What is MIPS in healthcare?

The MIPS in healthcare is the program that will govern Medicare payment adjustments. Eligible physicians may receive a payment penalty, bonus, or no payment adjustment in this program. Although, it all decides their composite performance score.
MIPS assigns a 100-point performance scale to eligible Medicare Part B clinicians, resulting in a Composite Performance Score (CPS). The query that is of more concern after (what is MIPS in healthcare) is;
What does MIPS stand for in healthcare? MIPS in healthcare stands for Merit-based incentive payment system. It designs to tie payments to quality and cost-effective treatment and stimulate improvement in care processes and health outcomes. Besides this, according to the Department of Health and Human Services (HHS), it expands the use of healthcare information and lowers the cost of care,".

MIPS Eligibility

Who is considered a MIPS-eligible clinician?

  1. Eligible Clinician Types: These include Clinicians, Physicians, Physician Assistants, Clinical Nurse Specialists, Nurse Practitioners, and Certified Registered Nurse Anesthetists. Additionally, it also covers Physical / Occupational Therapists, Audiologists, Speech-Language Pathologists, Clinical Psychologists, and Dietitians/Nutritional Professionals.
  2. The Low-Volume Threshold: Otherwise, qualified clinicians or groups are exempt from reporting MIPS;
  • If they charge a minimum of $90,000 for services. Concurrently,
  • if they provide care to less than 200 Medicare Part B patients,
  • Or offer 200 professional services that Medicare covers.

They may opt to or voluntarily declare under certain circumstances to be part of the incentive program or monitor their performance on other grounds.

  1. Other Possible Exemptions
    Recently enrolled in Medicare: If a doctor registers into Medicare during the middle of a performance calendar, they are not required to participate in MIPS reporting for that year. For instance, if a physician were to sign up for Medicare on February 6, 2021. Then, they will be exempted for the performance year 2021 (January 1, 2021, to December 31, 2021).
    Advanced MIPS Participation: If a doctor chooses to enroll in Medicare during the middle of a performance year, they will not require to take part in MIPS reporting for that year. For instance, if a physician were to sign up for Medicare on February 6, 2021. They would also be exempt from the 2021 year of performance (January 1, 2021- December 31, 2021).

All Medicare Part-B providers that match the criteria of a MIPS Eligible-Clinician should plan to participate in MIPS in 2022. Otherwise, their Medicare Part B payments will be subject to a negative 4% payment adjustment in 2024. The recent phrase explains the literal answer to the question; What is MIPS in healthcare?

MIPS Reporting:

Before starting to explain MIPS reporting, let us look at the 2022 MIPS requirement, i.e., what is 202 MIPS reporting?

In 2022, the CMS set a minimum performance criterion of 75 MIPS points (up from 60 MIPS points in 2021). That is the mean final score from the previous performance year. To avoid a MIPS penalty next year, doctors must attain a final MIPS score of at least 75 points.

MIPS annually assigns a 100-point performance scale to eligible Medicare Part B clinicians, resulting in a Composite Performance Score (CPS). The payment adjustment will base on the Composite Performance Score, calculated using the reported measures and categories.

There are four scalable categories of MIPS,

  • Quality (30%)
  • Promoting Interoperability (25%)
  • Improvement Activities (15%)
  • Cost (30%)

For a thorough understanding of MIPS categories, visit the link: https://neomdinc.com/mips-reporting-for-the-performance-year-2022/

2022 MIPS Exemptions

When healthcare professionals are ready to take a deep dive into MIPS eligibility and applicability. Then, they must be sure they have the correct response to the query: who is exempt from MIPS? There are three kinds of providers exempted from 2022 MIPS:

1. MIPS does not apply to those who are part of or participate in an APM (Advanced Payment Modal) according to MACRA defines.
2. Clinicians who charge less than $90,000.00 to Medicare patients in a particular period or treat under 200 Medicare patients per year are exempt from MIPS. CMS will utilize the data from claims to conduct a low-volume status assessment before or during the performance.
3. New Medicare-enrolled eligible Clinicians during the performance year, doctors who join Medicare initially can be exempted from MIPS until the following performance year.

The expected level of performance in 2022 will be considerably higher. We propose reporting measures to some capacity in each performance category to guarantee you get 75 points and avoid a negative payment adjustment in 2024.

What is the penalty for not reporting MIPS? Avoiding a MIPS penalty can save you a great deal of money. If you don't fulfill the MIPS requirements in 2022, you might face a penalty of up to 9% of your Part B professional service reimbursements in 2024. For further information on the scores and requirements for each category,

Visit the site's resource; https://qpp.cms.gov/mips/overview

MIPS consulting services are a critical component of meeting the requirements of the new MIPS quality rating system. Our MIPS Consultants from the NEO MD Certified Registry can assist providers in meeting all four MIPS criteria. They educate practice management and medical providers about the new system and build workflows, processes, and protocols to meet the requirements. Our MIPS experts also assist the practice in developing a care team model and tracking progress toward the MIPS goal.

Finally, to recapitulate the article, what is MIPS in healthcare? We may reasonably conclude that MIPS is the most authentic means to reward or penalize providers for Medicare Part B claims in healthcare. It will ultimately improve treatment quality, doctor-patient interaction, and revenue cycle management.

Author's Bio: 

NEO MD believes in delivering quality and customized services and ensures in fulfilling your practice needs. As a service-oriented company with a team of experts who has more than 10 years of experience, it’s our vision to expand our resource knowledge and use it to build a healthy client relationship. Relying on a quality base healthcare model, our experienced team of consultants and medical billers keep themselves updated with the new reform and quality programs. This mechanism helps the doctors to avoid the penalties, receive vigorous incentives, and improve their monthly collections.