MIPS in healthcare doesn’t leave you with many alternatives except for Alternative Advanced Payment Models (APMs). Therefore, clinicians, once they are eligible, have to go through MIPS reporting whether they like it or not. Hardship exceptions and practices in rural areas are allowed certain flexibility accordingly.
Medicare ACCESS and CHIP Reauthorization Act (MACRA) as seen in the image below represents the powerful functioning of MIPS under the Quality Payment Program (QPP). After the successful run of QPP 2018 and QPP 2019, we have QPP 2020 to look ahead, and so far, we have persevered enough to start it on a high note.
MIPS Performance Categories
Quality
Replaces PQRS
Promoting interoperability
Replaces MU
Improvement Activities
New Category
Cost
Replaces VBM
MACRA & MIPS: Value-based Care Implementation in the US Healthcare Industry
MACRA is the law that governs several programs, and the QPP is no exception. QPP combines the Physician Quality Reporting System (PQRS), the Value-based Modifier (VBM) and Medicare Electronic Health Record (EHR) program into one program that we know as the Merit-based Incentive Payment System (MIPS). Thus, allowing MACRA & MIPS to be inseparable.
Value-based care navigates through the veins of the healthcare system via the MIPS program. Centers for Medicare and Medicaid Services (CMS) defines MACRA as an enactment of the new payment order that rewards clinicians for demonstrating better care instead of looking after more patients.
Furthermore, MIPS suggests clinicians perform in four performance categories such as Quality, Promoting Interoperability (PI), Improvement Activities (IA) and Cost. A high MIPS final score depends on all of them as each category has measures to support and report. MIPS Quality measures are the common factor as they are similar in number (usually six) for practices.
TAKING A TRIP DOWN MEMORY LANE
MIPS PERFORMANCE YEAR 2017
MIPS PERFORMANCE YEAR 2018
Fee for Service to Pay for Performance
Department of Health and Human Services (DHHS) is responsible for the implementation of the MIPS program. As one of the MIPS submission methods is through a Qualified Registry, it gives us immense pleasure to be of value to the system, and doctors across various specialties. Not only do the doctors but clinicians across the board help us help them report MIPS to the CMS
As mentioned in the heading, US healthcare gradually moves from fee-for-service payment model to the pay-for-performance model. It is the value-based reimbursement model, a dire need of the hour for the end-users, the patients.
Healthcare via MIPS appears well-directed, and purpose-driven if you ask me as a health IT enthusiast. However, sometimes it doesn’t do justice to clinicians at large due to its reporting burden. Physician burnout happens as a result and goes to the credit of EHR and its burdening list of measures. CMS has removed some of the measures in MIPS 2019 as an effort to reduce some stress.
MIPS for Eligible Clinicians
Since each of the MIPS performance categories has to undergo reporting for a specific period, P3 Healthcare Solutions, Ontario, CA knows what it takes to report them. We are not only a medical billing service but have undergone PQRS successfully in the past before 2017.
As a plastic surgeon, dentist, orthopedic, pediatric, family medicine physician, physical therapist, urologist, psychiatrist, ophthalmologist, nephrologist, neurologist, pain specialist, optometrist, gastroenterologist, cardiologist, chiropractic, pathologist, cardiothoracic surgeon, radiologist, physiologist, gynecologist, obstetrician, rheumatologist, endocrinologist, and public health specialist, reporting MIPS is the easiest through a MIPS Qualified Registry such as ours.
MIPS 2019 Specifications
• Quality and Cost performance categories are to be reported over a 12-month period
• Improvement Activities (IA) and Promoting Interoperability (PI) performance categories for continuous 90 days
• Deadline for submitting MIPS 2019 reporting is March 31, 2020
• CMS provides performance feedback to 2019 participating clinicians in 2020
• MIPS payment adjustments (positive, negative or neutral) are applied to each claim: starts January 1, 2021
Final Score Calculation Chart According to Category Weights – An Example
Clinician-Friendly Packages
As a MIPS Qualified Registry, we have come up with three packages to cover every reward that is out there in the name of this program.
- MIPS Essential – Avoid penalty
- MIPS Budget-Neutral – Avoid penalty and earn up to 3”x” incentives
- Benchmark MIPS – Avoid penalty, earn up to 3”x” incentives, and become eligible for bonuses out of the $500 million pool
MIPS Reporting Step by Step
Step 1
A health IT expert spends 30 minutes with you on the phone to understand the clinical workflow and requirements
Step 2
Shortlisting measures and informing the practice manager of the reporting activity
Step 3
We take care of the Cost component making sure no workload is on your practice.
Step 4
Self-educating ourselves through feedback based on TIN level QRUR reports
Step 5
Regular reporting of updates in terms of compliance and CMS reporting criteria
P3 provides medical billing services and activates the revenue cycle management (RCM) process for practices in the US.
Address:
3200 E Guasti Rd Suite 100, Ontario, CA 91761, United States
E: info@p3care.com
