2018 has been a revolutionary year for MIPS in healthcare. MIPS has faced much criticism as physicians were not comfortable with its payment model. The minimum threshold for a penalty-less spot was unacceptable for many clinicians, as it didn’t seem to bring any improvement in the healthcare industry in any manner. Physicians only worried about saving themselves from negative adjustments and that’s just it.
CMS replaced prior MIPS reporting rules with the new ones to address such reservations and to benefit physicians and the healthcare industry’s growth.
Apart from the changes in the percentages of the performance categories, the changes that CMS proposed for MIPS quality measure reporting; let’s look at them and analyze how we can target incentives and bonuses instead of just worrying about penalties.
Virtual Group Participation is now LEGAL
- This year, a terrific advancement is seen in MIPS reporting guidelines as CMS is offering virtual group participation.
- Virtual groups should consist of solo practitioners and an eligible group of 10 or fewer clinicians. They should work together VIRTUALLY for the MIPS performance year.
- Generally, the participants in a virtual group report against all four performance quality measures and meet all reporting standards same as any non-virtual MIPS group would.
Requirement for a Virtual Participating Group
- Groups and solo medical practitioners who want to participate, as a virtual group needs to go through an election process.
- The election process must end before the performance year and can’t change in-between. For Example, election date for MIPS 2018 was from October 11- December 31st, 2017.
Low-Patient Threshold Update
Low-Patient threshold has been increased to exclude individual clinicians or groups with less than or equal to $90,000 in Part B allowed charges or less than or equal to 200 Part B beneficiaries. It is done in the determination period or during or prior to the performance year.
Bonuses for Care Services of Complex Patients
CMS grants 5 points as a bonus to the final MIPS scorecard by adding average Hierarchical Conditions Category (HCC) risk factor. The information is based on the complexity of the medical condition of the patient.
MIPS Favors Small Healthcare Practices
When small medical practices either individually or as a group submits data on at least one performance category, they get an additional 5 points in their final MIPS score. Thus, MIPS 2018 understands struggles that small medical practices go through and is trying to uplift such practices by favoring them.
Submit Hardship Exception Application for Extreme Cases & Save Yourself from Penalty
If the eligible clinician doesn’t use CEHRT- Certified EHR Technology, due to uncontrollable circumstances, for instance; natural disaster, he can submit Hardship Exception Application for reweighting Advancing Care Information (ACA) performance category. It increases the percentage of other remaining categories in the final MIPS score.
An update in this regard is that 31st December 2018 is the last date for hardship application submission.
According to CMS estimation, around 572,000 clinicians will participate for MIPS 2018 reporting. They also propose that clinicians will receive approximately $173million as positive payment adjustments via MIPS consulting services. So, why not report clinical data to CMS, the way it wants and get more payment incentive than expected.
The threshold for Penalty-Less Spot has increased
In its first year, keeping yourself safe was just a matter of three points. Now, the bar has been raised to at least 15 points. This way, clinicians have improved their care standards drastically and the overall pace of the healthcare industry improved.
Keeping track of all the changes is surely hectic for the clinicians; therefore, consulting a MIPS qualified registry becomes a necessity. P3Care has a distinguished name as a professional MIPS consulting service.
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