MACRA- Merit-Based Incentive Payment System
(MIPS)
MIPS Overview
MIPS is a key component of the Quality Payment Program (QPP) implemented by the Centers for Medicare & Medicaid Services (CMS). It is designed to measure and incentivize healthcare providers based on the quality, cost, improvement activities, and promoting interoperability of their services.
Who’s In: MIPS is tailored for individual clinicians and group practices meeting specific CMS thresholds. Eligible clinicians encompass a spectrum, including physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse.
Navigating Penalties: Participation in MIPS is not just a choice; it’s a strategic move. Failing to engage or achieving suboptimal scores can result in financial penalties. CMS recalibrates Medicare Part B payments based on MIPS performance, directly impacting the financial health of your practice.
MIPS Performance Categories
Promoting Interoperability: Promoting Interoperability replaced Meaningful Use to continue the effort for secure exchange of health information and the use of certified EHR technology (CEHRT). For most providers, this category is worth 25% of the MIPS final score.
Improvement Activities: The Improvement Activities (IA) performance category focuses on care coordination, beneficiary engagement, and patient safety. The IA category is worth 15% of the MIPS final score.
Cost: The Cost performance category is an integral component of MIPS, constituting 30% of the final MIPS score. Its primary goal is to track national healthcare spending and utilize this data, adjusted for risk and other factors, to establish benchmarks for value-based care.
Why Choose Optimity Health Solutions for MIPS Services?
At Optimity Health Solutions, we take pride in offering a suite of MIPS services designed to empower healthcare providers in navigating the complexities of the Merit-Based Incentive Payment System (MIPS). Our commitment to excellence is reflected in the comprehensive support we provide across various aspects of MIPS reporting.
Setting Quality Measures:
Our dedicated team is ready to assist in selecting the most impactful six quality measures tailored to your specialty. With vigilant performance monitoring and strategic improvement activities, we ensure your practice not only complies but excels. Count on us to maximize weighted scores, contributing to both enhanced patient outcomes and increased MIPS incentives.
CPT & QDC Selection:
Our team specializes in authentic and active Quality Data Codes (QDCs), specified CPT® II codes, and G codes essential for the meticulous submission of quality data. Trust our expertise to ensure precision in code selection, facilitating seamless compliance with MIPS requirements. Partner with us for a streamlined approach to coding, enhancing the overall efficiency and effectiveness of your reporting processes. With Optimity Health Solutions, rest assured that your MIPS submissions are in expert hands, reflecting the highest standards of coding accuracy.
Audit and CDI:
Optimity Health Solutions specializes in comprehensive audits and Clinical Documentation Improvement (CDI), committed to elevating the quality of your clinical documentation. Our expert team ensures With a focus on fulfilling CMS requirements, our experts ensure that your documentation meets the standards. Future orders will be seamlessly aligned with documentation requirements, preventing issues and promoting compliance.
Data Reporting
&
Submission:
Optimity Health Solutions is your trusted partner for streamlined MIPS reporting and submission. Our dedicated team excels in Quality, Interoperability, Improvement Activities, and Security Risk Assessment (SAFER). With precision and expertise, we ensure seamless data compilation and submission across all categories. Prioritizing accuracy and compliance, we go beyond regulatory requirements, emphasizing the safety and integrity of your data. Choose Optimity for a comprehensive and secure solution, integrating regulatory compliance and data security seamlessly into your healthcare practice.
Frequently Asked Questions
MIPS, or the Merit-Based Incentive Payment System, is a CMS program incentivizing high-quality care. For providers with 200+ Medicare patients and exceeding $90,000 claims, participation is essential.
MIPS participation is not mandatory, but providers should carefully consider their decision. Non-participation or low performance can result in a negative payment adjustment of up to 9% on Medicare claims.
Non-participation or low performance can result in a negative payment adjustment According to CMS estimates, MIPS eligible clinicians opting out of participation may face an average loss of 9% in Part B reimbursement. This substantial reduction translates to a significant financial impact, affecting every billed Part B item and service. For instance, a potential annual Medicare reimbursement of $190,000 could decrease to $172,900, resulting in a substantial loss of $17,100 in crucial revenueof up to 9% on Medicare claims.
To verify your MIPS eligibility status, you can use the CMS QPP Participation Status tool. Simply enter your NPI (National Provider Identifier) number into the tool, and it will provide information about your eligibility for participation in the MIPS program track for each performance year.
Optimity Health Solutions offers comprehensive support for MIPS reporting. Our dedicated team provides guidance on setting quality measures, assists with data submission through various channels (QCDR, Registry, EHR, Claims), and specializes in audits and Clinical Documentation Improvement (CDI). We tailor our services to meet the unique needs of your practice.
Certainly! We offer seamless integration with EHR systems, ensuring comprehensive reporting aligned with your practice’s electronic infrastructure. This integration streamlines the reporting process and enhances overall efficiency.
Getting started is easy! Simply contact us to discuss your specific needs and schedule a consultation. Our team will guide you through the process and tailor our services to meet the unique requirements of your practice.
Pricing Overview!
At Optimity Health Solutions, we prioritize your unique needs. Our MIPS services feature a one-time payment structure for a performance year, providing transparent and straightforward financial arrangements. With pricing segmented into two components, you have the flexibility to choose elements aligning with your practice’s goals. We emphasize complete customization, ensuring our solutions match your budget and objectives, regardless of your practice’s size. For a personalized and tailored pricing plan, Contact Us. Choose Optimity for adaptable and value-driven MIPS services.