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athenahealth Says it will Cover MIPS Payment Penalties for Customers

July 25, 2016
by Rajiv Leventhal
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athenahealth has said that if customers using the company’s athenaOne services get hit with Merit-Based Incentive Payment System (MIPS) payment penalties, it will cover the financial consequences for those unsuccessful practices.

The “MIPS Guarantee” from the Watertown, Mass.-based vendor applies to customers using athenahealth’s network-enabled athenaOne services, which feature workflows and native intelligence designed to manage quality, collect data, and handle reporting for MIPS, minimizing work and risk for practices of all sizes and specialties, the vendor attests. 

Under athenahealth’s MIPS Guarantee, announced on July 25, months before the Centers for Medicare and Medicaid Services (CMS) releases the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) final rule, new practices using athenaOne are guaranteed to perform at or above the national performance threshold set by CMS and avoid payment penalties to their Medicare Part B fee schedule. The vendor will cover penalties for those practices that are not successful, subject to certain limitations, such as clients being live on athenaNet by June 30, 2017.

Part of the new Medicare physician payment system established by MACRA, MIPS streamlines existing quality reporting programs and links fee-for-service payments to quality and value by commanding 4 percent Medicare payment adjustments. An estimated 90 percent of eligible clinicians billing Medicare Part B will qualify for MIPS and are required to participate in the program by 2017, with payment adjustments set to take effect in 2019.  

“At a time when nearly all providers across the U.S. are expected to keep up with ever-changing reimbursement rules and an estimated 45 percent of those who bill Medicare Part B are facing payment cuts under the MIPS program, we’re looking to lift the burden,” Jonathan Bush, chief executive officer, athenahealth, said in a statement. “The complexity of government reimbursement is just too onerous; and, it’s not something providers or practice staff should have to master. Because of our national network, our quality management and payer rules engine, our team of experts, and our track record of client success as part of other government-run programs, we believe we can free the industry of reimbursement cuts associated with MIPS. And if we can’t, we’ll put our money where our mouth is and reimburse clients up to the penalty amount.”

The outspoken Bush continued, “MIPS represents CMS’ unsubtle change in approach from ‘carrot’ to ‘stick.’  athenahealth is standing up to potentially bear the brunt of that stick’s whack, going at risk ourselves to manage the administrative technocracy so that doctors can be doctors. With so much uncertainty about how the MIPS program will unfold and what consequences it will have on healthcare, this is the boldest expression of athenahealth’s commitment to providers yet: we only succeed when they succeed.”

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