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MIPS - The Basics

CMS Wants to Measure the Quality of Your Care
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The federal government knows that the best way to get an industry to change is by poking its wallet.

At the start of 2017, CMS (that’s Medicare) announced a new Quality Payment Program called MIPS (Merit-based Incentive Program, as if we needed more acronyms from CMS). MIPS is like the great-great-grandchild of Meaningful Use, another program that financially incentivized physician practices and hospitals to make changes the federal government wants. After Meaningful Use and Meaningful Use 2 came PQRI, and then PQRS, and now MIPS.

In 2017, CMS laid out MIPS like this: complete a few tasks (or “measures”) that prove you’re improving the quality of your care and we won’t cut your Medicare reimbursements; but complete several measures along those lines and we will increase your Medicare reimbursements. Those various measures each have a weighted score attached to them, like in a football game. Some MIPS measures are worth 7 points, some worth 1, and so on. For the first year of MIPS (2017), you had to score at least 3 points to avoid having 4% of your Medicare reimbursements cut in 2019. For the reporting year of 2018 (which ended in March 2019), you had to score 15 points to avoid losing 5% of your Medicare reimbursements in 2020.

But in 2019, you have to score a minimum of 30 points just to avoid losing 7% of your Medicare reimbursements in 2021. Needless to say, this game CMS created is getting more difficult and more important. To add to that stress, CMS is building a website wherein all clinicians’ MIPS scores are published and available to the public. If you don’t score well in MIPS, the whole world will see and think you provide sub-par care based on the data you reported to CMS. Worst of all, private payers are beginning to use MIPS scores to determine their reimbursement rates and physician fee schedules!

 

SO HOW DO WE GET A BETTER MIPS SCORE?

Quality Scores

By completing Quality measures, you can score up to 45 points for MIPS 2019.

Promoting Inter-operability

You can score up to 25 points by completing Promoting Interoperability measures for 2019.

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Improvement Activities

You can score up to 15 points by completing Improvement Activities (also called CPIAs or IAs) for 2019. These are small projects your practice can complete quickly. But in 2019, you have to do more to avoid a 7% penalty!

Cost

You can score up to 10 points for Cost in 2019. However, this category is calculated by CMS and their is almost nothing a medical provider can do to influence their Cost scores unless they use IntellicureEHR. CMS only recently released details about Cost measures and they have stated that providers will receive an average of 3-5 points toward their total MIPS score. That will likely change in 2019.

Is MIPS worth my time?

Is 35 minutes worth saving 7% of your Medicare reimbursements? If so, sign up now.

The US Wound and Podiatry Registries makes MIPS reporting super easy. We’ll help you beat MIPS and avoid the 7% penalty as fast as possible. Most customers meet the minimum MIPS requirements in about 35 minutes. 

MIPS Gets Way Harder in 2019

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Penalty Increase

The penalty for not meeting the minimum requirements of MIPS in 2019 increases to a 7% cut of your Medicare Reimbursements. It was 5% in 2018.

Minimum Score Increase

The minimum required score to avoid the 2019 MIPS penalty doubles to 30 MIPS points. It was only 15 points for MIPS 2018.

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More Work

You can no longer beat MIPS by only completing Improvement Activities. You must now also complete another MIPS component -- like Quality measures or Promoting Interoperability measures -- in order to meet the 2019 MIPS minimum requirements and avoid a 7% reduction in Medicare reimbursements.

Must Use a Certified EHR

CMS is requiring all medical providers to use a CEHRT (2015 Certified EHR) in 2019 in order to meet the minimum MIPS requirements and avoid a 7% cut to their Medicare reimbursements. If your EHR isn't certified, we recommend making the easy switch to our partners at Intellicure.