What Is MIPS? A Complete Guide for Healthcare Professionals
What does MIPS stand for? Whether you are new to healthcare billing, or your clinic has moved toward seeing primarily senior citizens, it’s important to know the answer to this question.
This article provides background information on MIPS, a Medicare payment model. You’ll learn about the performance categories used in MIPS and how they affect payment calculations.
You’ll also get important information about upcoming changes to MIPS for 2024. The post ends with valuable tips on how to improve reporting to maximize payments, allowing you to better focus on serving patients.
NEED HELP WITH MIPS? Get started with MIPS Assist
What Does MIPS Stand For?
The acronym MIPS stands for Merit-Based Incentive Payment System. It’s one of the payment models used by the US federal government for clinicians who work with Medicare patients.
It was created by the Centers for Medicare and Medicaid Services (CMS). MIPS was originally part of a larger set of initiatives under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MIPS incentivizes better performance in the Medicare category and rewards providers with payment increases. Physicians who do not meet predetermined standards, however, can get reduced payments.
This QPP, or Quality Payment Program, was designed to both reduce the cost of Medicare healthcare delivery and improve its quality. It does this by rewarding best practices and penalizing actions determined to be wasteful—typically redundant and, therefore, not necessary healthcare practices.
FROM ONE OF OUR PARTNERS: How Healthcare Practices Are Saving Money with Technology
Key Components of MIPS
The MIPS program consists of four key categories that doctors are measured on. Each category is scored individually as part of a total MIPS score assigned by CMS. That total score determines the reimbursement amount you’ll receive for all claims under Medicare Part B.
It’s worth noting that the reporting option you choose may affect how you satisfy the MIPS requirements. Currently, there are three reporting options:
- MIPS Value Pathways (MVPs)
- Traditional MIPS
- APM (Alternate Payment Model) Performance Pathway (APP)
Be aware that the Traditional MIPS reporting option will be sunset in a few years.
Quality
Professional performance measures were created by CMS, with the assistance of various medical groups and related parties.
The metrics they came up with allow CMS to assess the quality of care delivered. In this quality category, they’re looking at both processes and outcomes.
Improvement Activities
This column looks at different ways care can be improved, including:
- Care processes
- Patient engagement
- Better access to care
As a reminder, one of the driving forces behind MIPS was to improve care quality in a cost-effective manner.
Promoting Interoperability
This category was created mainly to encourage patient engagement. It focuses on the use of new developments in certified electronic health record technology (CEHRT). It’s part of a larger initiative to boost the appropriate exchange of patient health information. Electronic medical records are a major part of this initiative.
Cost
This section examines the cost of healthcare to patients as determined by the reporting physician. CMS is always looking for ways to provide cost-effective care that doesn’t sacrifice quality.
FROM ONE OF OUR PARTNERS: Do You Know How to Increase Patient Satisfaction
Scoring and Payment Adjustments
It’s vital to understand MIPS scoring and payment adjustments. This is especially true for small clinics and independent physicians. Both of these affect how much a practitioner is paid, which, in turn, can increase or decrease revenue.
There are two key ways doctors’ offices can use this knowledge to have better control over their revenue:
- Consider MIPS scoring and payment adjustments at the time of providing care
- Immediately report from the billing office to CMS after patient care is rendered
RELATED ARTICLE: The Importance of KPIs in Measuring Revenue Cycle Management Success
How Are MIPS Scores Calculated?
The MIPS categories listed above are not weighted equally in the scoring process. Rather, they make up different percentages of the total MIPS score.
Also, you must know that these percentages change by performance year. There is a two-year gap between the performance year and the actual year in which the scores are applied.
So, Performance Year 2022 is being used to score MIPS reporting in 2024. Performance Year 2023 will be used in 2025, and so on. The percentages will not change between Performance Year 2022 and Performance Year 2023.
The breakdown of scores is as follows:
- Cost = 30%
- Quality = 30%
- Promoting Interoperability = 25%
- Improvement Activities = 15%
All the scores are tallied, which is a complicated process using CMS algorithms. Presently, if the total score is below 75%, the clinician receives a payment penalty. But if the score is above that threshold, the clinician is eligible for a payment bonus. Extremely high scores are eligible for even higher bonuses.
Like scoring percentage weights, the score threshold sometimes changes with the Performance Year. Therefore, keeping up to date with that number is essential to ensure your facility is not falling below it.
FROM ONE OF OUR PARTNERS: Patient Appointment Reminder Text Message Samples & Tips
Future Trends: Transitioning from Traditional MIPS to MIPS Value Pathways
As mentioned above, there are changes in the works for MIPS reporting options. Traditional MIPS is slowly being phased out.
In 2023, some practitioners were given the option to begin using MIPS Value Pathways. By 2026, MVP will be mandatory for certain specialties and subspecialties. And MVP reporting will be mandatory across all practices in the coming years. The details of this transition, however, are still being ironed out by CMS.
Since MVP reporting is the wave of the future, healthcare providers should consider transitioning to it now. Benefits of using MVPs include:
- Better assessment of quality of care
- Streamlined reporting and scoring
- Enhanced feedback on performance
- Reduced burden on CMS
The sooner you become familiar with MVPs, the better it will be for your organization in the long run.
FROM ONE OF OUR PARTNERS: Your Comprehensive Guide to Neurology Medical Billing
Other 2024 Updates to MIPS
There have been a few other updates to MIPS for 2024. One important one to note involves the Promoting Interoperability (PI) reporting category.
The minimum performance period for EHR (electronic health record) reporting has been raised from 90 days to a continuous 180-day reporting period.
Other updates include the removal of 11 quality measures, the modification of 59 existing measures, and the addition of 11 new quality measures.
There are also category weight updates for 2024. For the standard category, the weights will be as follows:
- 30% each, for quality and cost
- 25% for Promoting Interoperability
- 15% for improvement opportunities
And for small practices (those with 15 or fewer clinicians), the category weights are now:
- 50% for quality
- 20% for improvement opportunities
- 30% for cost
Depending on the practice you work for, you may be affected by other 2024 CMS changes. You can learn all about the 2024 changes in our comprehensive on-demand webinar. This resource will help clarify new policies, so you understand how they apply to your practice.
Maximize Your Reporting With Our MIPS Assist Program
As you have no doubt concluded, MIPS reporting and scoring is complex and challenging to work with. But it’s vital to understand it, as it affects your organization’s revenue.
As of 2023, less than 2% of non-pediatric physicians have opted out of Medicare because they don’t want to deal with its complications. Refusing to accept Medicare is not really an option if you deal with a high volume of older patients, such as in:
- Cardiology
- Nephrology
- Urology
- Neurology
- Orthopedics
- Rheumatology
- Internal medicine
- General surgery
- Infectious diseases
- Geriatrics
- Audiology
- Ophthalmology
- Gastroenterology
- Otolaryngology
- Pulmonology
- Dermatology
- Oncology
That’s why the MIPS Assist program was created.
What Is MIPS Assist?
MIPS Assist is a program that takes the guesswork out of MIPS reporting. It offers consultative services to keep you abreast of MIPS metrics and helps ensure you meet or exceed standards. That way, your practice can avoid MIPS penalties and qualify for bonus incentives.
The MIPS Assist program includes:
- Expert consultants and innovative tools
- Guidance to avoid penalties and position the practice for bonus incentives
- Up-to-date MIPS rules and regulations
- Continuous performance monitoring by the MIPS Assist team
- Regular meetings to stay on track with MIPS goals
Does Your Practice Need MIPS Assist?
Not sure if MIPS Assist would help your practice? Answer the following questions to find out:
- Would you like to optimize your MIPS score to qualify for bonus incentives and avoid penalties?
- Would continuous, weekly, or monthly performance tracking be helpful in meeting your MIPS goals?
- Could you use help walking through MIPS calculations and submitting reporting to CMS?
If you answered yes to the questions above, MIPS Assist can help! With our MIPS Assist offering, you will receive:
- Guidance on Registry Signup
- A MIPS one-hour kickoff meeting to review measures and training on how to collect, view, and report MIPS data
- Promoting Interoperability—Provide Patient Access activation/setup
- Four hours of MIPS template configuration and/or consultation time
- Quarterly check-ins with your MIPS consultant
- Assistance with final submission of your MIPS reports
How Do You Get Started with MIPS Assist?
It’s easy to start using MIPS Assist for your practice by taking these six steps:
- Check your eligibility by going to the CMS QPP website. Enter your NPI in the “Check Your Participation Status” section of the screen.
- Know your reporting requirements.
- Select your measures.
- Collect appropriate data.
- Ensure the FHIR API is enabled.
- Connect with DrChrono Support to activate MIPS Assist.
Don’t let your practice be penalized for a low MIPS score. Leverage your ability to receive incentive bonuses by getting started with MIPS Assist today.