QPP MIPS was created with the goals of reducing healthcare costs, improving care processes and health outcomes, increasing the use of healthcare information, and tying compensation to high-quality, cost-effective care. It’s very important for healthcare providers. They need to participate in it to get a good score. Read to learn about it more.
MIPS Is an Important Program
MIPS seems like an overwhelming program. This commitment is a yearlong event, and the charting burden seems never-ending. Every year, the criteria change, and she is becoming herder. On the other hand, participation in QPP MIPS is compulsory for physicians. So, even a few missed steps can cause a huge problem.
But not all doom is gloom. With some organization and attention to detail, clinicians can nab bonus pay and also apply for qualifying exemptions, and avoid penalties. When the right step can turn the harsh 9% penalty into a 9% bonus, then it is fair to say those steps are worth taking.
What Is MIPS According to CMS and What’s Its Purpose?
MIPS is an abbreviation of Merit-Based Incentive Payment System. It is a point-based payment program that either rewards or penalizes Medicare Part B eligible clinicians for providing higher-quality care to their patients. The Centers for Medicare and Medicaid Services (CMS) runs MIPS under the Medicare program.
CMS every year scores clinicians on a 100-point system across a few categories and then generates a Composite Performance Score. Based on this final score, CMS has adjusted payment for Medicare Services.
The main goal of MIPS in the healthcare industry is to compensate physicians for performance and value rather than just for service. It’s an effort to change business as usual and encourage patient first focus and then treatment outcomes without the fear of payment
Should You Focus on MIPS 2022?
The success of MIPS is very important for the physicians who will bill Medicare in high volume. It takes a lot of time and effort, but those who score well can earn a higher rate for Medicare services. A high MIPS score might make the difference between squeaking by and thriving in the healthcare industry, where margins are already razor-thin. In other words, it is worthwhile. All the physicians should focus on MIPS, as it’s the major program for their growth and success. Getting positive payment reimbursement and a higher score will be very beneficial for the clinicians, as they will be scored on their performance, so if they perform well, they will get a good score.
Who is Eligible to Participate in MIPS 2022?
MIPS is limited to certain types of clinicians. To be eligible for QPP MIPS, they must first be approved to bill Medicare Part B covered services and meet the low-volume threshold. Some of the eligible clinicians include:
- Physicians
- Physician Assistants
- Clinical Psychologists
- Nurse Practitioners
- Registered Dietitians
- Certified Nurse-midwives
- Physical Therapists
Exemptions
A clinician is exempt from QPP MIPS reporting for the first year if they first signed up for Medicare in January 2022. The Advanced APM track may also exempt anyone who attains Qualified Alternative Payment Model (APM) Participant status. They must: to obtain this status:
- Obtain 50% of Medicare Part B payments or
- Advanced APM is used by 35% of Medicare patients.
How Is MIPS Measured?
Measures in four categories, each with a distinct weight, make up a MIPS score. Although the score changes throughout the year, physicians should aim for a final score of 75 points or better in 2022. This is the cutoff point for avoiding a severe financial penalty.
What Is Meant by MIPS Measures?
There are four categories of MIPS to track: Quality, Cost, Improvement Activities, and Promoting Interoperability. Each of them has a variety of measures except the cost score. CMS calculates these from Medicare claims and matches them against the benchmark.
From a list of 200 options, clinicians can select up to 15 MIPS Quality Measures and must report on them in at least 70% of cases. Many groups select between eight and ten to allow for better performance in some metrics than others because the top six are automatically rated.
Clinicians select two to four patient safety and coordination-related tasks from the Improvement Activities category to report on for 90 days in a row.
Promoting Interoperability metrics consider how effectively a practitioner communicates and interacts with patients. The score is based on MIPS metrics, which include things like e-prescribing and giving patients access to their medical records. A 90-day reporting period is also needed.
How Can You Calculate Your MIPS Score?
The composite performance score is a maximum of 100 points, and the final MIPS score depends on the points a clinician accrues in each of the categories. CMS weights each category differently.
- Quality: 30%
- Cost: 30%
- Improvement Activities: 15%
- Promoting Interoperability: 25%
What Is the Risk and Benefits of MIPS Score?
Concentrating on the MIPS score might be worthwhile. A clinician’s Medicare payment rate is affected by the final MIPS score; therefore, a successful year results in up to 9% more bonus pay for physicians.
On the other hand, individuals who perform poorly suffer serious financial consequences. For 2022, CMS made two updates that will have a big impact on payments:
1. A minimum final score of 75 MIPS points must be obtained by each clinician. They will automatically get a -9% penalty adjustment on payments in 2024 if they fall short of 75 points.
2. CMS will automatically reduce compensation for 2024 by 9% if an eligible doctor doesn’t participate.
For most businesses, but especially for physicians, a 9% annual penalty is a steep price to pay. MIPS can have a significant negative impact on profits.
End Note
Monitoring performance over the entire year is one of the best approaches to earning high ratings in the QPP MIPS program. Clinicians can easily reduce reporting time and track performance against MIPS benchmarks with EHR software. Finding strategies to improve these categories can have a big impact on scoring because interoperability and charting account for 25% and 30% of the MIPS score, respectively.
