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The Merit-based Incentive Payment System (MIPS) is a reimbursement program that rewards high-value and high-quality healthcare performance with pay increases and monetary incentives. Designed to drive improvement in care processes and health outcomes, MIPS’ core goal is to support a healthier population.
Despite its potential, MIPS poses some serious challenges, the biggest of which is reporting. MIPS reporting and scoring is not always the most accurate nor the most reliable reflection of care quality, especially when providers only report performance measures that are relatively easy to achieve.
Registry reporting vs eQCM reporting
When it comes to MIPS reporting, there are two main ways to track and report: with a registry or eQCM.
Registry reporting is a long-standing, traditional reporting method. Despite there being newer and more efficient models, registry reporting has its benefits. These include:
- Comprehensive flowsheets to track trends and plan ahead
- Detailed dashboard to monitor data and track progress
One disadvantage of registry reporting is its inability to stand alone without a supporting documentation system. Registry reporting requires a tedious amount of admin that wastes a practice’s valuable time, energy and resources.
But the major disadvantage of registry reporting is that the points earned for a specific quality measure are lower when reported through a registry in comparison to an eCQM reporting method.
Electronic Clinical Quality Measures (eCQMs) reporting systems work alongside electronic health records (EHRs) to increase access to real-time information. Working in real-time with automated processes and systems, eCQMs have the advantage of reducing the need for additional IT resources, and administrative support for MIPS reporting. This means:
- Reduced time and energy spent on the turnkey submission process
- Maximized financial reimbursement by earning the most MIPS points
While eCQM reporting does rely on clinical data extracted from the medical record, it is vital that the clinical record be organized, and the tool(s) used for extraction are designed to scrub elements against countless combinations of available measures. The integration between the EHR and the extraction software must be seamless with constant feedback to the providers.
The challenges of MIPS reporting
Like any program, MIPS has some disadvantages. These include:
MIPS is a budget-neutral program, and every positive pay-out is funded by the negative adjustments of poor performers.
MIPS has comprehensive reporting frameworks which can occupy a significant amount of time and attention, thereby taking away the attention from care delivery. With penalties in place for poor performance and non-participation, it’s important that all reporting is done correctly, accurately, and on time.
Data collection runs from January 1 to December 31 each year and all reporting must be completed by March 31 the following year.
Eligibility status is specific to each practice that you are associated with and is based on these factors:
- Clinician type – you must be a MIPS eligible clinician type on Medicare Part B claims.
- Enrolment date – you must have enrolled as a Medicare provider before 2021.
- APM Status – you must not be a Qualifying Alternative Payment Model Participant.
- Threshold – you must exceed the low-volume threshold:
- Bill more than $90,000 for Part B services
- See more than 200 Part B patients
- Provide 200 or more covered professional services to Part B patients
If your practice is eligible for MIPS, you are required to report activity and measure data for performance throughout the performance year.
Though there are criteria for exemptions, these are subject to change and may not be available for 2022 filing. Unless exempt from MIPS reporting, penalties are in place for non-participation. These penalties can be as significant as 9% of Medicare revenue for not participating and not earning sufficient points to make it to the bonus pool.
Having a reporting plan in place is crucial to meeting the comprehensive reporting criteria and maximizing payment adjustments.
MIPS Reporting Options
Traditional MIPS reporting is the original reporting framework and can be used to select quality measures and improvement activities to collect data for and report on.
APM Performance Pathways
The APM Performance Pathway, short for the Alternative Payment Model Pathway, is a newer, more streamlined reporting framework that aims to simplify reporting by creating new scoring opportunities.
MIPS Value Pathways
MIPS Value Pathways, also known as MVPs, offer a subset of measures and activities that are more relevant to specialties, medical conditions, or episodes of care, making them more meaningful to specialized services.
How to improve MIPS reporting
Despite the challenges posed by MIPS reporting, there are ways to simplify and improve the process. These include:
Determining eligibility early
With extensive reporting frameworks and significant penalties in place for non-participation, determining eligibility early is a vital part of the process. Pre-outlining your benchmarks and specifications helps you to select target measures early on and start recording your best-performing measures to guarantee maximum payment adjustments.
You can determine eligibility and ensure compliance by:
- Checking if you’re participating as an individual group, virtual group, and/or APM entity.
- Confirming which reporting framework you’ll follow to collect and submit data.
- Establish if you qualify for reporting factors that may impact your reporting requirements.
- Reviewing the current performance year’s quality measures and determine which collection types (eCQMs, claims measures, etc.) align with your reporting requirements.
- Stay up to date with your eligibility status to assist in planning your reporting requirements.
Leveraging electronic technology
EHRs that can trigger Electronic Clinical Quality Measures (eCQMs) have increased benefits, making it easy to measure and track the quality of healthcare services.
Built into EHR systems, eCQMs are simple and easy to use and help practices across the US simplify MIPS reporting. With structured fields for reporting, eCQMs minimize the need for manual data entry whilst maximizing the total number of MIPS points.
With automated processes, eCQMs help to ensure healthcare providers deliver effective, safe, and efficient patient care without missing out on valuable MIPS points.
Practice EHR is The One partner you need to simplify and improve the MIPS reporting process. With our comprehensive cloud-based systems, you’ll streamline the complex reporting process to eliminate the worry of penalties and maximize time spent on care delivery.
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