Merit-based Incentive Payment System (MIPS) reporting is a key component of the Quality Payment Program (QPP) introduced by the Centers for Medicare and Medicaid Services (CMS) in 2015. MIPS is designed to incentivize eligible clinicians to focus on improving the quality of care provided to Medicare beneficiaries, as well as promote interoperability and patient safety.
As healthcare professionals, it is important to understand the crucial components of MIPS reporting to optimize your practice and avoid negative payment adjustment. MIPS participation will not only improve patient care but also maximize the Medicare Part B payment.
What is MIPS Quality Reporting?
MIPS Quality Measures are the quantifiable standards used to measure the quality of care provided by healthcare providers. Quality measures can be either process-based or outcome-based, and they help to evaluate and improve health outcomes and patient satisfaction.
Category: Quality
In the Quality category, healthcare providers select six quality measures from nearly 300 measures to report their patient care quality. This measure takes into account the number of patients that are being treated and the type of care being provided. It also looks at patient outcomes and ensures that the care provided is meeting the specified benchmarks.
Category: Improvement Activities
It is important to note that providers are required to report on a certain number of activities, depending on their specialty. This measure is focused on activities that healthcare providers are undertaking to improve their practice, such as patient engagement, workforce development, and care coordination. H3: Category: Promoting Interoperability
The third MIPS quality measure is the promoting interoperability measure, which is designed to ensure that healthcare providers are effectively utilizing technology to promote high-quality care. This measure requires providers to demonstrate that they are using certified electronic health record technology (CEHRT) to promote patient engagement, share health information, and improve patient safety.
Category: Cost
The fourth MIPS quality measure is the cost measure, which is designed to ensure that healthcare providers are providing high-quality care, while avoiding excessive costs. Providers are measured against benchmarks to ensure they provide cost-effective care.
MIPS Performance Categories
MACRA, short for the Medicare Access and CHIP Reauthorization Act, has brought significant changes to healthcare reimbursement and quality reporting. Under MACRA, healthcare professionals must meet the requirements under the MIPS Performance Categories to avoid financial penalties and earn favorable reimbursement rates. With that said, what are MIPS Performance Categories?
Category: Quality Performance
The Quality Performance Category relies on the reporting of quality measures, which are usually clinical processes or outcomes that indicate the level of care provided by a healthcare professional. In this category, healthcare professionals must report at least six quality measures, including one outcome measure, covering different domains of care.
The challenge of this category is that each measure has its own benchmarks that healthcare providers need to meet or exceed. These benchmarks are not the same each year, so healthcare providers need to be updated with the latest benchmarks to improve their MIPS score.
Category Distribution of Promoting Interoperability Performance
The Promoting Interoperability Performance Category is another critical aspect of MIPS, which carries a weight of 25% of the total MIPS score. To fulfill this category successfully, healthcare providers must achieve a certain score by fulfilling a set of required measures. This category focuses on the use of certified electronic health record technology (CEHRT), which aims to improve interoperability and patient engagement while ensuring that the exchange of health information is secure and private.
Category Distribution of Improvement Activities Performance
The Improvement Activities Performance Category is a relatively new addition to the MIPS program. It aims to improve patient outcomes and patient experience of care with a weight of 15% of the total MIPS score. In this category, healthcare providers must participate in one or more activities from the defined set of activities that show their commitment to improving their clinical practices. Some of the activities in this category include enhancing care coordination, expanding practice access, or implementing a health information exchange.
Category Distribution of Cost Performance
This category is not required for participation as CMS will automatically calculate the score based on the Medicare claims data. It is up to healthcare providers to ensure that the care they provide is both cost-effective and of high quality.
MIPS APMs
An APM (Alternative Payment Model) is a payment approach that incentivizes providers to deliver high-quality, coordinated care. MIPS APMs combine these two programs, allowing providers to earn incentives for participating in innovative payment models.
MIPS APMs consist of a set of payment arrangements designed to reward providers for delivering high-quality, patient-centered care. These arrangements can include shared savings models, bundled payments, and other innovative approaches. To participate in a MIPS APM, providers must meet specific criteria, such as providing sufficient services to Medicare beneficiaries.
Benefits of participating in a MIPS APM?
Participating in a MIPS APM can provide numerous benefits to healthcare providers. For example, it can help improve patient outcomes by incentivizing providers to focus on high-quality care. Additionally, participating in a MIPS APM can potentially lead to increased revenue, as providers can earn incentives for meeting the program’s performance requirements.
How can I participate in a MIPS APM?
To participate in a MIPS APM, healthcare professionals should first research the various models and determine which one aligns with their practice structure and goals. They should then carefully review the program requirements and determine if they meet the necessary criteria. Finally, providers should work with their team to implement any necessary changes or improvements that will meet the program’s performance standards.
MIPS Payment Adjustments
The payment adjustment is calculated based on the Composite Performance Score (CPS) of the healthcare professional or group. The CPS is a percentage score ranging from 0 to 100 and is based on the performance of the four categories.
A positive payment adjustment means healthcare professionals receive additional “bonus” payments, while a negative adjustment indicates lower payments than expected. The positive payment adjustment can be as much as 9%, which can have a significant impact on the financial sustainability of a healthcare practice.
How Do I Avoid Negative Payment Adjustments?
To avoid receiving a negative adjustment, healthcare professionals must have a CPS above the MIPS performance threshold or minimum performance standard.
Negative payment adjustments can be averted by performance in the four performance categories. Thus, healthcare professionals should focus on delivering high-quality care, implementing improvement activities, promoting interoperability, and adopting cost-efficient measures.
MIPS Data Submission:
Eligible clinicians must report their data on an annual basis before the MIPS reporting deadline. The following are five collection types for MIPS data:
1. Electronic Clinical Quality Measures (eCQMs): eCQMs are tools used to assess and measure the quality of healthcare provided to patients. They are specified in a standardized electronic format that allows healthcare organizations to collect and report data from their electronic health records and other health information technology systems.
2. Clinical Quality Measures (CQMs): CQMs are tools used to assess various aspects of patient care, including observations, treatment, processes, patient experiences, and outcomes. These measures are designed to evaluate the quality and effectiveness of healthcare services provided to patients.
3. Qualified Clinical Data Registry (QCDR): A QCDR is a specific type of clinical data registry that collects, manages, and reports clinical data on healthcare services provided to patients.
4. Medicare Part B Claims Measures: Medicare Part B Claims Measures are specific quality measures that assess the quality of care provided to Medicare beneficiaries under Medicare Part B outpatient services, including physician services, outpatient hospital care, medical supplies, and other healthcare services not covered under Part A.
5. Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS Survey: CAHPS for MIPS Survey is a family of surveys developed by the Agency for Healthcare Research and Quality (AHRQ) to assess patients’ experiences with healthcare services, including those provided by physicians, healthcare facilities, and health plans.
Tips for Successful Reporting
By focusing on the quality category – as it has the biggest weight in the scoring system – you can improve your MIPS score. You also should choose measures that align with your clinical practice and ensure that they meet the reporting requirements.
Also, joining an Accountable Care Organization (ACO) has become increasingly popular in the context of MIPS. One of the main reasons healthcare providers are turning to ACOs is the financial incentives they provide, including taking on the risk of penalties. By working together in an ACO, providers can share in these rewards and achieve better performance scores than they would on their own.
Summary: What is MIPS Reporting?
As payment adjustments and measures for healthcare providers become increasingly performance-based, eligible clinicians should prioritize the vital components of MIPS as they try to enhance patient care quality. By focusing on quality measures, performance categories, APMs, and MIPS payment adjustments, clinicians are equipped to meet the expectations and requirements for MIPS reporting. Understanding these key components could lead to positive payment adjustments from CMS and offer higher quality care to patients.
How Healthcare Consultants Can Help with MIPS
Medical Advantage’s MIPS consultants have years of experience helping healthcare professionals navigate the complexities of MIPS reporting. We also invite providers to join our accountable care organization (ACO) for comprehensive support in various quality initiatives including MIPS. Contact us to learn more about how our services can support your practice and continue improving the quality of care for increased revenue.
