According to cms.gov CMS is required by law to implement a quality payment incentive program which is referred to as the Quality Payment Program. This program rewards value and outcomes in one of two ways: Merit-based Incentive Payment System also know as MIPS and Advanced Alternative Payment Models or APMs for shorter.
Under the Merit-based Incentive Payment System, clinicians are included if they meet the low volume threshold and are an eligible clinician type, which is based on the number of Medicare Part B patients who are furnished covered professional services under the Medicare Physician Fee Schedule and the allowed charges for covered professional services under the Medicare Physician Fee Schedule (PFS).
There are four areas in which performance is measured through the data clinicians report. They are Quality, Improvement Activities, Promoting Interoperability (formerly Advancing Care Information), and Cost. While some of these areas were already being reported, a comprehensive approach like MIPS was needed to increase participation and benefit to both the clinician and the patient. MIPS updated and consolidated previous programs like the Medicare Electronic Health Records (EHR) Incentive Program for Eligible Clinicians, the Physician Quality Reporting System (PQRS), and the Value-Based Payment Modifier (VBM).
How it Works
Four performance categories make up your final score. Your final score determines what your payment adjustment will be. These categories are:
The quality measure performance replaces the PQRS and covers the quality of the care you deliver to your patients, based on performance measures created by CMS. These measures are also based on medical professional and stakeholder groups. You are allowed to pick the six measures of performance that best fit your practice.
Promoting Interoperability (PI)
Advancing Care Information performance category is re-named to Promoting Interoperability (PI). This is to focus on patient engagement and the electronic exchange of health information using certified electronic health record technology (CEHRT) effectively replacing the Medicare EHR Incentive Program for EPs, commonly known as Meaningful Use. The system does this by proactively sharing information with other clinicians or the patient in a comprehensive manner. This may include: sharing test results, visit summaries, and therapeutic plans with the patient and other facilities to coordinate care.
This brand new performance category includes a list of activities that assess how to improve your care processes, enhance patient engagement, and increase access. The list allows you to choose only the activities appropriate to your practice. Categories such as enhancing care coordination, patient and clinician shared decision-making, and expansion of practice access are all options to pick from.
This performance category replaces the VBM. CMS will calculate the cost of the care you provide based on your Medicare claims. MIPS uses cost measures to gauge the total cost of attention during the year or a hospital stay. As of 2018, this performance category counts towards your MIPS final score.
Quality and cost-efficient care, improvement in the care process and patient outcomes, use of health care info, and cost reduction are some of the reasons MIPS was designed.
The performance year cycle for MIPS starts on January 1 and ends on December 31. If you are participating, you must report data collected during one calendar year by March 31 of the following calendar year. For example, program participants who received data in 2019 must report their data by March 31, 2020, to be eligible for a pay increase and to avoid a payment reduction in 2021.
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