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MACRA MIPS, QPP MIPS, MIPS Reporting, MIPS program, MIPS data submission, MIPS Qualified Registry, MIPS consultants, MIPS solutions, How to Report MIPS Data, healthcare services, Promoting Interoperability

MACRA MIPS – What it Means for Physicians?

MACRA MIPS (The Medicare Access and CHIP Reauthorization Act of 2015 – Merit-based Incentive Payment System) is a program that caters to physician finances under Medicare. Not only that, but it determines the quality of care within hospitals, practices, and clinics should meet certain standards.

The program is now in its fifth year (started back in 2017) and it would be right to say that it facilitates the whole physician reimbursement process. MIPS 2020 submission is not rocket science; however, it requires a certain skill set to achieve good scores.

Key Elements of QPP MIPS

MIPS program has four categories that cater to meaningful quality healthcare services.

  • Quality
  • Improvement Activities (IA)
  • Promoting Interoperability (PI)
  • Cost

The quality category replaced the PQRS (Physician Quality Reporting System) and reflects the efforts to improve the quality of care.

Improvement activities translate patient convenience and satisfaction in quality healthcare delivery.

Promoting Interoperability replaced Advancing Care Information (previously known as the meaningful use program) to integrate technology in healthcare.

The cost category replaced the value-based modifier program and translates the efficiency of the cost factor.

Each category has different weights. The respective percentages change each year under MACRA MIPS. Eligible clinicians, who exceed the minimum performance threshold get positive payment adjustments and avoid a penalty of a certain percentage.

MIPS Full Form in Healthcare

Large medical practices already know the implications of MIPS data reporting. However, it is small healthcare organizations or non-eligible clinicians that need to understand MACRA MIPS to the core.

Now, the performance bar has gotten high. Although CMS (The Center for Medicare & Medicaid Services) facilitates small/rural/underprivileged medical practices to much extent, the appropriate approach is to consult a MIPS Qualified Registry for MIPS solutions.

What Physicians Can Get from MIPS Reporting?

There are many advantages that eligible physicians can get by submitting data to CMS under MACRA MIPS.

  1. Physicians get to improve care quality.
  2. They can improve ranking among fellow physicians via the Physician Compare portal, thus, improves patient rate.
  3. Against the exceptional performance, physicians can receive incentives.
  4. High achievers can even receive a share from the $500 million bonus pool.

However, MACRA MIPS requires consistent efforts, but practices could get help from MIPS consultants to guide them through the process. In case you are one of the practices with pending MIPS 2020 reporting, there is still time for you to submit until March 31, 2021.

Should Physicians Report Data Despite Corona Pandemic?

There are lots of benefits if MIPS eligible clinicians choose to report data despite hardships.

For instance, MIPS incentives and bonus pool worth $500 million are worth a try, and reputation on Physician’s Portal can help to improve patients’ volume. However, it all depends on how individual clinicians, groups, and virtual groups, report data to CMS.

The first rule is to deeply analyze your strengths and select MIPS Quality Measures that are most suitable for the medical practice. The more specialty-specific measures you report, the more chances you have for maximum points. Consequently, a smooth revenue cycle management is what you all get at the end of the reporting period.

How to Report MIPS Data?

Eligible clinicians can choose different ways to report MACRA MIPS. However, the easiest and comprehensive way is to report data via the MIPS Qualified Registry as P3Care.

We choose specialty-specific measures to submit data from the list as per the final rule proposed by CMS.

Conclusion

MIPS data submission under MACRA is a lot to take in, but as the years went by, it is in the best interests of physicians to attest to the quality payment program.

Especially with COVID, clinicians have lost millions of bucks to cater to the surge of patients. In such times, incentive payment programs are a ray of hope as they facilitate in many ways. Moreover, CMS also offered flexibility in the administrative load. So, there is no point in avoiding participation in such programs, right?

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QPP MIPS Payment Adjustments in 2020 and Beyond

CMS states up to ninety-eight percent of the participating clinicians received positive payments in 2020 for the fiscal year 2018. The rate is five percent higher than the previous year. In 2021, we will see an even greater number of participants receiving incentives for the fiscal year 2019. Moreover, the prediction indicator for MIPS 2020 reporting will reach record turnouts later in 2022. The more the merrier. Clinicians, across different submission types, will receive record amounts as positive payment adjustments and bonuses.

The trend of incentives and reimbursements is going to increase as the quality reporting is supposed to improve via MIPS Value Pathways (MVPs). In fact, MVPs are going to add to the momentum of MIPS quality reporting.

MVPs – A Chance to Succeed for Everyone

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In order to translate our medical expertise in the true sense, we must adopt MVPs. Small medical practices and medical facilities in rural areas irrespective of their operational size can earn rewards for rendered services. Seeing the numerous benefits of the MIPS program, rural medical facilities are participating more and more each year.  Statistics show that there was a rise of four percent in QPP MIPS participation from 2017 to 2018. However, the participation turnout for small and rural practices was much less than that of large practices.

The Report Card for MIPS 2018

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CMS published the results for MIPS 2018 participation. 889,995 eligible clinicians have reportedly received positive payment adjustment, and 872,148 of them have received neutral payment adjustment.

Seema Verma, CMS administrator was quite happy with the results as it depicts the higher number of physicians opting for quality healthcare delivery systems. The quality outcomes also credit the vision of empowered and cost-effective healthcare industry.

Despite the administrative burden, more and more participants succeed in the QPP MIPS. It is due to the lower performance thresholds, which ultimately reflect on payment adjustment. Moreover, CMS doesn’t want to jump up the positive payment adjustment, as it has to be balanced with the negative payment adjustments.

MIPS Future Holds Higher-Performance Thresholds

Generally, CMS increases thresholds for exceptional performance to reduce the reward distribution. Here, the strategy is to reward clinicians who continuously invest in the quality of healthcare and interoperability, and help patients to the best of their ability. The criterion gets tougher for them as there is a gradual increase in the performance threshold for penalties and bonuses.

Seema Verma hints at supporting clinicians by reducing the administrative burden and providing opportunities for meaningful services. The No-cost Small, Underserved, and Rural Support initiative tends to lend a hand with technical assistance for smooth and optimized performance in the healthcare sector.

This program also creates awareness about quality care and payment models along with helping eligible clinicians with participation in MIPS.

With continued research and taking into account what clinicians bring to the table, the future reporting criteria is estimated to only include a framework that flows without stressing physicians unnecessarily.

CMS also wants participants to give their feedback on MVPs. They are looking forward to advancements that help them drive value to the healthcare industry in terms of payment models, lower administrative burden, and positive patient outcomes.