The Centers for Medicare & Medicaid Services (CMS), operating under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), administers an incentive program known as the Quality Payment Program to help adjust payments for participating Medicare clinicians.
The Merit-based Incentive Payment System (MIPS) is one way to take part in the Quality Payment Program. Under MIPS, clinicians can earn a payment adjustment for Part B-covered professional services based on CMS evaluation of their performance across different performance categories.
The performance rating categories include:
- Quality of patient care
- Cost of patient care
- Promoting interoperability through electronic exchange of health information
- Improvement activities affecting clinical care processes and patient engagement
Providers that participate must provide reporting across all categories to qualify for a potential reimbursements adjustment increase.
Clinicians may be required to participate based on the number of covered patients, procedures and payments they handle each year, or may choose to take part voluntarily.
Clinicians who are required to report are subject to a potential adjustment for their Medicare Part-B-related reimbursements based on their MIPS score. They assess scores each year for an adjustment applied 24 months later.
Clinicians subject to mandated reporting who have a high score can receive an upward adjustment. Those who fail to report or who have a low score may not get an upward adjustment, or suffer a downward adjustment in their reimbursements.
Clinicians who aren’t required to report but do so voluntarily can receive feedback to help them prepare for future years when they may be subject to required reporting and subsequent adjustments.
The administrative work required to comply with QPP and MIPS requirements can vary based on the size of the practice, whether clinicians are reporting individually or as part of a group, and how many types of covered procedures are involved.
Ideally, providers will have automated systems in place for seamlessly identifying required actions for MIPS reporting within their daily patient workflows, and then easily extract the data for reporting.
If this is not the case, reporting can become difficult and time-consuming, and potential benefits lost. MIPS reporting handled efficiently and comprehensively throughout the year can help avoid a scramble at the end of the year that leads to a downward adjustment because of incomplete or improper reporting.
Why MIPS reporting Is So Important
Robust MIPS reporting delivers advantages such as better quality of care (QoC) and lower cost of care (CoC.) Since the goals of MIPS reporting for financial incentives center on these goals, achieving them in reporting means clinicians have also achieved them in practice.
Benefits of achieving high MIPS scores
Proactive healthcare, preventive treatment, medication management and other QoC initiatives can improve costs related to care by addressing minor health issues or at-risk populations, and taking steps to head off unnecessary hospitalizations or worsening of chronic illness.
Use of electronic health records (EHR) and the sharing of information between doctors and patients electronically reduces costs of care and improves quality of care. It also improves clinical care processes and enhances patient engagement and communication.
MIPS parameters for 2022
For the performance year 2022, which will affect adjustments applied in 2024, each category is weighted as follows, accounting for different percentages of the final MIPS score:
- Quality 30%
- Cost 30%
- Promoting Interoperability 25%
- Improvement Activities 15%
The minimum threshold for performance year 2022 to avoid a MIPS penalty and negative payment adjustment in 2024 is 75 points. Clinicians who must participate and do not, or who achieve a score under 75 points, will receive a negative adjustment of up to -9%.
Scores equal to 75 points will receive no adjustment to their reimbursements. Scores over 75 points will receive a positive adjustment up to +9%. For scores 89 points and above, an additional “exceptional performer” positive adjustment may be applied.
There are some time and cost challenges associated with MIPS reporting, which one can mitigate by the individual clinician or group’s approach to reporting within the context of overall practice data management.
For physicians and practices who have already embraced EHRs and are using data analytics to track metrics associated with cost of care and other key measures, compliance with MIPS reporting can be fairly easy and cost effective to achieve.
For practices and doctors who have not digitized their patient records and don’t have any type of data tracking for analytics in place, the administrative cost of MIPS reporting can be much higher.
In either case, the cost of MIPS reporting is unlikely to be greater than the cost of incurring a negative adjustment each year because of insufficient reporting or not reporting at all. MIPS reporting needs to be a priority to prevent erosion of profits. Done correctly, this can actually be a predictable and stable form of increased revenues.
Even those not yet mandated to report, but expect to grow their Medicare clientele in the future, can benefit from adopting the reporting measures to learn where they can improve. This will provide benefits when reporting becomes mandatory.
How Tangible Can Help
Tangible is the ideal partner for reducing the administrative load, time and cost effects of MIPS reporting while helping organizations achieve the highest possible reimbursements. We provide quality MIPS reporting that has helped many of our clients achieve exceptional performer status and increased reimbursement adjustments year after year.
The Happe-Analytics program helps maximize the value of MIPS reporting without sky-high administrative costs. With Happe-Analytics, you can find out exactly where your organization currently stands, both in relation to potential reimbursements from MIPS and other incentive programs.
You can also view your year-over year improvement (an important scoring weight) and choose the best measures to report. All Happe-Analytics reports are easy-to-read and we support integration with your existing EHR system.
Ready to manage quality reporting for lower administrative costs and maximize reimbursements? Contact us today.