciliation— a commonly reported claims measure.  


MACRA Resources


Learn about MACRA

Find a wealth of information and tools to help you understand and implement MIPS or APMs.


Are you exempt from MIPS reporting?

Use this tool to determine whether you might be exempt from MIPS reporting in 2017.


MIPS reporting: A decision support tool

Whether you are trying to avoid a penalty or receive an incentive, this tool will help you learn how to do just that.


Find quality measures

Find dermatology-applicable measures to satisfy MIPS quality reporting requirements.


Join AAD's MACRA community

Join an online discussion forum that allows members to ask staff experts questions about MACRA.


MIPS financial assessment tool

Find out how MIPS will impact your practice revenue with this interactive tool.