What is MIPS in Healthcare?
The Quality Payment Program’s Merit-based Incentive Payment System (MIPS) is one of two tracks for transitioning Medicare Part B providers to a performance-based payment system. MIPS has designed to tie payments to quality and cost-effective treatment and stimulate improvement in care processes and health outcomes. Besides this, according to the Department of Health and Human Services (HHS), it expands the use of healthcare information, and lowers the cost of care,”.
MIPS in healthcare combines the past three Medicare programs: the Physician Quality Reporting System (PQRS), the Value-based Payment Modifier (VM) Program, and the Medicare Electronic Health Record (EHR) Incentive Program (Meaningful Use).
All Medicare Part B providers that match the criteria of a MIPS eligible clinician should plan to participate in MIPS in 2022, otherwise, their Medicare Part B payments will be subject to a negative 4% payment adjustment in 2024. The recent phrase explains the literal answer to the question; What is MIPS in healthcare?
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MIPS in Healthcare:
What does MIPS stand for in healthcare? MIPS in healthcare stands for Merit-based incentive payment system. It is the program that will determine Medicare payment adjustments. A composite performance score has used in this program, and eligible clinicians may receive a payment penalty, bonus, or no payment adjustment. In the present era, healthcare refers to any aspect, service, or device that helps you take care of your health. It is not a gift, a purchase, or a saleable commodity.
Breaking Down MIPS
Before breaking down MIPS one should know about the literal MIPS healthcare meaning: it is a payment system that either reimburses or penalizes eligible clinicians after the designated performance period set by the CMS. MACRA regulates its function.
The MACRA Quality Payment Program (QPP) will be in its sixth year in 2022. And physicians have the option of either participating in an Advanced Alternative Payment Model (APM) or submitting data to the Merit-Based Incentive Payment System (MIPS).
After having a better understanding of; What is MIPS in healthcare? One must now dive into categories. MIPS in healthcare is a four-category performance-based payment system that gives clinicians the right to choose the activities and measures that are most significant to their practice. The MIPS Composite Performance Score, also known as the MIPS Final Score, is calculated by combining an eligible clinician’s performance in each of the four weighted performance categories. Such a score is used to determine Medicare Part B payment adjustments in future years.
MIPS’ Quality category replaces the Physician Quality Reporting System (PQRS), requiring eligible clinicians to provide data to CMS on quality measures. Such measures include; patient outcomes, proper use of medical resources, patient safety, efficiency, patient experience, and care coordination.
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MIPS – Promoting Interoperability
The promoting interoperability category encourages patient participation and electronic information sharing through the use of certified electronic health record technologies (CEHRT). In 2022, this performance category will account for 25% of your MIPS Final Score. MIPS-eligible clinicians must report data from their 2015 Edition CEHRT, 2015 Edition Cures Update or a combination of both.
MIPS’ Improvement Activities has designed to encourage eligible clinicians to participate in activities that enhance clinical practice in domains. These comprise shared decision-making, patient safety, care coordination, and access. Improvement Activities will account for 15% of a clinician’s or group’s final MIPS score in 2022.
The MIPS Cost category (also known as Resource Use) replaces the CMS Value-based Payment Modifier program and assesses eligible clinicians on resource utilization measures computed from Medicare claims. The Cost category will be weighted at 30% this year. In future MIPS performance periods, CMS has said that this category’s weight would grow.
The performance period for the 2022 MIPS quality category is from January 1, 2022, to December 31, 2022. During the year, clinicians can use a single reporting mechanism to provide data on quality measures at the individual, group, or Virtual Group level. Group reporting is the most convenient way to report.
For instance, when you are working with multiple providers in a single clinic, group reporting is an especially good idea. You can compare and contrast each individual’s MIPS score with the group’s average, making it easier to forecast payment adjustments. This also means fewer errors. For example, a clinician billing $1M a year might choose group reporting rather than individual reporting, so he or she only has to submit the information once to avoid replica data entry.
MIPS consulting services are a critical component of meeting the requirements of the new MIPS quality rating system. Our NEO MD Certified Registry of MIPS Consultants can help providers meet all four required categories of MIPS. They educate practice management and medical providers about the new system and develop workflows, processes, and protocols to meet these requirements. Our MIPS consultants also work with the practice to build a care team model and track progress toward the MIPS goal.
Finally, to recapitulate the article, what is MIPS in healthcare? We may reasonably arrive at the conclusion that MIPS in healthcare is the most authentic way to either reward or penalize clinicians for Medicare Part B claims. it ultimately enhances care quality, doctor-patient engagement, and revenue cycle management.