Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) has shared an authorized program for providers in the US. This program is not other than the Merit-based Incentive Payment System. Each year the Centre for Medicare and Medicaid Services gives a final rule with little modifications for implementation. The same goes for MIPS 2023 reporting requirements. MIPS is a program for the evaluation of patient care of a provider to give them rewards or penalties accordingly.
Nonetheless, one thing that is unchanged in every MIPS reporting year is its four categories. Each category measure may have several modifications. However, the main motto behind asking eligible clinicians to appear in MIPS program is to upgrade the care standard. Thus, MIPS reporting confines eligible clinicians to the practice of Medicare Part B professional services. If they can do so throughout the performance year, MIPS gives them an incentive as per the points of the MIPS score, they get.
Limiting our discussion to MIPS 2023, let’s see which reporting options MIPS-eligible clinicians have.
MIPS 2023 Eligibility and Requirements
As CMS has already informed in its previous preceding that they are going to start MVPs from the performance year 2023. Therefore, different modifications in MIPS programs are due to transitioning of MIPS to MVPs. Here are some particular points regarding the MIPS eligibility of participants.
- Like the past framework of the Traditional MIPS Program, clinicians still have four reporting categories: quality (30%), cost (30%), improvement activities (15%), and Promoting Interoperability (25%). Every participant will report data for 3 of 4 categories except the cost category. CMS will do this itself, if applicable.
- The performance of MIPS-eligible clinicians will be a MIPS final score-determining tool for CMS. Every participation type will get a final score ranging from 0 to 100 points.
- Next, the MIPS point will make a participant eligible for an incentive or penalty. MIPS payment adjustment year can give you negative, neutral, or positive reimbursements for their performance.
- For MIPS 2023, the eligible clinicians will get the payments for their Part B covered services in the CY 2025.
Available Reporting Option for MIPS Participation This Year
MIPS has provided its eligible clinician’s list before the start of PY 2023. Now, participants have to choose the MIPS reporting measure and reporting options. P3Care offers MIPS consulting services for this purpose. We can guide them in selecting the best measures to achieve a higher MIPS score. Anyhow, participants have three reporting options to fulfill their reporting requirements.
It is the conventional framework for every MIPS participant. They have been participating in the MIPS program since MIPS was implemented and initiated for the very first time. Anyhow, we must mention here that the MIPS program has been modified a lot in these years. Every MIPS-eligible participant first chooses their participation type; whether they want to participate as an individual, group, or virtual group. Later there is each category data via a selected collection type. It’s CMS that assigns the MIPS final score to every participant as per their performance outcomes.
Alternative Payment Model (MIPS APM)
It is another reporting option for MIPS reporting. A participant can appear in MIPS 2023 as a MIPS APM entity as well. The MIPS program was suffering a lot due to the huge reporting burden. Many participants were enrolling in the MIPS program. Also, MIPS has gone through several changes to support the higher patient-care standards in healthcare. So, QPP has introduced another pathway for all MIPS participants. As a MIPS APM entity, every participant has to report a predetermined set of quality measures. Alongside, they will also submit data for promoting interoperability measure sets just like the Traditional MIPS framework. However, improvement activities category data is examined yearly.
MIPS Value Pathways (MVPs)
It is a relatively advanced reporting option for MIPS participants. This option is available for participants from MIPS 2023 performance year. CMS has decided to alternate Traditional MIPS with MVPs in upcoming years. So, MVPs offer a measure set according to a specialty or medical condition. It provides a more streamlined grouping for all activities and measures for a connective approach to quality care. For MVPs, participants will choose, gather, and report on fewer quality measurements and improvement actions (as compared to traditional MIPS). Additionally, they will report the entire set of measures for promoting interoperability (the same as reported in traditional MIPS). For your benefit, CMS will gather and compute the data for the cost performance category and population health metrics.
That’s all about reporting pathways for MIPS 2023. Every participant is welcome to choose their reporting option at their convenience. As a MIPS-qualified registry, P3Care can give you MIPS consulting service to get the best participation score for any reporting option you will pick.