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Think about the last time your medical practice had a quiet, stress-free day. If you can not remember a peaceful day, it could be because you are running under the traditional fee-for-service model. It eventually encourages seeing as many patients as possible to generate profit.
Many doctors are not satisfied with this model, and policymakers are not too happy either. That is why in 2015, MIPS and MACRA term used. The government introduced a law called the Medicare Access and CHIP Reauthorization Act (MACRA), which created the Merit-based Incentive Payment System (MIPS). MIPS helps shift some healthcare providers away from the fee-for-service system.
In this guide, we’ll help you learn more detailed information about MIPS and MACRA.
Let’s get started!
What is MACRA?
The Medicare Access and CHIP Reauthorization Act (MACRA), passed in 2015, was a landmark piece of legislation designed to overhaul Medicare payment systems. Prior to MACRA, physicians were often frustrated with the fee-for-service model, where payment was based solely on the volume of care provided. This system often incentivized unnecessary treatments and didn’t prioritize quality or patient outcomes.
MACRA aimed to address these issues by replacing the Sustainable Growth Rate (SGR) formula with a more sustainable and value-driven approach.
It introduced two primary pathways for healthcare providers:
- The Merit-based Incentive Payment System (MIPS)
- Advanced Alternative Payment Models (APMs)
What is MIPS?
One of the two tracks in MACRA is the Merit-based Incentive Payment System (MIPS). The MIPS track under MACRA is designed to measure the performance of healthcare providers across various measures. Providers receive scores on these measures, and those scores determine whether a provider will be penalized or rewarded under MIPS and MACRA guidelines.
MIPS concentrates on 4 key performance categories:
. Quality
This category assesses the quality of care offered by a healthcare provider, considering patient outcomes, preventive care and chronic disease management.
. Cost
This category measures the efficiency of care provided, including the cost of services delivered to patients.
. Improvement Activities
Healthcare providers are incentivized for efforts to improve care processes, such as patient access to care or care coordination activities.
. Promoting Interoperability
Providers are evaluated on how effectively they use certified electronic health record (EHR) technology to improve patient care and facilitate information exchange between systems.
How Does MIPS and MACRA Affect Healthcare Providers?
MIPS and MACRA, therefore, have immense financial implications for healthcare providers. The scores you make in the MIPS categories have direct implications on your Medicare reimbursement. The higher your score, the more money you get, and a lower score may result in penalty payments.
MIPS performance is measured against benchmarks set by the Centers for Medicare and Medicaid Services (CMS). The better your performance, the more likely you are to receive a financial incentive.
However, poor performance or failing to submit data in any of the required categories can lead to penalties, which may reduce your Medicare payments for the following year.
How Do MIPS Penalties Work?
MIPS penalties are determined by your total performance score across the four categories. If your score is below a certain threshold, you will face a penalty in the form of reduced payments. Penalties can be high. In recent years, penalties for non-compliance or low scores under MIPS and MACRA have ranged from 4% to over 9% of Medicare reimbursement, depending on the provider’s overall performance.
Failure to report data for even one category could mean a score of zero for that category, which may greatly affect your total score and result in penalties.
About Our Prime Well Med Solutions Company
At Prime Well Med Solutions, we provides MIPS healthcare service and discuss the complexities of MIPS. Our team ensures your practice meets all performance measures in quality, cost, improvement activities, and interoperability. By simplifying the reporting process, we help you maximize reimbursements and avoid penalties.
With our expertise, you can focus on delivering exceptional patient care while we handle the MIPS requirements. Partner with us to boost your practice’s performance today!
5 Strategies to Avoid MIPS Penalties
Avoiding penalties under MIPS and MACRA requires careful planning and proactive steps.
Here are a few strategies that can help:
. Start Early
MIPS reporting is annual, running from January to December. Starting early gives you enough time to gather and analyze data, allowing you to make improvements in areas that need attention.
. Track Your Progress
Regularly monitor your performance using the available tools from CMS or third-party vendors. Tracking your progress helps you identify potential problem areas before the reporting deadline.
. File Accurate Data
Ensure that the data you submit is accurate and complete. Inaccurate or incomplete submissions can lead to penalties. Double-check your submissions to avoid costly mistakes.
. Focus on Key Areas
If you identify any weaknesses in areas like quality or cost, focus on improving those specific categories. Quality improvement initiatives, such as enhancing care coordination or increasing preventive services, can help you achieve a higher score under MIPS and MACRA guidelines.
. Engage in Improvement Activities
Participate in improvement activities that are relevant to your practice. This could include things like increasing access to care, implementing care coordination systems, or using telemedicine to reach more patients.
Tips for Maximizing MIPS Incentives
Maximizing your MIPS score is essential for earning incentives and increasing your Medicare reimbursement. Here are some tips to help you achieve that:
Exceed Performance Benchmarks
Aim to exceed the minimum thresholds for each MIPS category. For example, achieving higher-than-required patient engagement or exceeding quality measure thresholds under MIPS and MACRA can earn you extra points and improve your overall score.
Leverage Bonus Opportunities
MIPS presents bonus eligibility for certain measures, for example, Measure reporting high-priority measure or the participation in the specified improvement activities. Use bonuses to score higher.
Use Data for Improvement
Consider your data to know your performance weakness. For example, by improving patient satisfaction or increased preventive screenings could help elevate your quality scores.
Optimize EHR Usage
For the Promoting Interoperability category, make sure that your EHR system is actually being used to its fullest potential. To show meaningful use of EHRs can really boost your scores in this category.
What to Do Next? – Closing It All!
For healthcare providers seeking to thrive under MIPS and MACRA, it’s essential to stay up-to-date on the constant changes in these programs. It will be helpful to follow new rules, updates, and performance metrics in making the best decisions for your practice.
By adopting these value-based care models, you are ensuring financial security while doing your part for the high-quality care to be brought to your patients.
If you need more help in understanding MIPS and MACRA, reach out to Prime Well Med Solutions right now!
