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Looking Back at MIPS 2019 from the Eyes of a Clinician

Medicare and Medicaid Services, MIPS 2019, MIPS & MACRA, MIPS 2020, medical billing, MIPS consulting services, MIPS quality measures, CMS, MIPS Requirements in 2020

Centers for Medicare and Medicaid Services (CMS) came up with the proposed modifications earlier this year in August. They affect the doctors or their practices in ways they are still trying to understand. However, P3 has gotten it all figured out on behalf of providers for an efficient MIPS 2019 reporting right away.

MIPS & MACRA are two significant terms when we talk about quality care. They are the bedrock of the new system that we are trying to achieve. Moreover, the Quality Payment Program under Medicare Access and CHIP Reauthorization Act (MACRA) produces patient outcomes based on quality rather than quantity.

Now, that you have an idea, we want to dive into the changes to this program before 2020 begins. 

MIPS Requirements in 2020 – Threshold-wise


CMS has revised the minimum and additional performance thresholds of the program. The positive and negative payment adjustments have also been renewed. Since physicians and physician groups have done so great in this program until now, we can expect them to avoid penalties easily in MIPS 2019 by a distance.

Additionally, the average MIPS score is expected to remain above 74 points which is far beyond the minimum threshold score of 45. The organizations to cross that benchmark are expected to increase, therefore, the bonus amount per clinician will be smaller this year.

Promoting Interoperability (PI) Takes All the Attention


Prior meaningful use (MU) and current promoting interoperability (PI) have gotten the most attention in 2019. It is one of the major performance categories of MIPS 2019, thus requires a thorough understanding. Some of the measures such as sharing patient education and keeping a secure line of communication with them are removed. Previously, they had maximized a clinician’s score way above the benchmark.

In the best interest of clinicians, the removal of such measures was necessary to deal with the burnout epidemic. For them to stay productive and intact with the system, CMS removed bonus measures such as reporting on an improvement activity related to Certified Electronic Health Record Technology (CEHRT). After such detachments, the remaining measures have taken up more weight than usual. It continues to suggest that physicians should have a categorical approach to this category. That is where P3 comes in and expresses itself elaborately.

MIPS in healthcare is mostly about health information exchange (HIX) in which a patient’s data moves electronically across a provider’s network. Electronic exchange of patient data is not only a MIPS requirement but the requirement of regulatory authorities as well. For instance, small practices are required to send and receive patient summaries via direct messaging.

Improvement Activities – Not So Far Behind


CMS proposes the addition of two improvement activities and removal of 15 in MIPS 2020. As for those who have just joined us, improvement activities are MIPS measures for this performance category.

Due to these changes, the MIPS attestation process needs revision for practices in 2020, and it is where
P3 comes in, again, and leaves no room for ambiguities when it comes to medical billing or MIPS consulting services.

As a qualified registry for MIPS, to get you the right scores by choosing the relevant MIPS quality measures to report is part of our job. Not only that but to get you high scores, in the end, to increase your collections. After all, every small effort we put into your MIPS 2019 reporting results in a smoother workflow and better cashflow.

As part of the big plan, practices have to ensure a higher level of participation from now on since, in 2020, at least 50% of the providers in a group will have to participate in an activity. Although practices may already be doing that, it is a note for those organizations that are not fully participating in the level that is required of them.

Quality Category Is Here Too – Be Aware of the Topped-Out Measures


Although Quality has been the top category of the program, organizations still have room for improvement in it. Beware of the topped-out measures which are those measures in which everyone is performing well. CMS removes such measures in four years, decreasing the number of points a practice can receive in it each year until the measure is no more.

Hence, if an organization is reporting on six MIPS quality measures and two of them have topped-out, it will be harder to cross performance benchmarks. To select the best six measures for your practice, it is wise to use the benchmarkingtool by CMS. It is a useful tool when it comes to checking the score and measures that need to be revised.

P3Care supports providers by reviewing the benchmarking report on their behalf and scoring against the best possible measures.

To read more on MIPS 2019, The MIPS performance period 2019 enters the final stages is a good read.
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