Introduction to MIPs

Merit-based Incentive Payment System (MIPS) is a hot topic in the medical field right now. These incentives allow clinicians to make more money from their Medicare billing efforts if they can prove that they are giving better care to their patients.

MIPS is a program which combines elements of three older programs, PQRS (Physician Quality Reporting System, VM (Physician Value Modifier), and the Medicare EHR incentive program for eligible professionals.  It did not impact Medicare EHR for eligible hospitals, or Medicaid EHR incentives for professionals, but did affect Medicare EHR incentives for eligible professionals. The older programs phased out in 2016.

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MIPS program is comprised of four performance categories in which data are reported, and performance is measured: Quality, Cost, Advancing Care Information, and Improvement Activities (a new category added in 2017 dealing with clinical improvement).

MIPS officially began in 2017.  Data Submission was adjusted for 2018.  Also, points from each performance category were adjusted from the 2017 numbers.  Payment Adjustment began in 2019.

In 2018 (Year 2), MIPS eligible clinicians were defined as including doctors of medicine, osteopathy, dental surgery, dental medicine, podiatric medicine, optometry, chiropractors, in addition to physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists.  Whereas the low-volume threshold in 2017 was >$30,000 and >100 patients, the 2018 low-volume threshold was increased to >$90,000 and >200 patients. Other 2018 exemptions included clinicians newly enrolled in Medicare or those in an Advanced APM. Also, 2018 defined special statuses to the following categories: Small Practice, Rural Area, and Health Professional Shortage Area.  Another notable change in 2018 which was not available during the 2017 transition year was in the area of bonuses, which were defined to include the Complex Patient Bonus and Small Practice Bonus. In 2017, clinicians were able to “Pick Your Pace” in determining the extent to which they would participate in MIPS, from 90 days to a full year, while 2018’s reporting period was increased to cover twelve months. Reporting options for 2018 involved adding a third category in which to report to MIPS: Individual, Group, and Virtual Group (new for 2018).  Virtual groups allow solo practitioners and groups of ten or fewer to come together virtually to participate in MIPS.

The data submission mechanism, while it had no changes from 2017 to 2018, has several options within each reporting category, based on whether one is reporting for individuals or groups/virtual groups.  

How can your practice stay compliant with MIPS?  This snapshot of information is an example of the constant change in programs, policies, definitions, requirements, statuses, and categories that each individual or practice must implement these in order to make the most from their billing efforts.  Our job is to stay on top of changes as they occur so that clinicians can focus on their patients. We make it our business to stay aware of what it takes in order for you to remain in compliance with MIPS from year to year.

As we have stated before, a chronic care management program can meet all the measures in your MIPs criteria. It can change the way your practice is implemented in the daily lives of your patients and allow you to meet the needs of your patients better. Call or email RoseText today at 806-543-1435 or [email protected]  to set up a consultation.

Like what you read? If you're looking for help implementing Chronic Care Management at your practice, reach out to our team of experts!   

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