What is MIPS?
The MIPS is a Merit-based incentive payment system established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). It came into effect on January 1, 2017. It is a major catalyst toward transforming the healthcare industry for the year 2022 from fee-for-service to pay-for-value. Healthcare practitioners try far along to find the most precise answer to the following question, i.e., what does MIPS stand for? The MIPS stands for Merit-based incentive payment system and is a program that will determine Medicare payment adjustment. And eligible clinicians (ECs) either receive a payment penalty, a payment bonus, or no payment adjustment based on their composite performance score. MIPS reporting will decide your fate that either you will reimburse or pay a penalty for a performance year.
Reporting is the most crucial step of MIPS; it will finally decide your fate whether to get reimbursed or pay the penalty after the set period of CMS. A MIPS consultant is the only viable source who can help you in this regard. These days, practitioners are searching for answers to the appended questions, i.e., what is MIPS reporting 2022 and MIPS reporting 2021 score?
In 2022, the CMS HAS set a minimum performance criterion of 75 MIPS points (up from 60 MIPS points in 2021), 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.
Physicians can choose whether to participate in MIPS as an individual or group under the Quality Payment Program (QPP). This is one of a practice’s first decisions when it comes to MIPS reporting.
The impact of this decision affects the performance of each “EC” (Eligible Clinician) reporting under a “TIN” or individual NPI and, ultimately, the potential to receive an incentive.
When selecting a MIPS reporting option, either individual or group, the choice has been made for all three categories.
Individual MIPS Reporting
According to CMS, an individual is described as a single clinician, identified by a single “NPI” (National Provider Identifier number) tied to a single TIN (Taxpayer identification number). If you are an Eligible Clinician and choose MIPS reporting individually, your Final Score will determine your performance alone.
If you are reporting the three performance categories individually, you’ll need to find quality measures and improvement activities for each practice’s provider. To qualify for points in the category of “Promoting Interoperability,” each provider must pass the base score measures independently.
While reporting as an individual provides you complete control over performance and payment adjustments. Collecting data for your ECs individually might result in a significant administrative burden.
If you opt to report as an individual, CMS allows you to submit quality data using one of the following methods:
- Qualified Registry,
- Electronic Health Record (EHR),
- Qualified Clinical Data Registry (QCDR),
Group MIPS Reporting
CMS states that a group consists of a single Taxpayer identification number (TIN) (with two or more EC (Having at least one MIPS eligible clinician), as identified by their NPI (National Provider Identifier), who have reassigned their Medicare billing privileges to the TIN.
The group reporting procedure allows a group of providers to submit their data and have it assessed collectively, which means that each physician in the group will receive the same MIPS Final Score and payment adjustment (even ECs who weren’t in the group during the performance year).
In general, group scoring treats all of the ECs in the group as if they were one individual.
In most circumstances, group reporting reduces the amount of effort required. It may also be the only technically feasible approach for large organizations.
MIPS Quality Reporting
Instead of selecting measures for each provider in the group, you choose measures based on the total number of patients treated by the practice. The restrictions do not have to apply to everyone in the group.
In a multi-speciality group, you can select measures that the group performs well on, even if some providers perform poorly or are not eligible for the chosen measures. When you have a large number of specialists in your practice, this makes a significant impact.
The number of patients seen in the practice determines the measure’s qualifying instances, irrespective of which NPI doctor or how many NPIs doctors saw that patient.
For instance, Measure 226 requires you to question patients about tobacco use at least once in the two years leading up to the performance year’s eligible visit date. If a patient sees provider A in the performance year, the patient is in the denominator for the entire group. Provider B will earn “credit” for the quality action if the patient has asked about tobacco usage at a previous year’s visit.
Suppose provider B also saw the patient throughout the performance year. In that case, the patient is only reported ONCE for the group, and the group is given credit for the patient’s quality action.
CMS will calculate the All-Cause Hospital Readmission Measure automatically for any group of 16 or more providers with more than 200 eligible instances, and it will contribute toward their Quality score. The following measure does not apply to individual providers.
The Quality category of MIPS 2022 is accountable for 30% of your total MIPS score.
MIPS reporting regulations similarly apply to all specialities. 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 the best MIPS Reporting for the year 2022. For MIPS consulting services, you can contact us at (firstname.lastname@example.org) or (929) 502-3636.