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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 physicians’ finances under Medicare.

The program is now in its fourth year, and it would not be wrong to say that it facilitated the physicians’ reimbursement process.

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 current PRQS (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 submission. 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. However, 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 quality care.
  2. They can improve ranking among fellow physicians via Physician 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 data submission requires consistent efforts and MIPS consultants to guide through the process.

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 rules proposed by CMS.

Conclusion

Data submission under MACRA MIPS is a lot to take in, but as the years went by, it is in the best interests of physicians to try to qualify for this quality payment program.

Especially with COVID, physicians have lost millions of bucks to cater to the surge of patients. In such times, incentive payment programs as MACRA MIPS prove to facilitate physician in any way possible. 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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MIPS Value Pathways, MIPS program, QPP MIPS, QPP 2020, MIPS 2020 CMS administrator, healthcare industry, healthcare sector

An Insight into QPP MIPS Payment Adjustments in 2020

CMS states that up to ninety-eight percent of the eligible clinicians are expected to receive positive payments in 2020 for the year MIPS 2018. The rate is five percent higher than the previous year.

In the upcoming year, the trend of incentives and reimbursements is going to increase as the quality reporting is supposed to improve via MIPS Value Pathways (MVPs). MVPs will be operational from next year.

MVPs – A Chance to Succeed for Everyone

MIPS Value Pathways, MIPS program, QPP MIPS, QPP 2020, MIPS 2020 CMS administrator, healthcare industry, healthcare sector

In order to translate practice’s 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 their 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.

The Report Card for MIPS 2018

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CMS has 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 is 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

CMS has planned to make higher thresholds for exceptional performance to reduce the reward distribution. They are working on a strategy to reward physicians who continuously invest in the quality of healthcare and interoperability, and help patients in many manners. This can be seen in the gradual increase in the performance bar for penalties and bonuses.

Seema Verma also hints on supporting clinicians via reducing the 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 the quality care and payment model along with helping eligible clinicians with participation in MIPS.

With the research and taking into account what physicians 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’ feedback on the MVPs’ developments. They are looking forward to advancements that help them drive value to the healthcare industry in terms of payment models, lower administrative burden, and cost-effective patient outcomes.