Using MIPS Reporting to Help You Deliver a Higher Quality of Care
MIPS Reporting is one of the two tracks defined by Medicare that makes up what is called MACRA. MACRA stands for the Medicare Access Chip Reauthorization Act, formerly known as PQRS (Physician Quality Reporting Systems). MACRA is part of the Quality Payment Program, which consists of a series of programs designed to help healthcare providers focus on a higher quality of care.
Physicians receive incentive payments for implementing high-quality healthcare services to patients with Medicare insurance. The Centers for Medicare and Medicaid Services have implemented a scoring system that rates the four pillars that make up MIPS reporting. These components are Quality, Promoting Interoperability, Costs, and Improvement Activities. Each of the four pillars is weighted; they are added to get a composite score of up to 100 points.
This composite score is used by CMS to determine if eligible clinicians are to receive a positive, negative, or neutral adjustment to Medicare reimbursement. Eligible clinicians are those who bill at least $90,000 for Medicare Part B and see more than 200 Medicare Part B patients. The best way to determine a clinician’s status is to use the tool located on the Quality Payment Program website and search by NPI number.
The weights assigned to each of the pillars change for each reporting year.
- Quality = 45%
- Cost = 15%
- Promoting Interoperability = 25%
- Improvement Activities = 15%
The quality pillar accounts for most of the composite score and consists of 250 clinical quality measures, which are predefined procedures. Each of these measures is specific to the doctor’s specialty.
Medicare determines cost scores based on how the clinician bills for procedures.
This factor deals with the ability of clinicians’ EHR (electronic health records) to share data with other HIPAA-compliant entities.
There is a list of 118 activities that increase the likelihood of improved health outcomes.
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