Understanding MIPS and Its Importance in Value-Based Healthcare
Efforts for Success in MIPS 2018
Providing value-based healthcare services and maintaining a penalty-free status in the MIPS program for 2018 demands significant effort. However, with strategic planning, physicians can earn incentives and bonuses from this initiative. A thorough understanding of the MIPS program and accurate reporting of MIPS quality measures can enhance the likelihood of receiving favorable payment rates from CMS. Clarifying any misconceptions about MIPS is essential to avoid complications in the future.
FAQs About MIPS
Is Avoiding Penalties Enough in MIPS?
In 2018, the second operational year of MIPS, the minimum penalty threshold was set at 15%. This threshold is projected to increase in upcoming years due to more stringent reporting requirements. Achieving 70 MIPS points is essential to qualify for incentives. Physicians who surpass this score may become eligible for a bonus pool of $500 million. High-scoring physicians gain recognition, with endorsements from reputable authorities such as Medicare, AARP, and CMS, which bolsters their reputation in the healthcare sector. Therefore, focusing on incentives rather than merely avoiding penalties can lead to greater success.
Can Physicians Still Participate in MIPS Without EHR Technology?
Physicians not utilizing the 2014 version of EHR technology may miss out on points for Advancing Care Information (ACI), now referred to as Promoting Interoperability (PI). To maximize scores, physicians can still benefit from MIPS quality measures related to Quality and Improvement Activities (IA).
Does Reporting Data for Over 90 Days Improve MIPS Scores?
Physicians may opt to report clinical data for 90 days or extend up to 12 months. However, the results are based solely on the performance demonstrated throughout the performance year. It is advisable to select a reporting period that aligns with your needs and enhances your score.
Should Physicians Report as a Group or Individually?
Both group and individual reporting have their advantages. When reporting as a group, all physicians share the same payment rate. In contrast, individual clinicians receive their own payment rate. The choice between these methods should be based on which approach yields greater revenue. Additionally, physicians with a low-volume threshold will be considered part of a group rather than as individuals. In multi-specialty groups, it is essential to select measures that align with the specific specialties of the practice.
Are There Exclusions for MIPS Participation?
Yes, physicians may be excluded from MIPS participation under certain conditions:
– Medicare allowable payments are less than $30,000 or if there are fewer than 100 Medicare patients within a 12-month period.
– The healthcare provider is already engaged in a Medicare Advanced APM.
– Hospital-based providers are exempt from the ACI (MU) category, with 25% of that category’s weight reallocated to the Quality category, increasing its significance to 85% in the final MIPS scorecard.
What Happens if a Physician Changes Medical Practices During the Payment Year?
A physician’s MIPS score is transferable. If a physician transitions to a new practice, the score is determined by data reported in the previous year, regardless of the new medical practice. If a physician works at two different practices within the same year, the payment rate under the new TIN (Tax Identification Number) will be based on the higher score from either practice.
What Should Physicians Consider When Selecting MIPS Quality Measures?
Selecting appropriate MIPS measures tailored to your practice can be challenging. It is crucial to consider the following:
– There are 250 quality measures and five MIPS submission methods, with some measures applicable only to specific reporting methods.
– Avoid reporting measures with fewer than 20 eligible cases, as these will score only 3 points.
– Each reporting method has its own benchmark; understanding these benchmarks is vital. For instance, the same measure may exhibit a lower benchmark when reported through a qualified registry compared to EHR technology.
Conclusion
The information presented addresses common questions surrounding MIPS and aims to dispel any misconceptions that may impede physician success. For further details on MIPS and its reporting services, please visit our LinkedIn page at https://www.linkedin.com/company/p3-healthcare-solutions.