MIPS Blog

Technology has transformed how consumers perform a variety of daily activities and transactions. With a computer or smartphone, they can buy tickets and book travel, access their bank accounts, use GPS map assistance and so much more. Unfortunately, they don’t have the same flexibility when it comes to healthcare. This is changing, however, with the development of a new standard for exchanging electronic healthcare information called the Fast Healthcare Interoperability Resource, or FHIR (pronounced “fire”).  

The MIPS Promoting Interoperability (PI) category, which replaced the Meaningful Use program, establishes requirements that promote the electronic exchange of information using certified electronic health record technology (CEHRT). MIPS eligible clinicians and groups are scored on their performance on several PI measures. Making sense of all of the requirements can be challenging, so let’s examine how to report the PI category and the potential impact on the MIPS final score.

2020 MIPS performance feedback reports, which include MIPS final scores and payment adjustment information, are now available. Clinicians and groups should carefully review their reporting results. Any positive or negative payment adjustment will apply to their 2022 Medicare Part B payments for covered professional services. A targeted review can be requested until October 1, 2021, if clinicians believe an error was made in their 2022 MIPS payment adjustment calculation.

On July 13, 2021, the Centers for Medicare and Medicaid Services (CMS) issued the Proposed Rule for the 2022 Medicare Physician Fee Schedule (PFS) which includes several proposals to implement changes to the Quality Payment Program (QPP). CMS is accepting public comments on the Proposed Rule until September 13, 2021, and is expected to release a Final Rule later this year. The proposal includes significant revisions to the existing MIPS program and outlines a timeframe for transitioning to the new MIPS Value Pathways (MVPs). Here are the key takeaways that will have a major impact on the future of clinician reporting.  

A timeframe to gradually implement the new MIPS Value Pathways (MVPs) program was recently released as part of the Proposed Rule for the 2022 Medicare Physician Fee Schedule (PFS). The proposal would allow clinicians to report MVPs beginning with the 2023 MIPS performance year. This article answers key questions about MVPs and how MIPS reporting is expected to change in the years ahead.  

The MIPS Improvement Activities (IA) performance category measures a clinician or group’s engagement in clinical activities that improve clinical practice, care delivery, and outcomes.  It is one of four categories under the MIPS program. This year clinicians will need to attest to Improvement Activities, in addition to reporting the MIPS Quality and Promoting Interoperability categories, to ensure they reach the new minimum threshold of 60 points to avoid a MIPS penalty. This article provides an overview of the Improvement Activities category, explains how to maximize MIPS points, and offers tips on selecting activities most relevant to a clinician’s practice.

The MIPS Cost category weight is increasing to 20% of a clinician’s final MIPS score in 2021 and 30% in 2022. The increase reflects the priority that the Center for Medicare and Medicaid Services (CMS) has placed on controlling the cost of health care services as a component of the MIPS program. As Cost makes up a larger portion of the total MIPS score, it’s beneficial to understand how CMS measures Cost. Let’s review the basic components of the Cost category and examine strategies to manage and potentially improve performance.

CMS has proposed to sunset the Web Interface in 2024, so this will no longer be a data submission option going forward for Accountable Care Organizations (ACOs). ACOs participating in the Medicare Shared Saving Program (MSSP) will be required to report on all-payer eCQM/CQM MIPS measures established under the new APM Performance Pathway (APP). While these changes will present some challenges for ACOs, this article provides some tips to help prepare for the end of the Web Interface and to support compliance with the new reporting requirements.

The Centers for Medicare and Medicaid Services (CMS) Primary Care First (PCF) program is a new alternative payment model designed to support the delivery of advanced primary care. The program began in 2021 and it will examine whether financial risk and performance based payments that reward primary care clinicians will lower Medicare costs and improve health care quality. PCF participants must annually report data on specific quality measures, including the quality measure Advance Care Plan (ACP) which requires a Qualified Registry or QCDR vendor for reporting since it is not an EHR reportable measure. As a CMS Qualified Registry, MDinteractive can support practices participating in the program by reporting this measure on their behalf.

Please note: Cohort 1 practices must report ACP using a Qualified Registry or QCDR for PY 2021; Cohort 1 practices that fail to do so will not be eligible for a positive performance-based adjustment (PBA) in PY 2022.

You can finally breathe a sigh of relief that the 2020 MIPS reporting season is over! Now it’s time to turn your attention to 2021 MIPS reporting so you don’t get behind the curve.  This year reporting will be more complex and require early planning to meet the new requirements.   Developing a reporting strategy now will ensure you are better prepared for a successful outcome.