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Your Actual Clinical Performance May Be Better Than What is Indicated by MIPS Results

Your actual clinical performance may not be reflected in your MIPS results. If you’re missing out on important points that will increase your Composite Performance Score (CPS), you may be at risk.

Here’s why this is becoming more critical. Each year of the MIPS program, the payment adjustment amounts increase. Therefore, so does the importance of earning a higher MIPS Composite Performance Score (CPS). In fiscal year 2021, which is based on the 2019 performance year, the payment adjustment for a perfect CPS is anticipated to reach close to 5%.

There are two key items that you should know the answer to, in order to ensure that your MIPS results match your clinical performance.

The first item is knowing how your EHR or Registry tallies “met vs. not met” conditions and if they are doing so properly. If you are not documenting your data elements in discrete data fields within your EHR, it is very likely that those quality actions are not being reported and your reported performance is less than your actual performance. MIPS benchmarks continuously get harder to meet as quality measures become capped, topped out, or benchmarks are removed. The deviation between deciles becomes smaller and therefore a minimal amount of missed opportunities can have a heavy impact on your score.

The second item is knowing whether you are earning all possible bonus points for which you are eligible. By utilizing the electronic Clinical Quality Measure (eCQM) measure version, you can earn up to 6 more bonus points for end to end reporting in the quality category. Additionally, you could earn up to 6 more bonus points by reporting additional high priority and outcome measures above the required outcome measure. Additional high priority measures are worth 1 bonus point and additional outcome measures are worth 2 bonus points. Reporting measures that may be topped out or capped, but that are more likely to have higher performance versus reporting measures that are not topped out or capped but are poorly documented (or difficult to capture) should be reviewed prior to final measure submission.  If your practice has higher performance on these topped out and capped measures than measures that allow for 10 possible points, then you can utilize your bonus points to make up for the gap in possible achievement points. This is especially true for small practices that earn 6 bonus points in the quality category for their small practice special status. This allows for your practice to share the quality measures that they perform the best on, as well as still earn the highest possible quality category score.

If you are unsure about the above, ReportingMD has a solution for you. ReportingMD is focused on getting you the MAXIMUM score you can earn. Our Total Outcomes Management (TOM™) application allows operational visibility and our expert consulting for data, program and technology will set you up to earn the MAXIMUM score possible.

ReportingMD has a variety of options to collect data. Our consultants will help you to identify the data elements needed and assist with extracting those elements for reporting. In the scenario that documentation is severely sporadic, handwritten or just unable to be extracted; TOM™ has a manual update feature so that you do not miss out on any performance due to practice limitations. Your own Dedicated Advisor will work with you to optimize your score, ensure you are earning all possible bonus points and help identify missed opportunities so that you can close care gaps.

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 engine, ReportingMD can help you navigate the complexities of the pay-for-performance landscape.

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.

The experience of our client services team helps guide measure selection and a reporting framework designed for success. At ReportingMD, we help our clients earn the highest possible performance reimbursement possible.

 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 MIPS Program

The Medicare Access and CHIP Reauthorization Act of 2015 (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 (aka MIPS) track; and, (2) the Advanced Alternative Payment Model (Advanced APM) track.


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