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The Merit-based Incentive Payment System (MIPS) presents many challenges. Understanding the MIPS Quality measures category is vital for clinicians aiming to enhance their performance scores. As we reach the halfway point of the 2024 MIPS reporting period, clinicians should be well into the process of collecting and submitting Quality data.
This year, the Centers for Medicare and Medicaid Services (CMS) is not granting COVID-19 hardship exemptions. It means some clinicians may be reporting under MIPS again for the first time in years and may encounter substantial changes.
In this guide, we’ll explore the 2024 Quality reporting requirements, review recent adjustments to quality measures and offer advice on selecting the most effective measures for your practice.
Let’s get started!
What is MIPS?
The Merit-Based Incentive Payment System (MIPS) is a program that decides Medicare payment adjustments. Based on a combined performance score, eligible clinicians can receive a payment bonus, a penalty or no change in payment.
MIPS is one way to take part in the Quality Payment Program (QPP), a federal program that reimburses Medicare providers who are eligible under MIPS for Medicare Part B services. QPP also rewards providers for enhancing patient care quality and outcomes.
MIPS Quality Measures Category
The MIPS Quality Measures category evaluates clinicians and groups based on healthcare quality measures, such as processes, outcomes and patient experiences. The weight of the Quality category varies depending on the size of the practice:
- MIPS category weights may change depending on special statuses, exception applications or adjustments to other performance categories.
- For small practices (15 or fewer NPIs) that do not report the Promoting Interoperability (PI) category, it accounts for 40% of the total MIPS score.
- For large practices (16 or more NPIs), it counts for 30% of the total MIPS score.
Requirements of MIPS Quality Measures Category 2024
The Quality performance category covers the entire year from January 1 to December 31, 2024. This means that data must be collected for each measure throughout the year.
Clinicians need to:
Choose six measures, which can include an outcome measure or a high-priority measure or use a specialty measure set or a MIPS Value Pathway (MVP). If using an MVP, you must select four quality measures from the list, including one outcome or high-priority measure.
Report data for at least 75% (up from 70% in 2023) of eligible encounters for all insurance types. This 75% requirement will remain the same for the 2025 and 2026 performance years.
Which Quality Measures Can Be Reported in 2024?
There are 198 quality measures available for reporting in 20204. Clinicians should choose measures that best fit their practice, based on the type of care they provide and the conditions they commonly treat. You can explore the full list of 2024 MIPS Quality measures or find those specific to a specialty.
Changes to the 2024 Quality measures compared to last year include:
- 11 new Quality measures
- Removal of 11 Quality measures
- Partial removal of 3 measures (only available for MVP use)
- Major updates to 59 existing Quality measures
Changes to Existing Quality Measures
Each quality measure has its own rules, which can change from year to year. These rules explain how to report the measure, including:
- How often the measure needs to be reported (for example, once a year or at every visit).
- Which group of patients should be reported (based on billing codes, diagnosis codes, age, gender, etc.).
- What actions need to be taken for the patients to meet the quality measures.
For 2024, CMS made significant changes to 59 MIPs quality measures. Clinicians should carefully check the measure rules to make sure they are reporting them correctly.
Understanding How Quality Measures are Evaluated
CMS will score the top 6 MIPs Quality measures, which must include at least one Outcome or High Priority measure. The points given for each measure will depend on several factors.
Below are the MIPS Quality Measures Scoring policies:
1-10 Points
Measures can earn between one and ten points based on how well a clinician or group performs. To earn points, the measures must have a benchmark, report data for at least 75% of eligible cases and include at least 20 eligible cases for the year.
7 Points
New measures in their first year automatically start with a score of seven points. They can earn between seven and ten points if they meet the benchmark, data completeness and case minimum requirements. If the measure doesn’t have a benchmark or doesn’t meet the minimum number of cases, it will still get seven points as long as the data completeness requirement is met.
5 Points
New measures in their second year start with a score of five points. They can earn between five and ten points if they meet the benchmark, data completeness and case minimum requirements. If the measure meets the data completeness requirement but doesn’t have a benchmark or doesn’t meet the case minimum, it will get five points.
0 Points
Measures will earn zero points if they don’t meet the data completeness or case minimum requirements, or if there’s no benchmark. However, small practices will still earn three points.
Closing Point
Staying up-to-date with the latest updates to MIPS Quality Measures in 2024 is essential for clinicians who want to improve their performance scores and meet the required standards. With changes to reporting requirements, the introduction of new measures and adjustments to existing ones, it’s crucial to carefully review the available options and select the most relevant measures for your practice.
If you need any help regarding MIPS quality, you may contact PrimeWell Med Solution right now!
