What is MIPS? A Complete Guide for Healthcare Providers

shutterstock 1789101503

What is MIPS? A Complete Guide for Healthcare Providers

shutterstock 1789101503

The healthcare industry is becoming increasingly complex with the introduction of sophisticated technologies, evolving patient needs, and intricate reimbursement mechanisms. Among these complexities is the Merit-based Incentive Payment System (MIPS), a Medicare payment model that significantly impacts healthcare providers.

Understanding MIPS: The Basics

MIPS stands for Merit-Based Incentive Payment System. Established by the Centers for Medicare and Medicaid Services (CMS), MIPS is a compliance program which affects the Medicare reimbursements that a provider may receive. The system’s main objective is to encourage enhanced quality healthcare delivery using specific performance measures and metrics. If implemented effectively, it can result in increased Medicare reimbursements. Conversely, those who fall short of the benchmarks may face penalties and therefore reduced reimbursements.

Here is a quick breakdown of the key components of the MIPS program, which are evaluated to calculate your comprehensive MIPS score:

  • Quality
    This MIPS category assesses patient care processes and outcomes.
  • Improvement Activities
    This category is geared towards enhancing care processes, patient engagement, and access to care.
  • Promoting Interoperability
    This category encourages patient engagement and public health improvements through use of new technologies, including certified electronic health records (EHR) software, and state reporting.
  • Cost
    Evaluates the cost of providing healthcare to patients from the reporting physician’s perspective, with the goal of promoting cost-effective yet quality care.

The Incentive and Penalty System

The scores derived from these categories impact your Medicare Part B reimbursement amount. Those providers scoring below 75% face payment penalties, while those scoring above can qualify for bonuses. Higher scores can even earn higher bonuses. CMS may raise the 75% threshold to 82% in the coming year.

The different categories are not weighted equally. In the 2024 performance year, the weightage is as follows:

  • Cost = 30%
  • Quality = 30%
  • Promoting Interoperability = 25%
  • Improvement Activities = 15%

Transitioning to MIPS Value Pathways

In efforts to further streamline the system, CMS is looking to transition from Traditional MIPS to MIPS Value Pathways (MVPs) starting 2023 for practitioners. CMS anticipates transitioning the majority of providers to the MVP track by 2026.

So why transitions to MVPs now? Here are few benefits:

  • Fewer quality measures to report compared to traditional MIPS.
  • Time to work issues and enhance workflows before it becomes mandatory.
  • Feedback on new components performance
  • Reduced burden on specialties

Our MIPS Consulting Program

Given the complexities surrounding MIPS, healthcare providers may feel overwhelmed. However, it is crucial not to overlook the impact of MIPS on your practice’s fiscal health. Our mission is to alleviate this burden, help you navigate MIPS, and earn the incentives your practice deserves. Our MIPS consulting program is designed specifically to guide you through the MIPS landscape. Whether you wish to optimize your MIPS score, or want to maintain regular performance tracking, our consultants are here to help.

With our services, you gain access to expert consultants, innovative tools, and a team dedicated to continuous MIPS performance monitoring. Enjoy the benefits of regular meetings to stay on track with MIPS goals, up-to-date MIPS rules and regulations, and guidance to avoid penalties.

Are you ready to embark on your MIPS journey with us? Connect with us today at (888) 747-3836 x0! Your bonus incentives and penalty-avoidance strategies are just a call away.