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A Healthcare Provider’s Guide to understanding MIPS

MIPS (aka Merit-Based Incentive Payment System) is here. Not surprisingly, there’s been a lot of confusion surrounding just how MIPS will impact healthcare providers. To help shed some light on the subject, our team decided to provide you (our readers) with a few of the important facts you need to know about MIPS.

The Quality Payment Program

The Quality Payment Program (QPP) came into existence as a part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MIPS is one of two tracks available for selection by healthcare providers. The alternative to MIPS is (prepare for another acronym) APMs (Advanced Alternative Payment Models).

So, How Does MIPS work?

MIPS is comprised of four (4) performance categories. They are as follows:

  • Advancing Care Information (replaces Meaningful Use)
  • Quality (replaces PQRS)
  • Resource Use/Cost (replaces the Value Modifier)
  • Clinical Practice Improvement Activities (new)

Your practice should be actively collecting data that highlights your performance in the areas listed above. Providers can choose to report for a full 90-day period, but we recommend reporting for a full year. Reporting for a full year helps providers maximize the potential to qualify for a positive adjustment. The highest performers will receive a positive adjustment every year. So, there’s certainly incentive to be at your best!

Alternatively, providers have the option to not provide any performance measurements or activities. Sounds easy, right? While the effort may be zero, the results will be negative. For those who do not report any measures, a negative four percent (4%) penalty awaits. Doesn’t sound all that enticing now, does it?

Determining Your MIPS Score

In the last section, we mentioned the four (4) performance categories. To eliminate some of the questions you might have after reading that, here are a few more details regarding just how each of those categories factors into your score.

  • Advancing Care Information: This accounts for twenty-five percent (25%) of your total score in the first year. It focuses on things like EHR usage and the exchange of information.
  • Quality: This is a big one. Hold onto your seat. Quality accounts for half (a full 50%) of your MIPS score. So, it’s important to measure the quality of your providers. Things to consider here are patient outcomes, patient safety, and patient experience, along with various additional clinical components.
  • Resource Use/Cost: This area only accounts for ten percent (10%) of your score. That’s not to say you shouldn’t waste your effort here. The focus is on your practice’s efficient use of resources, as well as the cost (only relevant to Medicare claims).
  • Clinical Practice Improvement Activities: This accounts for fifteen percent (15%) of your score. The score is based on data related to improvement activities such as care coordination, population management and beneficiary engagement, to name a few.

Staying Informed

If you choose to take the MIPS route, the most important consideration is to stay up-to-date and know what’s required of you. Here’s a great, Downloadable MIPS Reference Guide to keep by your side. Hopefully this information was useful and helped shed some light on the topic of MIPS!

To learn more about what’s in store for year two of MIPS, we recommend visiting this overview of the Quality Payment Program Year 2 from CMS.gov.

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