MACRA & Role of MIPS Consultant

Role of MIPS Consultant

The Affordable Care Act (MACRA) has required healthcare organizations to participate in the MIPS and Alternative Payment Model programs. These programs have been designed to ensure better care, coordination, and lower costs. But because these regulations are constantly changing, many changes can affect your practice. An experienced MIPS consultant can help you ensure that your practice complies with the requirements. To get started, contact a consultant at NEO MD. Depending on the type of services you need, they will be able to make recommendations for your organization’s most effective implementation practices and strategies.

What is MACRA?

The Medicare Access and CHIP Reauthorization Act, MACRA, is a legislative act that passed on April 16, 2015. President Obama signed the act. It has gathered 392 to 37 votes in the House of Representatives and 92 to 8 votes in the Senate. MACRA replaces Medicare’s current reimbursement schedule with a new pay-for-performance system that emphasizes quality, value, and accountability. According to the CMS, MACRA establishes a new payment mechanism that compensates healthcare providers for providing better care rather than more service.

MACRA adds to the already lengthy list of regulatory requirements that practices must meet. Physicians, nurse practitioners, clinical nurse specialists, nurse anesthetists, and physician assistants are among the nearly 55 million clinicians (qualified medical workers under MACRA).

Some practitioners have spent countless hours finding out how to comply with MACRA independently. The MACRA measures have changed to a point system. Doctors are compared to one another using points. A score is calculated based on what they could have done vs what they did. Finally, this decides how much money someone earns.

Final 2022 Rules released by CMS (Centers for Medicare and Medicaid Services)

MIPS 2022 Reporting Changes

CMS has adopted many policy changes to MIPS reporting in 2022 and future years.

The Centers for Medicare & Medicaid Services released the Final Rule for the 2022 Medicare Physician Fee Schedule (PFS) on November 2, 2021. It contains several improvements to the Quality Payment Program (QPP). The Rule modifies the existing MIPS program significantly and establishes a timeline for transitioning to the new MIPS Value Pathways (MVPs). Here are the key takeaways that will significantly influence clinician reporting.

MIPS Eligible Clinicians

With the beginning 2022 performance year, two new clinician types have been added to the list of MIPS eligible clinicians:

  • Certified nurse-midwives
  • Clinical social workers

MIPS Performance Category weight changes

Following are the CMS designated 100 scale performance scores for eligible clinicians.

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

How many performance threshold points are required to avoid the MIPS 2022 penalty?

In 2022, the CMS set a minimum performance requirement of 75 MIPS points (up from 60 MIPS in 2021), the mean final score from the 2017 performance year. To avoid a MIPS penalty the following year, clinicians must obtain a final MIPS score of at least 75 points.

Role of MIPS Consultant
Role of MIPS Consultant

NEO MD MIPS consulting services

Compliance: The most crucial aspect of MIPS reporting is compliance, and a consultant can help you determine which strategies are most effective for your practice. Aside from compliance, they can help you understand how to sets your 2022 MIPS measures and which metrics to report. MIPS consultants can also help you develop and maintain a care team model, which is the best way to ensure that your practice is on track for 2022 MIPS success. Contact our consultant if you want to know more about MIPS and need consulting services. 

Pre-requisite actions:

A NEO MD certified MIPS consultant could help you understand the new system’s requirements and guide your practice to achieve maximum results. With its focus on quality, the goal is to improve the patient volume and reduce costs. It is crucial to stay focused on these three elements. MIPS can also increase revenue, so hiring a MIPS consultant can help you navigate the process. If you have difficulty with 2022 MIPS reporting, consider hiring a MIPS consultant to help you.

Improve overall performance:

A MIPS consultant can help you improve your MIPS-qualified score. The program can help you improve your patient care and rank among other physicians in your area. MIPS-qualified providers can also improve their rate on the Physician Compare portal. A MIPS consultant can help you improve your patient care. It is essential to understand the MIPS system. Without MIPS, your practice will not be able to receive value-based reimbursements.

To maximize your 2022 MIPS score, you should focus on cost and quality. While the quality category is the most important, the cost will account for a substantial portion of your MIPS score. It is essential to maximize your cost-based performance because it aligns with quality-based care. In addition, maximizing your MIPS final score will help you avoid penalties and improve your practice reputation.

MIPS reporting regulations similarly apply to all specialties. Regardless of their EHR and PM platforms, NEO MD CMS Certified registry of MIPS consultants work with all sorts of practices to help them provide—and report on—the best quality of care measures.

For acquiring MIPS consulting services, you can contact us at ( or (929) 502-3636

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