MACRA MIPS, also known as the Medicare Access and CHIP Reauthorization Act of 2015 – Merit-based Incentive Payment System, is a program designed to address the financial aspects of physicians under Medicare. Additionally, it establishes standards for the quality of care delivered in hospitals, practices, and clinics.
Having entered its fifth year since its inception in 2017, MACRA MIPS plays a vital role in streamlining the physician reimbursement process. Although the process of submitting MIPS 2020 data is not overly complicated, it does require a specific skill set to achieve favorable scores.
The Quality Payment Program (QPP) MIPS comprises four categories that focus on providing meaningful and high-quality healthcare services. These categories include Quality, Improvement Activities (IA), Promoting Interoperability (PI), and Cost. The quality category replaces the Physician Quality Reporting System (PQRS) and reflects the efforts made to enhance the quality of care.
Improvement activities aim to improve patient satisfaction and convenience in the delivery of quality healthcare services. Promoting Interoperability replaces the Advancing Care Information program, formerly known as the meaningful use program, and promotes the integration of technology in healthcare. The cost category replaces the value-based modifier program and assesses the efficiency of cost factors.
Each category carries a different weight, and the respective percentages change annually under MACRA MIPS. Eligible clinicians who exceed the minimum performance threshold receive positive payment adjustments and avoid penalties.
While larger medical practices are already familiar with the implications of MIPS data reporting, smaller healthcare organizations and non-eligible clinicians need a comprehensive understanding of MACRA MIPS. In such cases, consulting a MIPS Qualified Registry for MIPS solutions is highly recommended.
Submitting data to the Centers for Medicare & Medicaid Services (CMS) under MACRA MIPS offers several advantages to eligible physicians. They can enhance the quality of care they provide, improve their ranking among peers through the Physician Compare portal, and receive incentives for exceptional performance. High achievers may even receive a portion of the $500 million bonus pool. However, succeeding under MACRA MIPS requires consistent efforts, and MIPS consultants can provide guidance throughout the process.
Despite the challenges posed by the COVID-19 pandemic, reporting data under MACRA MIPS can still be beneficial for MIPS-eligible clinicians. Incentives and the $500 million bonus pool are enticing opportunities, and a positive reputation on the Physician’s Portal can help increase patient volume. However, the success of reporting data depends on how individual clinicians, groups, and virtual groups effectively submit their data to CMS.
To report MACRA MIPS data, eligible clinicians have various options. However, the easiest and most comprehensive method is to utilize a MIPS Qualified Registry like P3Care. They select specialty-specific measures from the list according to CMS’s final rule.
We are currently in the middle of the QPP MIPS 2021 performance year, which means it is crucial to start strategizing the reporting process. MIPS consultants play a vital role in adapting to changing reporting requirements and maximizing incentives and bonuses. While reporting the Cost category is based on claim submissions, eligible clinicians must be prepared to implement profitable strategies in the Quality, Promoting Interoperability, and Improvement Activities categories to earn maximum points. Taking advantage of this opportunity can significantly improve revenue cycle management and prevent financial setbacks in 2023.
In conclusion, submitting MIPS data under MACRA is a complex task, but over the years, it has become increasingly important for physicians to participate in the quality payment program. Particularly during the COVID-19 pandemic, clinicians have faced significant financial losses while catering to the surge of patients. Incentive payment programs like MACRA MIPS provide a ray of hope by offering various forms of assistance. CMS has also provided flexibility in administrative burdens, making it even more beneficial for physicians to participate in such programs. Therefore, there is no reason to avoid participating in these programs.
