If you are a healthcare provider who participates in the Medicare program, you would be familiar with MIPS, Merit-based Incentive Payment System. Being one of the key components of the Quality Payment Program, MIPS will have huge financial implications on healthcare practices. Noncompliance with MIPS healthcare may mean penalties. However, achieving performance benchmarks may bring significant incentives.
In this guide, we break down the essential steps to enable you to avoid penalty and maximize your earnings potential under MIPS.
Letโs roll!
ย What is the MIPS Healthcare Program?
The Merit-based Incentive Payment System (MIPS) is a value-based payment system that has been instituted by Medicare. It is a system to measure performance across categories by healthcare providers. MIPS assesses the performance of healthcare providers on clinical quality, efficiency, patient engagement and other aspects of care delivery.
The program rewards MIPS healthcare providers who deliver high-quality care and penalizes those who do not meet the set performance standards.
Under MIPS healthcare program, eligible providers will be awarded scores based on their performance in 4 core categories:
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- ย ย ย Quality reporting on effectiveness of care offered to the patient
- ย ย ย Cost measurement on the efficiency of care offered
- ย ย ย Improvement Activities showing the efforts placed in enhancing clinical practices and patient care
- ย ย ย Promotion of Interoperability – showing how the certified health IT has been used
This score determines the amount of financial adjustments made to your Medicare reimbursements. The better your score, the higher the incentives, while a lower score can result in penalties.
ย Key Performance Categories in MIPS Healthcare
To avoid penalties and earn incentives, it’s important to know the four performance categories in MIPS:
- ย Quality
Providers must submit data on several quality measures related to patient outcomes, prevention screenings, and chronic disease management. High-quality care is rewarded with better scores.
- ย Cost
This category focuses on healthcare costs, which include Medicare spending and hospital admissions. Practices that provide efficient patient care while curtailing unnecessary costs can do better in their cost score.
- ย Improvement Activities
Improvement activities, such as implementing care coordination systems or increasing patient access to services, improve this score.
- ย Promoting Interoperability (PI)
Providers must demonstrate meaningful use of certified electronic health record technology to ensure that patient information is shared across different settings for better care coordination.
ย How MIPS Penalties Work?
MIPS healthcare penalties are applied against Medicare payments based on the total MIPS score a provider makes. If your score falls below a certain threshold, you risk a payment decrease the following year. Payments can be substantial, including 4% and in excess of 9% in recent years, depending upon overall performance.
Moreover, failing to report data in one or more categories automatically triggers penalties. For instance, a provider who fails to submit quality measure data or to demonstrate meaningful use of health IT will receive a zero score in that category, which can severely affect the total MIPS score.
Strategies to Avoid MIPS Penalties
To avoid penalties, here are some key strategies to follow:
Start Early
The MIPS reporting period runs from January to December each year. It is important to start early so that you have enough time to collect the required data and improve areas that need attention.
Monitor Your Progress
You can track your progress all year with help from tools and resources within MIPS or third-party vendors. Knowing your performance in a particular category early will keep you from having a bad surprise at the end of your reporting period.
Check If Your Data is Filed Accurately
If the data you file isn’t correct, or some just don’t file data for one category or more, there is a very high likelihood that it may cause an automatic penalty for MIPS.
Focus on High-Impact Areas
If your practice has been weak in one area, such as Quality or Cost, focus on improving that area. Use quality improvement strategies and patient feedback to improve care delivery.
Engage in Improvement Activities
Participate in activities that are easy to report and meaningful to patient care. Some examples of these activities are enhancing care coordination, telehealth, or participating in patient safety initiatives.
Optimize Your EHR Use
For the Promoting Interoperability category, ensure that you are optimizing all uses of your EHR system. Meaningful use of electronic health records really makes a difference in an overall PI score and with your success.
In addition to these strategies, understanding related roles within healthcare, such as “What does a billing specialist do,” can further enhance your practice’s efficiency. Billing specialists ensure accurate medical billing and compliance, which directly impacts reporting accuracy and financial outcomes.
Tips to Maximize MIPS Incentives
Achieving incentives requires you to avoid not only penalties but also exceed performance thresholds. Here’s how you can maximize your chances of earning incentives:
Exceed Performance Benchmarks
For instance, trying to beat the minimum requirements for every category can earn you extra points. For example, trying to exceed quality measure thresholds or achieving higher patient engagement can push you closer to incentive eligibility.
Participate in Bonus Opportunities
MIPS provides bonus opportunities for reporting on specific measures or participating in certain programs, such as bonus points for small practices or for reporting on high-priority measures.
Use Data to Drive Improvement
Analyzing your performance data and identifying areas for improvement can help you improve your overall score. For example, improving patient satisfaction or increasing preventive screenings can boost your Quality score.
Leverage Advancing Care Information
Maximum use of health IT systems, such as EHRs, will be helpful in the Promoting Interoperability category. Use any incentive programs that offer bonus points for enhancing interoperability and improving care delivery.
Closing It All
Avoiding MIPS healthcare penalties and earning incentives is crucial for healthcare providers looking to thrive in today’s value-based healthcare environment. By focusing on quality, cost, improvement activities, and the effective use of technology, you can avoid financial penalties but also maximize your Medicare reimbursement through incentives.
With this approach, you will be on your way to providing higher-quality care and increasing the financial success of your practice.
If you need guidance or help with MIPS reporting and strategy, feel free to contact Prime Well Med Solutions!
