The time is here! The first performance year for the Merit-Based Incentive Payment System (MIPS) began January 1, 2017 with the first payment year implementing in 2019. It’s important for your organization to prepare now to maximize incentives and avoid penalties on your Medicare Part B payments.
As directed by MACRA, the goal of MIPS to create one, unified goal towards quality improvement in healthcare by combining legacy measures, activities, reporting and data standards. MIPS combines three existing programs and adds a new performance category. Reimbursements are based on performance in these four categories:
- Quality – replaces Physician Quality Reporting System (PQRS).
- Cost – replaces Value-based Payment Modifier (VM)
- Advancing Care Information (ACI) – replaces Meaningful Use (MU).
- Improvement Activities (IA) – the NEW category
It's important to note, however, that when the formula was finalized for the first year’s scoring, CMS announced that evaluation based on cost would be delayed until the second year of MIPS. That means data submitted in 2017 will not be scored on cost (resource use), so providers have a little extra time before they are accountable for their performance in that area. This gives your organization the opportunity to make efficiency improvements that will help you score well in this category when the time does come. Read more in our previous blog, "Improving Efficiency is Vital During MIPS' First Year".
In the meantime, here are a few things you should have on your agenda to prepare for MIPS:
1. Successfully report current quality reporting measures. If you can't keep up with existing measures now, how are you going to be ready for MIPS. Not to mention, these will be streamlined into MIPS, so you’ll be that much more ready once it does start.
2. Use certified EHR technology (CEHRT).
First things first, make sure it captures all of the necessary data. CEHRT helps providers meet Meaningful Use and PQRS requirements by providing quality measure information and developing attestation documentation to successfully meet the goals of these programs.
3. Prepare for Clinical Practice Improvement Activities (CPIA).
These are in addition to the current quality programs. Clinicians are rewarded for care focused on care coordination, beneficiary engagement, and patient safety.
Eligible clinicians will report 2 high-weighted (worth 20 points each) or 4 medium-weighted activities (worth 10 points each), or a combination of the two to reach 40 points total.
Eligible clinicians in small practices (15 or fewer clinicians), rural practices, or health professional shortage areas will report 1 high-weighted or 2 medium-weighted to reach 20 points total.
You may select from the list of 92 activities. View the list here.
Read, "More Accountability for Health Outcomes in Motivation to Focus on Population Health Management", to learn how advancing population health management can help you adapt to new reporting requirements.
Looking for ways to learn more?
Everyone in healthcare is talking about the buzzwords MACRA, QPP, MIPS, APM and so on. With your money on the line, you want to make sure that you are researching accurate infomation. CMS provides an abundance of information about the Quality Payment Program (QPP) and MIPS. Visit their site dedicated soley to the QPP. They also provide materials, webinars and other educational videos here.
While the rulings and requirements are very complex, the end result is much more simple—earn money or lose money. Your MIPS score will significantly impact your Medicare reimbursements over the next several years. However, with some proactive planning and early action you can start investing in resources and processes that will maximize your score.