CMS modifies the rule to some extent and even revises the adjustment ratio with time. For MIPS 2023, the eligible clinicians have to attain 75 points to be in a safe spot. Likewise, points lower and higher than 75 will result in up to 9% of the payment adjustment. CMS has upgraded the hardship level for participants in MIPS 2023, raising the adjustment ratio from 7 to 9. The fear of receiving a penalty destroys the peace of mind of MIPS participants.
Therefore, we need a practical approach to prevent penalties in MIPS 2023. We came up with a helpful blog to guide healthcare providers in their MIPS 2023 reporting. Today’s blog is a brief guide for them to secure every penny of their Medicare revenue from MIPS penalties.
Medical practices generate their revenue by rendering devoted services to patients. However, a significant portion of their practice revenue comes from Medicare patients. Here comes the role of MIPS reporting on the financial management of your medical practice. The MIPS reporting framework of QPP impacts providers’ Medicare payment adjustments.
It offers payment adjustments to providers using its complex point-scoring system. MIPS requires eligible clinicians to report their Medicare Part B claims. That’s how they reflect the care standards they are practicing in their facilities. It covers every aspect, from quality to improvement activities to promoting interoperability. Later, CMS assigns a score for reporting each of these category measures. Basically, CMS accesses the clinicians’ performance in MIPS by doing so.
Every year, CMS determines providers’ fates via its point-scoring system. Combining the scores from its four performance categories, it determines the MIPS final scores. Later, the clinicians receive payment adjustments in the form of bonuses or penalties.
Not only does MIPS reporting give penalties for bad performance, but it also gives a bonus for performing well. So, if you’re confident enough about your secure spot in MIPS, you can plan to perform extraordinarily. In short, by reflecting excellence in your MIPS reporting, you can get up to 9% positive adjustments.
Now consider that your practice earns $10 million annually, of which 30% is your Medicare revenue.
Now, do some quick math and find the value for the negative adjustment of 9% on that 30%. It will be a 2.7% loss, equal to a $270K loss in annual revenue. It is the large amount of revenue that practices can’t lose so easily.
That’s why healthcare practices need a practical approach to perform well in MIPS 2023.
QPP MIPS is your trusted MIPS-qualified registry with unparalleled MIPS consulting services. Like MIPS 2022, our MIPS consulting services are here for MIPS 2023 as well. Also, use this guide as a practical approach to improving your MIPS 2023 score.
Get ready to boost your MIPS performance with best practices.
Through Improvement Activities, eligible clinicians can score a maximum of 15 points in MIPS 2023. Comparatively to other performance categories, the IAs category awards minimum points to clinicians. Yet, these points have a significant role in determining the overall MIPS 2023 final score. We can consider IA the lowest-hanging fruit in MIPS. CMS has allocated only 15 points because this category is under the direct control of physicians. Thereby, you can get a maximum of 15 points by fulfilling the data completeness requirements. Here are some best practices for doing so:
- Use a clinical decision support system (CDSS).
- Implement a PDMP (prescription drug monitoring program).
- Put referral tracking into practice and raise your ratio of closed referral loops.
- Work on increasing patient access, such as through foster telehealth services, etc.
- Use 2015 Edition Cures Update-certified EHR technology to collect patient data.
This category is worth 25 points in the MIPS 2023 final score. The simplest and finest method of getting maximum MIPS points in PI is the adoption of the EHR system. The EHR system has the built-in function of improving the interoperability standard.
Cost is a difficult category, but it is not unbridgeable. You can simply focus on lowering the total cost of patient care to achieve at least 10 out of 30. Depending on your specialty and the treatments offered, your strategy may include after-hours or telemedicine care. It will reduce ER visits. Likewise, you can adopt less expensive treatments that produce results on par with more expensive ones.
MIPS quality measure reporting is worth 30% of final scores. You can simply target to get a maximum score using customizable software. Thereby, you can conveniently improve your MIPS scores. Usually, clinicians prefer reporting 6 to 8 easily reportable measures. Instead, they can choose those measures that will get them a maximum score with less effort. Look, it’s so simple. Consider that you have one measure that gives you 1 or 2 points. Whereas, you have another measure that will get you 5 points with a little effort. Which one is better? Obviously, wise ones will go with the measure offering 5 points. Also, research and choose the most suitable quality measures for your specialty. And if you have multiple sub-specialties, aim for measures that encompass the full range.
The ultimate impact of MIPS reporting on provider payments convinces us that the MIPS score is a problem worth solving. QPP MIPS has therefore identified some best practices that any participant can adopt for fine performance in MIPS 2023. For more strategic solutions and guidance, take advantage of our MIPS consulting services. We are eager to facilitate providers in their MIPS 2023 reporting.