MIPS, or the Merit-Based Incentive Payment System, is a key element of MACRA. Its components have changed the methods that many medical providers can use to qualify for reimbursement from Medicare in the future. The following tips can help ensure that participating providers are complying with the new system.
1. Know Who it Affects
The Centers for Medicare and Medicaid Services (CMS) notes that about 600,000 medical providers are affected by the MIPS requirements. There are, however, a few groups of providers that are currently exempt from the requirement of submitting their data to MIPS. These include clinicians were enrolled in Medicare for the first time in 2017, those who serve 100 or fewer Medicare patients and those who billed Medicare for $90,000 or less in the course of one year.
Clinicians who participate in the alternative payment model (APM) launched by MACRA also except from MIPS. Those who are a partial qualifying participant (QP) or a qualifying APM participant, as well as those who practice outside a specialty that is MIPS eligible, are exempt too.
2. Know the Performance-Based Categories
Aligning with the industry’s focus on performance-based billing, Medicare reimbursements are adjusted by MIPS based on four general categories. A primary category is quality which, in 2018, accounts for 50 percent of a clinician’s score. By 2019, this category will comprise 30 percent of their score.
Advancing care information is slated to comprise 25 percent of a provider’s score for 2018 and 2019. Resource use will see its weight jump from 10 percent in 2018 to 30 percent by 2019. Activities aimed at improving the clinical practice will comprise 15 percent of the provider’s score for both 2018 and 2019.
The performance in each category is used to calculate a final score between zero and 100. A sliding scale is then used to award adjustments with higher performers securing rewards that are proportionate to their performance. CMS has also stated that those clinicians that provide exceptional performance and meet the agency’s threshold will receive additional compensation up to 10 percent.
3. Demonstrating Compliance
MIPS is now standard so it’s incumbent on medical providers to efficiently gather, maintain and report those key metrics that effectively demonstrate their compliance. Whether they fall into MIPS or APM, most clinicians will increase their use of electronic health records (EHR) systems to do so. Reducing the risk of negative adjustments while also increasing positive payment adjustments hinges on identifying gaps that exist within the reporting and tracking systems already in use. Another key metric that can lead to higher scores is choosing an EHR platform that efficiently and effectively captures the kind of patient information that leads to positive outcomes.
In order to better meet the MACRA guidelines concerning MIPS, medical providers should carefully review them to determine the measures that will deliver the best outcomes in terms of both their patients and the intricacies of their practice. Exscribe is an innovative EHR platform designed especially for orthopedic surgeons. Learn more or sign up for a free demo today.