The merit-based incentive payment system has been designed to encourage clinicians to perform well. Do all the clinicians take part in MIPS reporting? The answer is a clear ‘no’. Not everyone can enroll in MIPS (the Merit-Based Incentive Payment System). Only MIPS-eligible clinicians are required to do so. MIPS is a QPP reporting framework governed by CMS. It is solely structured for eligible clinicians with the motto of increasing the standard of healthcare in the US.
So, what do you think? Who are the MIPS-eligible clinician types? Simply put, CMS asks for reporting from these clinician types in its PFS final rule. Every year, the CMS provides a list of eligible clinician types before the beginning of the MIPS performance year. These clinicians have to select their measures and then strive to meet certain criteria. This practice allows them to retain their MIPS eligibility throughout the PY. Mainly, clinicians’ Medicare billing and patient volume thresholds lay the foundation for eligibility criteria.
Well, that’s the simplest overview of MIPS reporting. It is equally meaningful for healthcare-related or non-healthcare-related people. But what if you are participating for the very first time in MIPS reporting? How will you cope with the MIPS 2023 reporting requirements? Above all, you must be familiar with the different MIPS terms.
Here in this blog, we will give you a brief introduction to all MIPS-related terminologies. Stay tuned with us!
According to the PFS final rule for MIPS PY 2023, the following types of clinicians must take part in reporting:
- Clinical social workers
- Certified nurse-midwives
- Occupational therapists
- Physician assistants (PAs)
- Nurse practitioners (NPs)
- Clinical nurse specialists (CNSs)
- Certified registered nurse anesthetists (CRNAs)
- Physicians (including doctors of optometry, osteopathy, medicine, dental surgery, dental medicine, and podiatric medicine)
- Physical therapists
- Occupational therapists
- Speech-language pathologists
- Registered dietitians or nutrition professionals
- Clinical psychologists
CMS revised its list of MIPS clinician types in FY 2022. At that time, it mandated MIPS reporting for clinical social workers and certified nurse-midwives. So, the MIPS program is new for them. They were not familiar with the intricacies yet.
CMS has not modified the clinician type list for 2023 PY. Yet, there may be many clinicians who are reporting MIPS for the very first time. For all such beginners, it is difficult to understand the MIPS requirements and their framework.
The first-time MIPS reporting experience for a practitioner might be very different. Typically, a clinician may have overwhelming and perplexing feelings when they first face MIPS. The complicated program requirements, nomenclature, and reporting methods terrify them. Meanwhile, the sheer volume of data and documentation can be daunting. It can ultimately result in fear and a feeling of doubt.
The first MIPS reporting experience of a clinician depends on two main things:
- Clinician’s familiarity with the program
- Readiness of their practice
Anyhow, keeping it in view, here we have unfolded details about the common terminologies of MIPS. After understanding the mysteries behind them, you might be able to get familiar with QPP MIPS at least.
- Collection Type
- Submission Type
- Submitter Type
Let’s explore each of them individually.
One of the MIPS reporting categories is quality. Clinicians choose their measures and report the data to CMS. The term “collection type” is specifically related to the quality category of MIPS. It is a sort of quality measure set with comparable specifications and data completeness requirements. The clinicians consider their practice’s capabilities and requirements before making a selection. They can either have one or multiple collection types for reporting quality measures.
Currently, there are six collection types for MIPS reporting.
They electronically assess the quality of care provided, such as through EHRs.
These are particularly for the evaluation of care quality and are specific to the MIPS program.
They require a MIPS-qualified registry for the collection and reporting of data.
These measures are particularly available for small practices.
These are available to groups, virtual groups, and APM entities with two or more clinicians. This measure is typically based on patient feedback.
For the evaluation of care quality, these measures utilize administrative data, such as billing and reimbursement information.
The method for the MIPS data submission to the CMS by submitter type is termed “submission type”. One thing that must be noted here is that there is no submission type for the cost category. Rather, the CMS calculates the cost score itself using administrative claims data.
Some available submission types for MIPS reporting are given as follows:
This entails sending information to CMS via computer-to-computer communication. Typically, we do so through application programming.
This approach requires submitters to log in to a specific platform. Then attach a file containing the data to be submitted.
After logging in, the data must be manually entered into the appropriate platform.
This particular submission type belongs to the cost performance category.
We use this term for MIPS participants eligible for MIPS reporting. They can be:
- Eligible clinicians
- Virtual groups
- APM entities
- Third-party intermediary
We hope this information will be very helpful for beginners. For further information and understanding, you can place your queries in the comment section. We can also assist all the providers in MIPS reporting as we are a qualified registry. We offer MIPS consulting services that will assist you in performing well and scoring high.