In 2020, around 20 percent of doctors experienced a 50 percent revenue drop due to the pandemic. Unfortunately, many providers have struggled to build back and achieve revenue numbers post-pandemic. With more care providers focusing on building revenue, a deep dive into all things that can inherently affect that revenue is a necessary step in the process. The Merit-Based Incentive Payment System (MIPS) can play a huge role.
MIPS is a payment program based on quality (quality payment program or QPP) used by Medicare and Medicaid to determine increases and penalties in payment. This score-based system assigns each Medicaid/Medicare provider a score in certain categories to determine how much annual payments will be adjusted. Providers with top scores are eligible for a bonus payment, while providers with lower scores or that don’t report face costly penalties. Therefore, understanding MIPS reporting guidelines for 2021 is undeniably important.
Overview - MIPS Reporting is Getting More Difficult
MIPS reporting was established in 2017 in an effort to support a pay-for-value setup in the healthcare industry. While the program has undergone a few changes since its establishment, MIPS 2023 is said to be much more complex.
The Centers for Medicare and Medicaid Services (CMS) announced a number of alterations at the end of 2022 that may make it more challenging to earn bonus payments and easier to receive a penalty. A few of the most noteworthy things to keep in mind as a clinician in terms of MIPS performance include:
- Not reporting can still mean a 9 percent penalty for Medicare Part B payments
- The minimum MIPS score threshold for clinicians will be 75 points
- The additional MIPS performance threshold to gain a bonus for performing at an exceptional level was eliminated for 2023
- 198 new quality measures will be included in quality category updates
Tips on How to Get Started with MIPS in 2023
Get to Know the 2023 MIPS Categories
Thankfully, the MIPS 2023 performance category weights will remain unchanged in 2023 compared to 2022. However, it is important to get familiar with what categories will most affect how your practice is scored. The four categories that make up a clinician’s MIPS score include:
- Cost – 30%
- Promoting Interoperability – 25%
- Quality – 30%
- Improvement Activities – 15%
These categories look slightly different for a smaller medical practice with Cost and Improvement Activities each bearing 30 percent of the MIPS score weight and Quality making up 40 percent.
Learn the Steps to Prepare for Data Submission
The MIPS reporting system is set to be available through MIPS Value Pathways (MVPs) at the start of the reporting year in 2023. To make sure you are prepared to gather the appropriate data for MIPS quality measures, it will be important that you know how to report MIPS data and what is involved.
1. Check Your Current Eligibility
Use the QPP Participation Status Tool to determine if you are eligible for reporting. You will sign in to the QPP and use your National Provider Identifier (NPI) to determine your eligibility status. Be sure that you pick MIPS 2023 as your reporting year.
2. Choose How You’ll Participate
You may have different participation options as a provider, such as group, individual, subgroup, APM entity, or virtual group. Once you have plugged in your NPI in the QPP Participation Status Tool, you should see where you are eligible to participate. Keep in mind, even if you are not eligible for MIPS reporting due to not meeting the required payment or patient volume threshold, you still may be able to participate voluntarily.
3. Determine Your Reporting Framework
Decide how you plan to report your data as far as what methods will be used. For example, you may choose to use your electronic health record (EHR) system or Consumer Assessment of Healthcare Providers and Systems (CAHPS) assessments.
4. Select and Perform Your Measures and Activities
Determine which MIPS quality measures you want to report in 2023, and then work on measuring the data you need to cover those bases throughout the year. You will need to:
- Select your quality measures
- Determine which improvement activities apply to your practice
- Determine if you should be reporting how you promote interoperability
Remember, while cost is a major category, this data will automatically be collected based on the claims submitted. Therefore, you don’t have to do any separate reports.
5. Verify Your Final Eligibility
At the end of 2023, MIPS eligibility status will be determined based on data collected during the determination segments of the year. Before proceeding to the final submission process, be sure to recheck your eligibility.
6. Submit Your Data
The MIPS submission window will open to accept data from reporting clinicians at the beginning of 2024. At this time, double-check the information you intend to submit by comparing what you have with the reporting requirements checklist and proceed through the data submission process.
A Quick Recap of FAQs for MIPS Reporting 2023
You are required to participate if you are an eligible MIPS clinician, you meet the billing threshold for Medicare Part B services ($90,000 or more), and have provided at least 200 covered services to patients. Some MIPS-eligible care providers can be exempt from MIPS reporting if they do not meet certain criteria. For example, providers who have just enrolled in Medicare may not have to report in their first year. Volume thresholds also apply.
MIPS applies to:
Certified registered nurse anesthetists (CRNAs)
Clinical social workers
Certified nurse midwives
Physician assistants (PAs)
Nurse practitioners (NPs)
Clinical nurse specialists
Registered nutrition professionals
The reporting period for MIPS 2023 will be between January 1st and December 31st, 2023. This window will be for the collection and measurement of data, and submission windows for 2023 will open in 2024. Watch for submission window announcements and deadlines to be announced near the end of 2023. Typically, there will be a submission window for data submission during the first few months of the year. For example, for the performance year 2022, the performance quality data can be submitted until March 31st, 2023.
If you do not participate in MIPS reporting and you are not considered exempt, you could face penalties set forth by the CMS.
The penalty for not reporting in 2023 remains at 9 percent, which is unchanged from 2022.
Ensure Your EHR Is Up for MIPS 2023 Reporting
The EHR you have in place may play a major role in how effectively you can collect data for MIPS reporting in 2023. Do you need to upgrade to a more innovative, intuitive EHR? Be sure to schedule a demo of PrognoCIS EHR.