What is MIPS in Healthcare and Medical Billing?
As healthcare providers, you’re always looking for ways you can improve your bottom line – not least when you’re a smaller practice that’s struggling to compete with larger practices as it is.
Thankfully, there are ways you can receive a payment adjustment regarding the reimbursements your practice receives due to a few different programs, one of them being the Merit Based Incentive Payment System (MIPS).
The Centers for Medicare & Medicaid Services (CMS) have designed this program, and it falls under their Quality Payment Program, which essentially influences how much medical practices receive when it comes to reimbursement.
From the MIPS composite performance score to calculating cost measures, there’s quite a bit to unpack here. So, over the course of this article, we’ll be looking to simplify this program into its four performance categories and how you can report MIPS data for better reimbursements.
It may sound slightly jarring, but hopefully, you’ll have a clearer understanding of why programs like these are important for small practice owners like yourself.
Let’s get started with a basic overview:
Put simply, MIPS acts as a kind of framework that aims to reward eligible clinicians (like you) for their overall commitment to their job – providing healthcare services to a high standard. For smaller practices with less stable cash flow, this program is particularly meaningful as it has a direct impact on your financial outcomes and what your reimbursement rates will look like.
In essence, eligible clinicians (which includes staff such as physicians, nurse practitioners, and even physician assistants) are evaluated based on how well they’ve been performing across a few different categories during a performance period, sometimes referred to as a performance year, too.
At the end of this period, CMS will take a look at your performance in each category and ultimately assign you a MIPS final score that serves as a reflection of how well your practice is meeting these goals.
Naturally, this final MIPS score holds a significant amount of weight as it determines whether your practice is going to receive either a positive or negative payment adjustment.
CMS has outlined four different MIPS performance categories to assess clinicians, so let’s break them down one by one:
1. Quality Category
Think of this first category as the heart of MIPS that zeroes in on the quality of care you’re providing to your patients. Generally speaking, it’s not just the quantity of care that you’re delivering – it’s the quality of it that defines it.
So, whether it’s preventive services or managing chronic conditions, this category basically refers to how effective your treatments are and how well your patients are faring as a result.
2. Promoting Interoperability Performance Category
It’s a bit of a mouthful, but don’t let the jargon scare you here – this category is just about your ability to use technology to enhance the level of care you provide to your patients.
Electronic Health Records (EHRs) often come into play here as they give you a hand when it comes to sharing patient information and involving them in their care decisions.
It’s also where the term “claims data” comes in, which is basically a wealth of information that you can use to show how you’re promoting interoperability.
Of course, budgets are tight when you’re a smaller practice, so investing in a range of additional tools for your practice isn’t always the most efficient option.
Instead, it’s worth partnering with an outsourced medical billing company such as PMN! Over the last 20+ years, PMN has been helping small practices reduce their administrative burden and get back to their core strengths, and this includes handling MIPS to prevent any negative payment adjustments.
PMN offers more than just assistance with achieving a high MIPS score, though – they also offer various other services such as Accounts Receivable Management and provide medical billing and coding audits so your practice is always compliant with the relevant laws within the state.
If you’d like to hear more about how PMN can help save your practice money and increase your bottom line/improve claim submission rates, don’t hesitate to contact one of their helpful staff members today! You can get in touch by calling (949) 215-5055 or scheduling a face-to-face chat at their office in Laguna Hills, Orange County, California.
3. Improvement Activities Category
As you’ll know, healthcare isn’t just about the treatments and prescriptions you provide; you’re ultimately trying to create an experience for patients that’ll lead to better health outcomes.
So, this category basically acknowledges any efforts you make to enhance care coordination, engage patients, and even improve your own practice’s operations.
4. Cost Category
Lastly, we have the cost category, which covers how efficiently your practice is managing resources to deliver quality care without breaking the bank. Managing your finances is a huge part of what gives a practice longevity, so this is all about the art of balancing cost and quality in healthcare.
What’s The ‘Low Volume Threshold’ And How Does It Impact Small Practices?
Low Volume Thresholds are basically a criterion that will exempt certain clinicians from participating in the MIPS program if they have a significantly low number of Medicare patients or billings. For instance, if your Medicare Part B allowed charges are less than or equal to $90,000 then your practice might be allowed to participate in MIPS.
Can a High MIPS Score Impact My Practice’s Reputation?
Absolutely! Not only are you able to receive a positive payment adjustment, but having a high MIPS score is something worth advertising as it ultimately demonstrates your practice’s overall commitment to delivering quality care. Aside from this, meeting the relevant performance standards generally helps enhance patient trust and also attracts new patients.