Recalling MIPS 2023, Reporting Changes Impact RCM Can Help?

If you are new and you don’t have knowledge about the MIPS 2023. Here’s a little basic introduction of MIPS regarding their eligibility and the score and how can you do reporting.

The Feels Good Nostalgia

MIPS (Merit-Based Incentive Payment System), a CMS initiative that determines the Medicare payment adjustments to all the eligible providers based on the over MIPS performance score of providers. The provider’s MIPS score determines the reimbursement bonus, reimbursement penalty, and if the provider remains neutral (no bonus, no penalty).

Providers want to obtain a bonus or at least stay neutral.

Just like the other CMS Initiatives or programs, MIPS has deadlines, exclusions, and extensions as well. Well, you haven’t deeply tuned into its details, possibly because you thought MIPS wouldn’t significantly impact you and your practice.

What can be regarded as “garden-type MIPS” reporting today will end in a much more complicated manner in MIPS 2023 In essence, the minimum level to avoid penalties will be raised. In other words, the limbo stick is now just a few inches off the ground (Google it if you don’t recall what that is).

Hence, to support your efforts to succeed with MIPS, we share the following information that you need to know to help you get ready for – and avoid – penalties while you do what you do best: give your patients the greatest healthcare services possible.

Who Is Eligible?

Now, generally, you have remembered about the MIPS. The question it raises is, Are you eligible? Does it apply to you?

Use the physician lookup tool, which will allow you to check your status after entering your National Provider Identifier (NPI) number, to identify eligibility. If you are an eligible physician, then you will have to report enough to remain neutral or perhaps even obtain a bonus or be penalized.

If you are working in multiple locations then you will have a special status which includes the hospitals, clinics, and under more than one Tax Identification Number (TIN). Ensure that MIPS calculations are based on the combination of TIN and NPI. So, your scores are relevant to the locations for which you are MIPS eligible.

The low-volume threshold (LVT), which encompasses three facets of the covered services you provide, including all of the following, is also used to evaluate eligibility over 12 months.

Allowed Charges
Number of Medicare patients who used your services
Amount of services rendered

You must take part in the MIPS program unless you have an exemption if you billed more than $90,000 for Part B-covered professional services, saw more than 200 Part B patients, and rendered more than 200 covered professional services to those patients.

Additionally, to those requirements. You are eligible if you are one of the following types of providers

1. Clinical social workers

2. Clinical nurse midwives

3. Physician assistants

4. Clinical psychologist

5. Physical and Occupational therapist

6. Certified registered nurse anesthetists

7. Qualified audiologist and speech-language pathologist

8. Registered dietitians or nutrition professionals

Consequences

All the eligible clinicians must report to prevent a negative 9% downward payment adjustment (penalty) for all the Medicare Part B claims paid two years before the reporting period. For example, claims submitted in 2023 for which MIPS reporting was lacking will result in penalties on reimbursement of 2025.

But as noted, the penalties are avoidable through Quality reporting. There are multiple reporting options depending on your practice specific.

Solution

As you can see, MIPS reporting is becoming complicated, tricky, and unwieldy to the point where the individual practitioners and providers can’t handle the proper reporting to avoid the 9% penalty on Medicare reimbursement.

Partnering with a knowledgeable RCM and trusted billing service with the MIPS staff in place to help and work with clients to make sure the reporting is on the track is an essential resource. That’s so true because it gets more complicated, as described in the following pathways.

Reporting through Pathways

Traditional MIPS Reporting

It calls the providers to select the quality measures and improvement activities on which to report and with which to communicate with MIPS. Moreover, the providers will complete the Promoting Interoperability measure. CMS collects and calculates the data for the cost-performance category on behalf of providers.

The Alternative Performance Pathway

(APP) is intended for qualified clinicians taking part in MIPS APMs. For quality assurance and improvement efforts, they will use predetermined metrics. High-quality treatment is ensured by working with stakeholders and medical professionals to develop performance metrics that are defined by CMS.

This contributes 50% of the final grade. Promoting interoperability through patient participation and electronic information interchange utilizing approved electronic health record technology accounts for another 30% of the outcome (CEHRT). The remaining 20% comes from improvement efforts, such as enhancing patient participation, access to care, and the systems that underpin these.

MIPS Value Pathways

To shift away from organized reporting and concentrate on particular metrics and activities that are more crucial to your practice or specialty and, consequently, to the health of your patients, MVPs were developed. They enable targeted actions and procedures that are more pertinent to a specialty, episode of care, or particular medical condition.