Basics of MIPS

The US legislation has introduced a medical reimbursement framework. The physicians should have enough know-how of the MIPS payment adjustments. It is also necessary for the companies which are offering the Medical Billing Services in USA to comply with MIPS. In this article, we will assist you to understand the basics of MIPS in just a short span of 3 minutes. Let’s get started!

Introduction to MIPS

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) entails the Centers for Medicare and Medicaid Services (CMS) to promulgate an incentive program referred as Quality Payment Program (QPP) for changing the payment structure for the Medicare Patients. It emphasizes the quality of the outcome. The Quality Payment Program (QPP) offers two tracks:

  • MIPS (Merit-based Incentive Payment System)
  • APMS (Advanced Alternative Payment Models)

Under MIPS, the Medical Practitioners and other clinicians submit all the measures and steps which they have taken ahead to focus on the quality. It requires evidence-based and specialty-specific standards. MIPS influences the performance, management, and reporting of the physicians explicitly.

Timeline of MIPS

MIPS was enforced on January 1, 2017. The timeline of the MIPS is as follows:

  • April 27, 2016: Introduce MACRA rule containing draft MIPS code of practice
  • October 14, 2016: MACRA final rule published, expounding the Quality Payment Program (QPP)
  • January 1, 2017: First MIPS performance year begins
  • June 20, 2017 – 2018: draft rule for the Quality Payment Program published
  • August 31, 2017: Comments due on the 2018 draft rule

There is no suggested official date to end MIPS until now.

Financial Impacts:

There are two financial impacts defined by MACRA:

  1. A short annual inflationary regulation to the Part B Fee Schedule.
  2. MIPS value-based payment adjustments (incentives or penalties) based on the MIPS 100-point final score.

These are the basics of MIPS. MIPS encourage the promotion of the ongoing improvements and innovations by the Clinicians. The companies who are providing the services of medical billing and coding can also help the physicians in making a perfect report for Merit-based Incentive Payment System.

Eligibility Criteria for MIPS

CMS referred the professionals included in MIPS as “MIPS eligible clinicians.” MIPS eligible Clinicians are defined as follows:

2017 and 2018 Performance Years:

  • Physicians (MD/DO and DMD/DDS)
  • Physician Assistants
  • Clinical Nurse Specialists
  • Certified Registered Nurse Anesthetists

2019+ Performance Years:

  • Physical and occupational therapists
  • Speech-language pathologists
  • Audiologists, nurse midwives
  • Clinical social workers
  • Clinical psychologists
  • Dietitians/nutritional professionals

Exemptions from MIPS

The Clinicians who are not included in the general definition of MIPS eligible Clinicians are exempted from the MIPS payment adjustment system. Moreover, the physicians, who would consider otherwise MIPS qualified clinicians, may not be included in MIPS even if they are MIPS eligible Clinicians; they would be excluded from the MIPS payment adjustment if they meet the following criteria for one of the three MIPS exclusion.

  1. Clinicians enrolled in MIPS performance period are excluded from reporting until the following [performance year.
  2. Qualifying APM Participants (QPs) are exempted.
  3. Clinicians that are billing Medicare Part B around $30,000 in allowed charges or providing care for up to 100 Part B patients in one year.

Factors affecting the payments:

Following are the four factors that can affect the Medicare Payments to a large extent:

  • Quality: it can affect the payments by up to 60%
  • Cost: the Cost has typically had a minimum or no effects on the MIPS payments
  • Improvement Activities: Improvement Activities can affect the payments by 15%.
  • Advancing Care Information: The advancing Care Information can change the MIPS payments by 25%.