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MIPS 2021 in healthcare leaves you with a great reputation besides incentives and bonuses. The only alternative to healthcare MIPS is the other track – Alternative Advanced Payment Models (APMs). Once you are eligible, you must submit MIPS in order to avoid a penalty – a few thousand dollars are cut from your Medicare reimbursement. For assistance with COVID and in general, Hardship exceptions apply, and practices in rural areas can take benefit from them accordingly.
Medicare Access and CHIP Reauthorization Act (MACRA) is bipartisan legislation turned into law on April 16, 2015. President Obama did the honors back then. Not only does it drive MIPS but everything that comes with it. That is indeed the power of MACRA.
MIPS 2021 reporting window is open until March 31, 2022, so you can submit data if it is still outstanding. The year 2021 is going to be the toughest year yet because CMS has increased the performance threshold score from 45 to 60 to avoid a penalty. After the success of QPP 2018, QPP 2019 and QPP 2020, P3, as a MIPS Qualified Registry, continues to report QPP 2021 on behalf of eligible clinicians and practices.
MIPS & MACRA function side by side. MIPS bases itself on quality, value, and accountability. As long as the purpose is met, eligible clinicians (ECs) have nothing to lose and everything to gain. In the end, MIPS incentives are there to provide the right impetus to your practice.
MIPS Performance Categories
Quality
Replaces PQRS
Promoting interoperability
Replaces MU
Improvement Activities
New Category
Cost
Replaces VBM
What is MACRA?
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 Quality Reporting Steps
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 MIPS appears well-directed, and purpose-driven if you ask us as health IT consultants. However, sometimes it doesn’t do justice to clinicians due to its reporting burden. Physician burnout happens as a result and goes to the credit of EHR and its burdening list of measures. Subsequently, 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.
Data Validation and Verification
MIPS data submission requires you to choose one of the collection types first. With us, clinicians get to choose MIPS CQMs (Clinical Quality Measures) to report ahead. Proper validation and verification of the measures to report have to happen to score above 75. That is where the incentives are, with bonuses to follow.
As a third-party intermediary, P3 follows tradition with excellence and submits on behalf of practices. You have an option to report CMS MIPS Quality measures as an individual or a group.
CMS recognizes registries and approves them year after year based on set standards criteria. On the whole, a MIPS consulting firm, which is also a registry, is your answer to care-free and accurate submissions. In this way, you do what you are meant to do, i.e., look after your patients.
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
How to Submit MIPS Data to CMS?
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
We primarily provide HIPAA medical billing services and MIPS consultancy, among other services. As your HIT consultant, we optimize providers’ performance for improved RCM.
3200 E Guasti Rd Suite 100, Ontario, CA 91761, United States
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