The Merit-based Incentive Payment System (MIPS) is an essential component of the Quality Payment Program (QPP) implemented by the Centers for Medicare & Medicaid Services (CMS). MIPS aims to improve the quality of healthcare services by rewarding providers based on their performance across various categories. These categories include Quality, Cost, Improvement Activities, and Promoting Interoperability. In this detailed guide, we will explore the intricacies of MIPS healthcare services providers, their roles, responsibilities, and the impact of MIPS on the healthcare system.
Understanding the Merit-based Incentive Payment System (MIPS)
The Four Performance Categories
Quality: This category measures healthcare outcomes, process improvements, patient safety, and efficiency. Providers must report on specific measures that reflect their practice and patient population. Quality accounts for 45% of the total MIPS score.
Cost: Cost measures the resource use associated with treating patients. CMS evaluates this through claims data, with no additional reporting required by providers. Cost makes up 15% of the total MIPS score.
Improvement Activities: This category assesses providers based on their participation in activities that improve clinical practice, such as enhancing patient engagement and safety. Improvement Activities account for 15% of the total MIPS score.
Promoting Interoperability: Previously known as Advancing Care Information, this category focuses on the use of certified electronic health record technology (CEHRT) to improve patient care. Promoting Interoperability represents 25% of the total MIPS score.
Scoring and Payment Adjustments
MIPS scores range from 0 to 100 points, with providers’ scores determining their payment adjustments. These adjustments can be positive, neutral, or negative, impacting Medicare Part B payments two years after the performance year. High-performing providers may receive additional positive adjustments and exceptional performance bonuses.
Roles and Responsibilities of MIPS Healthcare Services Providers
Clinicians Eligible for MIPS
MIPS eligible clinicians include physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists. These clinicians must meet certain criteria, such as billing more than $90,000 in Medicare Part B allowed charges, providing care to more than 200 Medicare patients, and offering over 200 covered professional services to Medicare patients annually.