In a recent blog post, we looked at the strong advantages of the MIPS/MACRA program to a practice’s profitability. To reiterate, MIPS and MACRA are the Merit-based Incentive Payment System (MIPS) and the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act (MACRA).1
Advantum Health attributes four tenets to MIPS success. Financial, clinical, and technical optimization and the right staff expertise will be critical to thriving in value-based care. Practices can begin building a solid foundation for success by maximizing existing revenue streams to secure funds that may serve the practice elsewhere under MIPS. Specifically, this can be achieved financially by optimizing revenue capture, particularly in the areas of coding and denial management. In the clinical area, we streamline provider workflow, documentation and care coordination goals. The technical aspect is improved by customizing EHR resources based on your specific quality measures and specialty KPIs. With staff this is ensured by understanding MIPS deliverables and execution.
Four MIPS Categories
For 2022, Reporting Requirements have the following Performance Categories. A single composite score on a scale of 0-100 determines Medicare incentive or penalty payments for physicians under MIPS. That score is currently derived from four weighted categories for the reporting period, which will affect a provider’s Medicare payments. Non-participation by an eligible individual or group that must engage in the program may result in them receiving a -9% adjustment on their Medicare Part B payments.
However, participation and scoring above set thresholds can have positive consequences, and to do so clinicians will need to meet the following criteria in the 2022 MIPS reporting period:
- Cost Performance Category (30 points)
- Improvement Activities Performance Category (15 points)
- Promoting Interoperability Performance Category (25 points)
- Quality Performance Category (30 points)
Testing Exceptions
There are exceptions to these categories that can change scoring and are worth exploring. For example, if the provider is identified as hospital-based, as often the case in some specialties such as
anesthesiology, they qualify for automatic reweighting of the Promoting Interoperability performance category to 0%. The 25% category weight will be redistributed to another performance category (or categories) unless they choose to submit the Promoting Interoperability data.2
Other categories, such as those providers that are facility-based, ambulatory surgery center (ASC)-based, part of a small practice, or rural, may also have applicable Special Status Impacts and Circumstances. Their data submission, rather than utilizing reweighing, is also at the discretion of the provider.
Merit-based Incentive Payment System
The scoring metrics for 2022 on which the payments – or penalties – are based are also on a scale. If an eligible individual’s or group’s score is above 75 points during the performance year 2022, they will receive a positive payment adjustment. Conversely, those that score below 75 points will receive a negative payment adjustment applied in 2024. Practices that score exactly 75 points will receive a “neutral adjustment.” Finally, those that score at or above 89 points will earn an “exceptional bonus.”
Impactful Results
It quickly becomes apparent that accurate and applicable MIPS reporting and scoring can have a big impact on the financial well-being of a provider. Make sure that your practice’s MIPS reporting yields positive results to your Medicare payments. Contact Advantum Health today and learn how we can guide your practice to even stronger financial results.
References
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MIPS/MACRA: How it can be positive for both patients and profitability
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https://qpp.cms.gov/mips/special-statuses?py=2022
Further resources