The 10 Top MIPS Resources in 2020

Ashley Tuley, Quality Improvement Advisor Healthcare Consulting

With the COVID-19 pandemic continuing to cast uncertainty over our industry and beyond, it has never been more critical for value-based healthcare providers to maximize their reimbursements through the federal Merit-based Incentive Payment System program, or MIPS.

But despite the availability of significant MIPS monetary reimbursements, confusion about the reporting process prevents many providers from being reimbursed as well as they could be: yearly changes to eligibility and reporting measures, vast systemic disruptions caused by COVID-19, and the day-to-day time constraints of running a practice have all made it difficult to stay on top of reporting effectively. That is why Medical Advantage has compiled 10 of the best online resources to help you maximize your MIPS score– and your financial reimbursements.

1. MIPS Eligibility Status

It is important to check on your MIPS eligibility status, as it can vary from year to year. CMS has made this easy with a user-friendly website which allows you to check your eligibility by provider NPI number. Your search results will tell you whether you meet the low-volume threshold at both the individual and group levels, whether you have any APM associations, and if you meet the criteria for any special statuses which might impact your reporting or scoring. It also has a new feature allowing you to view any hardship application approvals. Eligibility status is updated every year around mid-November; we highly recommend reviewing eligibility status for all providers at least once a year.

2. Quality Measure Specifications

Understanding the numerator and denominator criteria for your chosen measures is crucial to improving performance. This file includes the claims and registry specifications for all MIPS measures.

*Note: Clicking this link will automatically download a zip file from the QPP website with multiple files, one for each measure. The files are named according to the Quality ID number, rather than measure name, so you may need to reference the QPP.CMS.GOV MIPS Quality page to find the corresponding ID for your measures.

3. Quality Benchmarks

You will earn 3-10 points for every MIPS quality measure you submit, based on your performance against national benchmarks. This Excel spreadsheet lists the decile scoring for each quality measure that currently has a benchmark. Use this tool to estimate your MIPS quality measure score based on current performance, and select your 6-12 highest-scoring measures for final submission at the end of the year. The spreadsheet will also indicate any topped-out measures that may have a 7-point cap.

*Note: Clicking this link will automatically download a zip file from the QPP website with a few related files. The one you need is called 2020 MIPS Historical Quality Benchmarks.

4. List of Qualified Clinical Data Registries (QCDR)

A Qualified Clinical Data Registry (QCDR) is like a Qualified Registry, except that a QCDR usually collects and reports data only for a specific specialty, condition, or patient population. Some specialty associations include the cost to use their registry in your yearly dues. In addition, QCDRs sometimes have specialty-specific measures available to choose from that are not available from regular registries or from your EHR, making this option a helpful resource for specialty practices looking to boost their MIPS score. This link leads to a list of all approved MIPS QCDRs.

*Note: Clicking this link will automatically download an Excel file from the QPP website.

5. eCQM specifications

If you are using an EHR to track and report your MIPS quality measures, check out this list of specifications EHR vendors use to calculate your numerators and denominators. While using this site, make sure to select the appropriate performance period before searching for a measure. Information about each measure can be accessed by clicking on the measure’s hyperlink.

6. MIPS 2020 Promoting Interoperability Measure Specifications

This zip file is a great reference to keep handy as you tackle the Promoting Interoperability measures. The specifications include definitions for applicable terms, numerator and denominator requirements, exclusion options, and useful tips to help you make sense of the measures under the Promoting Interoperability umbrella.

*Note: Clicking on this link will automatically download a file from the QPP website.

7. MIPS Data Validation Criteria

This resource contains information related to meeting measures in the Improvement Activity and Promoting Interoperability categories. Most importantly, it offers suggested documents for these measures to have on hand in case of an audit.

*Note: Clicking on this link will automatically download a zip file from the QPP website which contains several related files.

8. Technical Assistance Support Contact Information

Through partnerships with local organizations, CMS offers free, direct MACRA assistance for providers and practices in small, rural, or underserved areas. This page on the QPP portal can help you find the partner assigned to your area.

9. The Payment Reform Glossary

A simple but useful tool: if you are drowning in the acronyms and jargon related to MACRA, this comprehensive but easy-to-use reference is a lifesaver.

10. 2021 Proposed Rule Fact Sheet

Finally, if you feel that you have MIPS under control for 2020, but want to start preparing for next year, check out this summary of proposed changes for 2021. Just remember that these changes have not yet been finalized– the final rule for 2021 will be out at the end of 2020.

*Note: Clicking on this link will automatically download a file from the QPP website.

If you are having trouble successfully navigating the MIPS program, Medical Advantage offers a host of services and resources including MIPS consultants who understand MACRA and industry best practices. Let our experts help guide you through the process to maximize your incentive opportunities, avoid penalties, and help you run a more efficient and profitable practice.

Talk to one of our MACRA experts today