Just Reporting MIPS is No Longer “Good Enough”

The Centers for Medicare & Medicaid Services (CMS) recently reported that 91 percent of eligible clinicians participated in the first year of MIPS reporting, up from their goal of 90 percent1. What does that mean? That nine percent of the total of clinicians who were eligible to report did nothing–not even the minimal 90-day of data reporting.

While CMS plans to introduce a gradual implementation of certain requirements under MIPS, clinicians will be assessed at a +/- 4 percent adjustment on reimbursements, depending on their performance measures as well as how they compare to similar clinicians (both in specialty and regional demographics), although that comparison will not affect the clinicians’ scores or reimbursement. That adjustment on reimbursements grows yearly to +/- 9 percent by 2022.

The scores on the performance measures will be shown on the Physician Compare website, and may have an impact on your reputation as patients begin to use the site to compare providers in their communities.

Did your practice or eligible clinicians submit “just enough” data to get by? And do you know how your performance scores will affect your practice’s revenue with reimbursements under CMS? As the largest healthcare payer in the U.S., CMS’ reimbursements will have a significant influence on any practice, and particularly when dealing with specialty care.

There are things you need to consider, ensuring you are reporting your best numbers:
  • Understand the measures you have chosen, as well as how you will gather data and under what submission method you plan to use. It is vital that you check your data gathering system (your certified EHR) method to ensure you are capturing all relevant information and that your professionals are accurately entering information.
  • Is your practice looking at the numbers monthly to help those eligible clinicians who may not be aligned with practice goals? Or maybe your processes need some ‘tweaking’ to ensure you are gathering the right data.
  • Do you have an internal champion who will help your practice move toward improving quality and cost? And do your clinicians understand the goals set for them as a practice and individually?
Many smaller practices or solo practitioner practices may see an increased burden in MIPS reporting, especially without a dedicated resource overseeing MIPS reporting. The Quality Reporting Engagement Group can help identify the most appropriate measures and submission methods, and help your practice maximize their potential reimbursements under the Quality Payment Program. 

Learn more about how our experts can help your practice maximize reimbursements.

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  1. https://blog.cms.gov/2018/05/31/quality-payment-program-exceeds-year-1-participation-goal/