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5 MIPS topics for a solid MIPS strategy – Part 3

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The 2019 proposed and final rulemaking as well as the information available on the QPP portal have revealed a great deal about these topics… Read part three of our three-part series.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) replaced the Medicare Sustainable Growth Rate (SGR), which was how CMS previously controlled the cost of Medicare Payments to physicians. MACRA is aimed at strengthening Medicare access, improving physician payments, and encouraging better patient care among other improvements. Under MACRA, CMS is required to implement a Quality Payment Program (QPP), which offers clinicians and practices two separate tracks: (1) the Merit-Based Incentive Payment System (MIPS) track; and, (2) the Advanced Alternative Payment Model (Advanced APM) track. Both tracks can result in penalties for not meeting certain requirements/benchmarks or incentives for meeting and exceeding requirements/benchmarks.

When thinking about a solid MIPS strategy we narrow in on five topics:  eligibility, measure selection, penalties and incentives, and information availability. The 2019 proposed and final rulemaking as well as the information available on the QPP portal have revealed a great deal about these topics and how they should be considered within the scope of a practice’s MIPS strategy for 2019 and for years to come.

These five topics will be covered in a three-part series – welcome to part three. Parts one and two can be found here.

Information Availability

What is there to know and what is unknown? One of the most common mistakes we see by practices is to overlook the importance of access to the Quality Payment Program (QPP) portal. After almost a decade of poor information availability, CMS has finally provided a website that is easy to use and full of information that practices need to excel in a value-and-performance-based quality reporting system. Unfortunately, clinicians and practices have often neglected to explore this wealth of information.

Some of the information available on the QPP portal includes eligibility information, performance feedback, and beneficiary-level cost information.

Eligibility and reporting tab

This tab shows allowable charges at the group and individual level that are subject to adjustments based on past performance in several quality payment programs. It also includes group and individual eligibility information pertaining to various pay-for-performance programs.

Performance feedback tab

This tab shows past performance scoring feedback so that practices and clinicians can understand how they scored, where they need to focus improvement efforts, and what adjustment rates they will see in future or current billing years. Additionally, if CMS had inaccuracies in their review and calculation of submitted data, this is where practices can submit a target review to have CMS conduct a reassessment in order to reverse their errors.

Beneficiary level data

In the past, there was no window into what could be done to fix poor cost scores. As of July 2019, the performance feedback finally includes beneficiary-level information for practices to understand the cost information for the patients and the events that result in the scores they receive for the MIPS cost category.

2019 is finally seeing incentive rates that more closely resemble the incentive rates CMS had originally represented for the MIPS program. Now is the time to implement a solid MIPS strategy utilizing the correct resources and information.  More incentive dollars back into eligible practices means added attention and emphasis on the quality of care.

The criteria which determine MIPS eligibility are multi-faceted and complex. ReportingMD understands these criteria’s and works with client organizations to optimize incentive performance in the MIPS (and other value-based care programs.)

With the proven experience of our client services team and Total Outcomes Management (TOM™) a powerful measure calculation solution, ReportingMD can help you navigate the complexities of the MIPS program.

We were invited by CMS to help develop the MIPS program, which provides our team with unique expertise and a depth of experience that’s unmatched.

Using TOM™, practices can gain operational visibility to the quality performance of their physicians and avoid CMS penalties for non-compliance. TOM™ aggregates data from multiple sources to identify and manage patient care gaps.

Learn why mid to large sized healthcare organizations turn to ReportingMD for powerful tools that help improve patient care, improve quality outcomes, and maximize reimbursements.

About the author

Molly Minehan is ReportingMD’s Director of Client Services and Innovation

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