Making the Most of MIPS

The Merit-based Incentive Payment System (MIPS) was established with great motives: improve healthcare, reduce costs, and promote efficient use of healthcare information by tying Medicare payments to clinician performance. 

Like any large program, MIPS evokes a range of opinions and perceptions, even misconceptions.

To participate in MIPS, providers fulfill reporting requirements across four categories (Quality, Promoting Interoperability, Improvement Activities, and Cost). For some practitioners, the associated administrative tasks can feel bureaucratic at times, like checking boxes. 

But there are clear benefits to be gained from the program – both by patients and medical practices. 

In fact, the value that practices realize from MIPS can be related to how they approach the program. An important question for any practice to consider is, “Are we maximizing our opportunity with MIPS?” 

To MIPS or Not to MIPS?

For some practices, a precursor to maximizing program benefits begins with deciding whether to participate at all. For practices earning below the threshold specified by the Centers for Medicare & Medicaid Services (CMS), MIPS is not mandatory.

However, there are potential consequences to sitting it out. Practices that choose not to participate in MIPS may be at risk of lower compensation, missed insight, and competitive challenges.

For example, eligible clinicians who choose not to participate in MIPS or fail to meet the reporting requirements risk negative payment adjustments and reduced Medicare reimbursements.

By not participating, providers can also miss valuable insights into performance and areas that need improvement, which in turn can hinder the ability to optimize patient care and operational efficiency.

Another consideration relates to competition. Providers not participating in MIPS may find challenges in a competitive healthcare market, as patients and payers gravitate towards providers with proven track records of delivering high-quality care.

Providers who neglect MIPS may allocate fewer resources to quality improvement initiatives and health IT integration, potentially hindering their long-term growth and adaptability in the changing healthcare landscape.

For all these reasons, practices earning below the threshold often opt to participate to increase potential reimbursement and capitalize on associated benefits.

Stay Current, Avoid MIPS-conceptions

If your practice does participate in MIPS, it’s important to maintain a clear understanding of current program requirements.

With frequent changes and updates to MIPS regulations (including adjustments to reporting requirements, quality measures, performance thresholds, and payment adjustments), medical practices must make a concerted effort to stay informed and adapt their reporting practices accordingly. 

(The challenge of evolving MIPS requirements is one of the reasons many practices utilize Verana Health MIPS Advisory Service. By staying current with all rule changes, scoring and measurement specifications, MIPS Advisory Services frees practices to focus on patient care.)

It’s also important for practices to avoid common misconceptions about the program. Two of the most significant misconceptions relate to MIPS documentation and forgiveness of mistakes.

Many clinicians think they only need to complete MIPS documentation for Medicare patients. This is not true. Though it is just Medicare patients whose reimbursements are directly tied to MIPS performance, the calculation is based on all measure-specific eligible patients regardless of the payer. Providers must submit MIPS documentation for all patients.

Another common misconception is the idea that CMS will extend leniency during audits for honest mistakes that practices make related to lack of comprehension of regulatory details. Again, this is not true. Though MIPS measures and rules can be complex and changing, responsibility for keeping abreast of and understanding the current regulatory landscape lies entirely with the practice.

Shifting Perceptions: A Look to the Bright Side

Since keeping abreast the program’s reporting requirements can be complex and time-consuming, some practices perceive MIPS as a burden.

However, understanding the importance of MIPS and how it supports better patient care can be a valuable transition for clinicians. 

For example, Measure 130 in the Quality category (Medication Documentation Attestation), may seem on the surface like just another box to check, but it’s really about patient safety. Having an accurate and up-to-date medication list is essential to avoiding negative drug interactions – ensuring not just compliance but also good clinical care.

Viewed from this perspective, MIPS fundamentally supports clinicians’ primary focus: delivering safe, high-quality care.

What About MVPs?

One example of MIPS evolution is the MIPS Value Pathways (MVP), a new, voluntary reporting option for clinicians as an alternative to traditional MIPS or the APM Performance Pathway (APP). 

MVP reporting has less complexity compared with traditional reporting, particularly within the Quality category. MVPs will become mandatory by the 2029 performance year, but it can be useful for practices to get comfortable with this option in advance.

In fact, if a practice reports on both MVPs and traditional MIPS, CMS will apply the higher of the two scores. 

Smart Decisions, Better Outcomes

The Verana Health MIPS Advisory Service was designed to help medical practices confidently navigate MIPS requirements, stay compliant and perform at their best.

The service provides practices with the expertise and technology to ensure accurate data submission to CMS to maximize incentive payment potential, as well as tools to quickly spot trends and errors in MIPS-related documentation, making it easier to catch issues and improve performance.

With the right approach to MIPS, providers can enhance patient outcomes and financial performance, through improved reimbursement rates, access to additional funding, refinement of IT, enhanced decision-making, and reduced inefficiencies. 

Learn more: MIPS Submissions: Reducing the Burden on Medical Practices While Improving Patient Treatment.