April 02, 2021

If you take any form of insurance as payment for your services then you need to understand MACRA and MIPS. MACRA is the law and MIPS is the implementation. 

Key Points:

• If you see more than 200 Medicare patients and/or bill more than $90,000 annually in Medicare Part B allowed charges, you’re automatically enrolled. 
• MIPS collects data and then you see the effect on your reimbursement 2 years later.

Why is participating in MIPS a big deal:

• MIPS results in Medicare Part B incentive payments and penalties.
• MIPS scores effectively market you—free advertising for exceptional performers, as well as potential liability for underperformers.
• MACRA requires CMS to publish MIPS final scores and performance category scores on every MIPS participant within 12 months of the performance year through CMS’ online portal, Physician Compare and the database is available to third-party physician rating websites
• You can use your MIPS when negotiating commercial insurance contracts. 
• MIPS scores are irrevocable since they become a permanent part of public record. 
• CMS ties MIPS scores to the practitioner so that scores follow the practitioner from one practice to another. If, for example, a clinician performs poorly in 2020 and joins a group in 2021, the new group will inherit the clinician’s 2020 performance via his or her 2022 payment adjustment. 
• Key point: MIPS scores will  impact patient attraction and retention, insurance contracting AND  physician recruiting, contracting, and compensation plans.

How MIPS Works?

MIPS is a performance-based payment system that includes four categories. You as the clinician have the flexibility to choose the activities and measures that are most meaningful to your practice. 

The four weighted performance categories are combined to create the MIPS Composite Performance Score (MIPS Final Score) and used in determining future Medicare Part B payment adjustments. 

Here are the categories and what they are worth towards your final score:

• Quality 40% 
• Cost 20%
• Promoting interoperability 25%
• Practice improvement 15%

In this episode, I'll describe each of these categories and tell you what you need to do to score points.  

How many points do you need to be eligible to get the incentive?

• Performance threshold: 60 points to avoid a penalty and start to earn an incentive. 
• Additional performance threshold: 85 points to  earn additional incentives from the additional incentive pool of $500m. 

Key Points:  

• Your final total score is compared to everyone else participating in MIPS. If there are more people who meet each threshold, then the pot of money for bonuses gets divided by that many people. 
• Higher scores earn higher additional incentives.

Links for more MIPS details:
https://qpp.cms.gov/mips/explore-measures?tab=qualityMeasures&py=2021
https://qpp.cms.gov/mips/explore-measures?tab=advancingCareInformation&py=2021
https://qpp.cms.gov/mips/explore-measures?tab=improvementActivities&py=2021
https://qpp.cms.gov/mips/explore-measures?tab=costMeasures&py=2021

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