Where are you in the Merit-Based Incentive Payment System (MIPS) reporting process? Does the MIPS extension apply to you? Did you already start last year, but not receive the full reimbursement? If not, do you know what you need to get going? We’re here with the answers.

First, some big-picture good news: most eligible providers are now participating. CMS Administrator Seema Verma announced this past summer that 98 percent of Accountable Care Organizations submitted the proper records in the Quality Payment Program’s (QPP) first year. Additionally, nearly 95 percent of rural practice facilities are complaint.  However, the 2 to 5 percent still not participating represents a considerable number.

Does the MIPS extension apply to you?

Firstly, MIPS applies exclusively to practices that bill for Medicare Part B. This includes medical doctors, physician assistants, nurse practitioners, certified registered nurse anesthetists and clinical nurse specialists.

However, just because you accept Medicare Part B does not mean you’re automatically subject to the rule right now. For example, if you only recently started accepting Medicare Part B – meaning within the past calendar year – you’re excluded from the 2018 performance year. The same is true for clinicians whose billing is $90,000 or less for 200 or fewer Part B beneficiaries in the average year.

This is an important consideration to establish, given how much time is spent on back-office tasks. According to a Health Affairs study,

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specialists and their staff commit approximately 785 hours per year to tracking down and recording quality measures. That’s the equivalent of $15.4 billion.

Did you receive the full reimbursement?

Because MIPS is going into effect on a gradual basis, participants have flexibility on how they report. For example, last year participants were able to submit reporting information for only one of the MIPS reporting categories or over a period of 90 days. This year, in order to receive the full incentive, practices must deliver the proper reporting data for the full year and for all four performance categories.

Are you unclear of what you need to do?

If you are subject to MIPS, you may not be sure about what you need to do to be 100% compliant and get the full reimbursement. Because the MIPS program is a scoring system – measured on a scale of 0 to 100, with the highest scores resulting in higher reimbursements – you need to collect the information CMS uses to gauge your office’s overall quality of performance. Here are the categories CMS uses:

  • Quality: You get to select the six measures of performance that CMS analyzes to determine quality of care.
  • Promoting Interoperability: Satisfying this category includes the sharing of test results, visit summaries and therapeutic plans with other providers. You just have to provide evidence of promoting coordination and patient engagement.
  • Improvement Activities: Have you expanded patient access in the last year by making electronic medical records available to them? Did your office implement a rehabilitation plan within a month of his or her discharge to reduce the risk of readmission? Submitting data of this type fulfills this category.
  • Cost: How did your office make use of its capital resources in providing care? The cost of the care you provide – and to what extent patients’ spending went to treatment or services – is determined by the Medicare claims you submit.

The four performance metrics are weighted in terms of deciding your MIPS score:

  • Quality (50 percent)
  • Promoting Interoperability (25 percent)
  • Improvement Activities (15 percent)
  • Cost (10 percent)

Are you confused about the MIPS performance year reporting deadline?

What practices need to know about MIPS in 2018

Related Article: What practices need to know about MIPS and reporting through an ACO

Since MIPS launched in 2017, and has been implemented in phases, you may be confused about when to submit the appropriate material to get your MIPS score. March 31 of the following year is the date to remember. In other words if the performance year begins Jan. 1 and concludes Dec. 31, you have three months to submit your facility’s performance metrics to CMS.

Although MIPS compliance may seem like an administrative chore, it’s something that can really pay off when your quality of care is top notch. Tangible Solutions can provide the assistance you need to achieve compliance in an ever-changing regulatory healthcare landscape. Tangible Solutions serves as your trusted technology partner, with over a quarter of a century of experience to back you up.

Speak with a Tangible Solutions specialist today.


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