MIPS can seem like an overwhelming program. The commitment is a yearlong event, the charting burden seems never-ending, and the criteria change every year and seem to grow increasingly harder. On top of that, MIPS participation is mandatory for many clinicians, so even a few missteps can cost a pretty penny.
But not all is doom and gloom. With some organization and attention to detail, clinicians can nab bonus pay — or apply for qualifying exemptions and avoid the penalties. When the right steps can turn a harsh 9% penalty into a delightful 9% bonus, it’s fair to say those steps are worth taking.
What is MIPS in CMS, and what is the purpose?
MIPS, which stands for Merit-based Incentive Payment System, is a points-based payment program that either rewards or penalizes Medicare Part B clinicians for providing a better quality of care. The Centers for Medicare & Medicaid Services (CMS) runs MIPS under the Medicare program.
Every year, CMS scores clinicians on a 100-point system across a few categories and generates a Composite Performance Score. Based on this final score, CMS adjusts payment for Medicare services.
The goal of MIPS in health care is to compensate clinicians for performance and value rather than just for service. It’s an effort to change business as usual and encourage a patient-first focus and better treatment outcomes — but without the threat of payment cuts.
Should you focus on MIPS in 2022?
MIPS success is important for clinicians who bill Medicare in high volume. It takes a lot of time and effort, but those who score well can earn higher rates for Medicare services. With health care margins already razor-thin, a high MIPS score can mean the difference between scraping by and thriving. In other words, it pays off.
Who can participate in MIPS in 2022?
MIPS is limited to certain types of clinicians. To participate, they must first be approved to bill Medicare Part B covered services and they need to meet the low-volume threshold. Some eligible clinicians include:
- Physicians
- Physician assistants
- Nurse practitioners
- Clinical psychologists
- Physical therapists
- Registered dietitians
- Certified nurse-midwives
Exemptions
If a clinician first enrolled in Medicare in January 2022, they’re exempt from MIPS reporting for this first year. Those who achieve Qualifying Alternative Payment Model (APM) Participant status under the Advanced APM track may also be exempt. To achieve this status, they must:
- See 35% of Medicare patients through Advanced APM or
- Receive 50% of Medicare Part B payments
How is MIPS measured?
A MIPS score is based on measures in four categories, each with a different weight. The score evolves over the course of the year, but clinicians should shoot for an end goal for 2022: 75 points or higher. This is the threshold for steering clear of a painful financial penalty.
What are MIPS measures?
There are four MIPS categories to track: Quality, Cost, Improvement Activities, and Promoting Interoperability. Each one has a variety of measures, except for Cost scores. CMS calculates these from Medicare claims and matches them against benchmarks.
Clinicians choose up to 15 MIPS Quality Measures from a list of 200 and then report on them for at least 70% of cases. The top six are automatically graded, so many groups choose between eight and 10 to allow for better performance in some measures than others.
In the Improvement Activities category, clinicians choose between two and four activities that focus on patient safety and coordination and report on them for 90 consecutive days.
Promoting Interoperability measures look at how well a clinician engages with a patient and exchanges information. The score is based on MIPS measures such as; e-prescribing, providing patient access to health records, and more. It also requires a 90-day reporting period.
How to calculate your MIPS score
The Composite Performance Score is a max of 100 points, and the final MIPS score depends on the points a clinician accrues in each category. CMS weights each category differently:
- Quality: 30%
- Cost: 30%
- Promoting Interoperability: 25%
- Improvement Activities: 15%
Risks and benefits of MIPS scores
Focusing on the MIPS score could be worth its weight in gold. The final MIPS score changes a clinician’s Medicare payment rate, so a successful year means providers enjoy up to an extra 9% bonus pay.
On the flip side, those who perform poorly take a stiff hit to the pocketbook. CMS added two new changes for 2022 that significantly affect payments:
- Each clinician must achieve a minimum final score of 75 MIPS points. Falling short of 75 points means they’ll automatically receive a penalty adjustment of -9% on payments in 2024.
- If an eligible clinician doesn’t participate, CMS will automatically lower 2024 payments by 9%.
A 9% penalty all year is a hefty price to pay for most businesses, but especially for clinicians. Ignoring MIPS can put a serious dent in profits.
MIPS 2022: Success with ChartPath
One of the best ways to achieve high scores in the MIPS program is to monitor performance all year long. With EHR software like ChartPath, clinicians can track performance against MIPS benchmarks and shorten reporting time with a simple click. With charting contributing 30% of the MIPS score and Interoperability at 25%, finding ways to improve these areas can significantly impact scoring.
Learn how ChartPath can simplify the process. Schedule a demo to chat with our MIPS experts about boosting your score and successfully navigating MIPS while delivering quality, patient-focused care.
