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How Does MIPS Impact Oncology

Revenue Cycle
17 Jul

How Does MIPS Impact Oncology

How Does MIPS Impact Oncology

Approximately 38.4 percent of men and women will be diagnosed with cancer at some point in their lives. Furthermore, 7.6 million people die from the disease. With cancer becoming more common, many patients seek the highest quality medical care. Thus, it is crucial for you as a physician to have a high Merit-based Incentive Payment System (MIPS) score. MIPS evaluates the physician’s quality of care and scores it based on a 100-point system. Additionally, MIPS can have a huge reputational and financial impact on an oncology practice, particularly in how MIPS impacts oncology.

Revenue Cycle

Revenue Cycle

CMS considers MIPS a budget-neutral program. Eligible clinicians can receive incentives, while those who do not comply will face penalties. In 2019, the penalty was -7%, increasing to -9% in 2020. To earn high scores and receive incentives, clinicians must excel in Quality, Promoting Interoperability, Improvement Activities, and Cost categories. The weight of each category changes every year, with the 2019 breakdown below:

  • Quality (45%)
  • Promoting Interoperability (25%)
  • Improvement Activities (15%)
  • Cost (15%)

Financial Implications of MIPS

The complexity of MIPS reporting has increased since it became effective in 2017. Thus, practices must become well-versed in the ever-changing rules to stay ahead. Along with this complexity, financial implications have increased manifold since MIPS’s inception. In 2018, the maximum incentive was 2%, and the maximum penalty was 5%. In 2019, the maximum incentive increased to 7%, and the penalty rose to 7%.

Oncology practice revenue usually is relatively high. Therefore, whether you report for MIPS significantly affects the bottom line. For instance, if an oncologist earns $500,000 in Medicare reimbursement annually, not reporting MIPS costs them 7% of $500,000, i.e., $35,000. If you report for MIPS and score high, you could receive an incentive of up to $28,500, considering the budget neutrality factor. Using MIPS consulting services from a reputed firm like TriumpHealth saves your practice money. Furthermore, it boosts your reputation and creates opportunities for growth and advancement, especially regarding how MIPS impacts oncology.

Source: Cancer Statistics. (April 27, 2018). Retrieved from https://www.cancer.gov/about-cancer/understanding/statistics

By: Alexis Cardona, Healthcare Solutions Consultant