Providing value-based healthcare services to patients and having a penalty-less spot in MIPS 2018 requires great effort. However, if strategize properly, physicians can get themselves incentives and bonuses from this program.
Knowing the MIPS program better and accordingly report MIPS quality measures to increase your chances of payment rate from CMS. Therefore, it is always the best to resolve any misconception that might disturb later.
Given below are some of the important FAQs about MIPS that might answer your MIPS queries.
Is saving from penalties in MIPS is not enough?
2018 was the second operational year of MIPS and the minimum threshold for penalties was 15%. This bar is expected to rise in the coming years with strict reporting criteria.
70 MIPS points are the threshold set to get incentives. However, when achieved score higher than that, physicians can qualify for the bonus pool of $500 million. Physicians’ score is displayed on website www.medicare.gov/physiciancompare. The high scorer physicians get an extreme reputation and well-renowned authorities like Medicare, AARP, and CMS endorse them as a brand in the healthcare industry.
Thus, targeting incentives rather than just aiming for a penalty-less spot can open success gateways.
If physicians are still eligible for MIPS, when not using EHR technology?
If you don’t use the 2014 version of EHR technology, physicians may not be able to earn points for Advancing Care Information (ACI), now known as Promoting Interoperability (PI). For maximizing your score, physicians can earn from MIPS quality measures of Quality and Improvement Activities (IA).
Does reporting data for more than 90 days increases chances of getting higher MIPS score?
Physicians can choose to report clinical data for 90 days or more for up to 12 months. However, your result is solely based on the performance you showed throughout the performance year.
Thus, choose report for the period that best suits your requirements and helps to increase the score.
What is the best practice, reporting as a group or an individual clinician?
Both practices benefit clinicians in their own manner so before deciding the best approach, consider the following points.
- While reporting data to CMS in a group, all physicians will have the same payment rate. However, as an individual clinician, you’ll get your own payment rate. You have to decide which practice will benefit in more revenue generation.
- Moreover, if any physician has a low-volume threshold, he will not be considered as an individual but as a member of the group.
- In a multi-specialty group, some providers may find measures that are suitable for their practice, and conversely, they may not be suitable for others’ practice. In such cases, you have to choose measures that suit the single specialty of the medical practice.
Is there any exclusion for MIPS?
YES! Physicians are only excluded from the participation of MIPS when,
Medicare allowable is less than $30,000 or less than 100 Medicare patients in 12 months
The healthcare service provider is already a participant of Medicare Advanced APM
Hospital-based healthcare providers are exempted from ACI (MU) category. For them, 25% weight of this category is reassigned to Quality category making its worth to 85% in the final MIPS scorecard
What happens when a physician moves to another medical practice in the payment year?
MIPS score moves with the physician. Even, if you have moved to a new working place, your score will be based on the data reported in the last year, no matter what the medical practice is.
When you work in two different medical practices in the same year, your payment rate under the new TIN (Tax Identification Number) will base on the higher score among both.
What factors should be in mind while selecting MIPS Quality Measures?
Choosing the right MIPS measures, according to your practice is a difficult task so research properly about the following points.
There are 250 quality measures and 5 MIPS submission methods and some quality measures are only available for specific reporting methods, so how will you collect data and report to CMS?
Never report for a measure that has less than 20 eligible cases or no benchmark will receive 3 points.
Each reporting method has its own benchmark; thus, determine score by using the correct benchmark. For Example,
The same measure may have less benchmark when reported via a qualified registry as compared to EHR technology.
Above-mentioned points are the most frequently asked questions (FAQs). This article is all about clarifying those misconceptions, which may confuse physicians and block their way of success.
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