MIPS: Are you ready?

Donna White

Donna White

By Donna White, Principal Consultant and Owner of Legacy Consulting Services and Legacy Billing Solutions in Montgomery, Alabama.

Previous government incentive programs like Physician Quality Reporting System (PQRS) and Meaningful Use (MU) have officially been phased out as of 2017. In healthcare, we have a new alphabet soup to work with to receive Medicare incentive payments called the Merit-based Incentive Payment System, or MIPS. In this article we’ll try to de-mystify some of the more complex aspects of the system.

This system combines the previous measurement programs under one roof. However, that roof actually has four rooms beneath it:
• Quality Measures
• Resource Use
• Clinical Practice Improvement Activities
• Advancing Care Information.

Quality Measures

This is essentially the PQRS replacement. But now instead of 9 measures, you are only required to report 6. This gives you a little less pressure when choosing your measurement categories, but you want to make sure you choose measures you will successfully achieve. Quality Measures accounts for 50% of your total MIPS score! But with over 200 measures to choose from, you should have no problem finding measures you can easily achieve based on your current clinical documentation. Just make sure you choose one cross-cutting measure (a measure that can broadly be applied across specialties) and one outcome measure, or a high priority measure if you cannot do an outcome.

Resource Use

Next is Resource Use, which is 10% of your overall score. This is the easiest measure as there is nothing you need to do. All data for this measure will be collected from your claims submitted to Medicare.

Clinical Practice Improvement Activities

After that is Clinical Practice Improvement Activities. This is a brand new measurement category. From the list of over 90 activities, you only need to choose one activity to achieve your 15% of this category. However, you can choose to measure more than one activity for bonus credit!

Advancing Care Information

And lastly is the Meaningful Use replacement, Advancing Care Information for 25% of your total MIPS score. With this measure your score is comprised of a Base Score for 50 points, a Performance Score for 80 possible points, and a possible bonus point for participating in your state Immunization Registry.

To achieve the base score, you only need provide the numerator/denominator or yes/no for each measure in the following categories:
• Protect PHI (yes is required)
• Electronic Prescribing (numerator/denominator)
• Patient Electronic Access (numerator/denominator)
• Coordination of Care (numerator/denominator)
• Health Information Exchange (numerator/denominator)
• Public Health and Clinical Data Registry Reporting (yes is required)

For the Performance score, you will need to measure these categories under ACI: Patient Electronic access, Coordination of Care through Patient Engagement and Health Information Exchange.

The key to remember about MIPS is that 2017 is the measurement year. In 2018, Medicare will be reviewing all the data collected to calculate Medicare Incentive increases or decreases for the 2019 payment year.

We hope this helps clarify some of the confusion surrounding MIPS. Additional resources are available online to find the list of measures for each category. Or reach out to us and we can help you find them!

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