MIPS: your dos and don'ts
2/23/2022
Dear providers, now is the perfect time to get acquainted with MIPS!
Merit-based Incentive Payment System (MIPS) is a compulsory quality payment and incentive program (QPP) for Medicare-participating providers. It is an annual evaluation campaign that you are obliged to sign up for if you qualify.
How does it work?
MIPS is all about making sure that your practice is on the same page with the contemporary quality measurements and rewarding you for it if you are. Since this is an annual program, MIPS evaluates your services performed within 1 calendar year. Four aspects are considered upon participation:
• Quality
• Cost
• Improvement Activities
• Promoting Interoperability
Why is it so important?
Participation in MIPS helps you to ensure that you provide top-quality services to your patients, while also doing your best to document it. Besides, an incentive can be quite beneficial in these extraordinary times.
How do I know if I am obliged to participate?
MIPS eligibility can be checked online by entering your NPI on the CMS Quality Payment Program portal:
You will not receive any invitation or notification from the CMS requesting your participation.
I am an eligible healthcare provider. How do I sign up? What are the steps to take to enroll in this program?
First, you would need to make sure that your data is getting reported & collected on a permanent basis, starting from January 1st, and ending by December 31st of a respective year. Then, you would familiarize yourself with the current quality measures and reporting requirements to make sure that you comply with them. Afterward, your data would have to be gathered and submitted to the CMS by March 31st, 2022. Once you submit the data, just wait for final feedback by July 2022.
I submitted the documentation on time. How do I find out the outcome of the evaluation? Also, how much would I earn if I prove that my services are "in a good condition"?
The outcome can be checked on the CMS QPP portal. Once logged in, you would be able to see the final score of your performance (0-100). This score determines the outcome of your participation. There are three possible outcomes:
Positive - your future Medicare payments will be positively adjusted by 9%
Negative – the same payments will be negatively adjusted by 9%
Neutral – your payments will not be adjusted at all.
These adjustments become effective in 2 calendar years since the evaluation year. For example, if you submitted your documentation for 2021, you would see the changes for the dates of service after January 1st, 2023.
What if I decide not to participate in this program?
Opting out of MIPS, as well as failure to submit the documentation in a proper manner will result in a negative adjustment applied to your practice in the future.
Can WCH help me with that?
Yes. Here is what we can do to ensure that your practice is up to date with the current state of affairs when it comes to MIPS:
• Assistance in the monitoring of measurement period
• Preparation of the results of monitoring
• Coordination of quality measures, improvement activities, promoting interoperability and cost performance categories
• Follow-up calls to the QPP client support center
• Keeping you informed about any new guidelines
• Regular review of your documentation
• Assistance in registration on the QPP and CMS web portals
• Keeping you updated on potential causes of a negative adjustment.
Interested? Contact us using the form on our homepage.
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