OD Link Manual Insurance/Financial Information and ReportsHow to successfully navigate MIPS with OD Link

How to successfully navigate MIPS with OD Link

You are automatically exempt from MIPS in 2017 if you receive less than $30,000 from Medicare. The amount for 2018 raised to $90,000. You are also exempt for 2018 if your practice has less than 15 doctors or if you are in a rural area.

MIPS has 4 categories.  CMS has taken what was formerly Meaningful Use and what was formerly PQRS along with a new third category and a new fourth category (coming in 2019 or 2020) and together that is what makes up MIPS.  Each one is scored separately and together they equal 100 points or possibly a little higher if you can get any of the offered bonuses.  You can choose how you participate and how much you want to participate.  Essentially you get to pick and choose which categories to participate in and how much you want to do in each category.

Quality (formerly PQRS) is worth 60% of your score in 2017.  Advancing Care Information (formerly Meaningful Use) is worth 25% and Improvement Activities (new category) is worth 15%.  OD Link users cannot get credit for Advancing Care Information this year but you can get full credit for the other two categories.  Quality and Improvement Activities require very little extra work and no extra costs associated with them and can equal up to 75% of your score. Advancing Care Information would require a great deal more work on your part and extra cost (approximately $2000 per doctor per year).  In 2018 a fourth category will be introduced.  Cost.  Which will require nothing on your part.  You will be evaluated based on your billing habits.

Quality Measures (Formerly PQRS) for 2017

OD Link does not ensure compliance with PQRS, but it helps by auto-inserting the common PQRS codes for you based on diagnose.  PQRS is now called Quality Measures.  It is woth the largest part of your overall score.  Quality is also the easiest category to report.  You can simply attach PQRS codes on claims that you send to Medicare.  You can choose to do the minimum which would be to put one code on one single claim for the entire year.  If successful, this one claim would help you avoid any kind of penalty in 2019.  You can also choose to report on every single claim or anything in-between.  If successful, you could earn up to 60 points and even 65 if you get a bonus.

OD Link users will be in the first category along with Most participants.  Report up to 6 quality measures, including an outcome measure for a minimum of 90 days in 2017.  Report for the full year in 2018.

Use this website to explore measures and choose which ones apply to you.  Depending on which version of OD Link you have, the software auto-inserts some or most of the common optometric related codes.  Please watch your claims to make sure this is happening.  Do NOT rely on OD Link.  It is up to you to make sure you are reporting enough codes and to make sure those codes are properly inserted and appropriate for each claim.  


Improvement Activities

Improvement Activities is a new category.  Use this website for more information and to search for activities that apply to you.  This is also the website you will go to when you're ready to attest to the improvement activities you performed for the year.  Attesting is open between 1/1/18-3/31/18 for 2017 attesting.

Check your participation status

Be aware that you may be exempt from MIPS.  Use this website to check your status.

This website also has information about hardship exemptions and applications.