Reporting is the most crucial step of MIPS. As it will decide the provider’s fate whether to get reimbursed or pay the penalty after the set period of CMS.
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What is MIPS Reporting in Healthcare?
The MIPS in healthcare is the program that will determine Medicare payment adjustments. A composite performance score has utilized in this program. And eligible clinicians may either receive a payment penalty, bonus, or no payment adjustment.
MIPS reporting Score Evaluation from 2017-to 2021
CMS has attempted to ease people into the MIPS program from its beginning in 2017. By progressively increasing the minimum score from 3 points in 2017 to 15 points in 2018. Afterwards, in 2019 and 2020, it stood at 30 and 45 points, respectively, and 60 points in 2021. CMS would continue to observe the rise in the threshold, with an ironic increase scheduled in the coming years.
Apparently, the most concerning question that every practitioner searching for is, i.e., what is MIPS reporting in 2023?
In 2023, 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 Reporting Categories
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,
Promoting Interoperability 25%
Improvement Activities 15%
The quality category in MIPS reporting accounts for 30% of the total MIPS performance score for 2023.
Physicians must provide six measures, one of which must be an outcome measure. The reporting period is one calendar year.
For 2022 and 2023, data completeness will remain at 70%.
Scoring For the quality measures.
New quality measures will have a 7-point floor for the first performance period. Alternatively, another 5-point floor for the second performance period.
E2E Reporting and Additional Outcome Measures do not get bonus points. Bonus points will no longer be provided in 2023 for end-to-end (ETE) electronic reporting. Whereas reporting additional Outcome/High-priority measures beyond the required standards will add to the difficulty of meeting or exceeding the 75-point threshold.
CMS Web Interface for Groups of 25+: For the 2023 performance period, traditional MIPS will maintain this collection and submission type for registered groups and virtual groups. And it will also cover APM Entities with 25 or more clinicians. That collection type will also be available as a reporting option for Medicare Shared Savings Program ACOs through 2024.
For groups of 16 or more qualified physicians with a minimum of 200 eligible patients. The “CMS” (Centers for Medicare & Medicaid Services) will use claims data to establish the all-cause hospital readmission measure.
What is MIPS quality reporting? MIPS’ Quality category replaces the Physician Quality Reporting System (PQRS). It requires eligible clinicians to provide data to CMS on quality measures. Such measures include patient outcomes, proper usage of medical resources, patient safety, efficiency, patient experience, and care coordination.
What is PI Category?
The MIPS PI (Promoting Interoperability) category replaced the Meaningful Use program. The PI provides standards to encourage electronic information exchange utilizing certified electronic health record technology (CEHRT).
Promoting interoperability category accounts for 25% of the total MIPS performance score for 2023. And it was the same 25% in 2021.
Automatic reweighting: In addition to the hospital-based and non-patient-facing eligible clinicians and groups. CMS will apply automatic reweighting of the PI category in 2022 for the following:
Clinical Social Workers
MIPS Reporting requirements: FollowingChanges made in PI requirements.
To assist public health agencies, specific reporting burden requirements for the Public Health and Clinical Data Exchange objective have reduced.
CMS will require reporting of the Immunization Registry Reporting and ECR (unless an exception is available).
Reporting the measures for Clinical Data Registry and Syndromic Surveillance will be optional. However, MIPS eligible clinicians who report a “yes” response for any of them might receive an additional 5 bonus points.
SAFER GUIDES: CMS has established a new required measure called the Safety Assurance Factors for EHR Resilience Guides (SAFER Guides). Solely designed for the performance period of 2023. This measure demands MIPS-eligible clinicians to certify to use the SAFER Guides on an annual basis.
For the performance period of 2023 only, there is a fourth exclusion added to the Electronic Case Reporting.
CMS Modified the Prevention of Information Blocking attestation statements.
The cost category of MIPS reporting weighted 30% of the total performance score for the year 2023.
5 brand-new episode-based measures have been added to the cost category for 2023.
2 procedural measures: Melanoma Resection, Rectal and Colon Resection,
CMS is also beginning the process of prioritizing and conceptualizing four more episode-based cost measures. These will introduce between 2022 and 2023.
Improvement Activities (IA) Category
The reporting period has still at a minimum of 90 days.
Group Reporting: At least 50% of the providers must engage in the designated Improvement Activities. Created for the same 90-day (period as in 2021) for a Group submission.
Changes in IA Measures Since the Inventory of 2021:
7 new measures added to the Group reporting.
The existing 15 measures have changed.
6 former measures have eliminated.
Eligible clinicians and their affiliated groups should retain documentation of their improvement activity performance.
Along with Traditional MIPS and Advanced APMs, the MIPS 2023 landscape is evolving and transforming to create space for the new MIPS Value Pathways. As a result, each of the performance categories observed significant changes. The most considerable change is increasing the Performance Threshold to 75 points to avoid a penalty.
If you want to avoid a penalty or gain exceptional performance, i.e., 89 points, you are on the right platform. Our NEO MD CMS Certified Registry and MIPS consultants work with various practices to help them provide and report on the best quality of care measures. NEO MD has a track record of experience in facilitating clinicians to not only meet their MIPS criteria but also to achieve distinction. We are working across all states of the US with numerous providers associated with different healthcare facilities.
For MIPS consulting services, you can contact us at (email@example.com) or (929) 502-3636.