The Merit-Based Incentive Payment System (MIPS) was introduced in 2017 as a critical component of the Medicare Access and CHIP Reauthorization Act (MACRA) Quality Payment Program (QPP), marking a significant shift toward enhancing patient outcomes and transitioning to a value-based healthcare model. By linking physicians' payments directly to their performance across various measures, MIPS aims to foster an environment focused on quality care. Yet criteria changes and complexities involved with data collection mean that healthcare providers need to remain proactive in understanding the scoring methodology and reporting requirements.
MIPS Overview
At its core, MIPS is designed to evaluate healthcare providers based on several critical performance categories:
- Quality measures – Accounts for 30% weight; 30 MIPS points maximum
- Improvement activities – Accounts for 15% weight; 15 MIPS points maximum
- Cost – Accounts for 30% weight; 30 MIPS points maximum
- Promoting Interoperability (PI) – Accounts for 25% weight; 25 MIPS points maximum
2024: Key Changes
A significant update in 2024 is the change to the reporting period for the PI category. It will now span to 180 days rather than 90 consecutive days. This aims to provide a more comprehensive assessment of a provider’s performance over a longer time period.
CMS also introduced new improvement activities for 2024, with a total of 106 activities including five new ones. These new activities focus on enhancing practice capacity for HIV prevention services, practice-wide improvement in MIPS value pathways (MVPs), improved adherence to cervical cancer screening, and improvements in behavioral/mental health and substance abuse management.
The Role of Technology in MIPS Tracking and Reporting
Technology plays a pivotal role in enabling efficient data abstraction and reporting for MIPS. Leveraging advanced health IT systems and software solutions, such as a Computer-Assisted Professional Coding system (CAPC) with built-in MIPS capabilities, can significantly streamline the process.
Advanced technologies enable:
- Accurate patient qualification: Automatically identify patients qualifying for MIPS measures utilizing various parameters such as International Classification of Diseases, Tenth Revision (ICD-10) codes, Current Procedural Terminology (CPT) codes, and exclusions to improve the potential for achieving accurate MIPS scores.
- MIPS coding edits: Real-time alerts inform medical coding professionals if a patient encounter qualifies for MIPS and suggest potential actions to ensure compliance and maximize MIPS point accumulation.
- Streamlined MIPS validation and audit workflow: The adoption of integrated technology solutions simplifies the validation and audit workflow, making it easier to navigate the complexities of MIPS reporting requirements and avoid potential penalties.
- Reporting: Advanced software can automate the entire reporting process, from data collection to submission, including
- Real-time inventory tracking of charts within the MIPS workflow can offer invaluable insights into a practice's performance and areas for improvement.
- Precise calculation of MIPS numerator and denominator numbers by participating measures allows practices to monitor their progress and adjust strategies as necessary.
- Automated systems can provide frequent updates regarding MIPS edits, ensuring that practices remain in compliance with current standards.
- Technology solutions offer detailed reports on physician queries and MIPS coding quality, enabling practices to identify areas for improvement and refine their reporting strategies.
The 2024 changes to the MIPS program underscore the increasing complexity of MIPS reporting and the critical role technology plays in simplifying this process. By simplifying the complexities involved in data collection and ensuring compliance with scoring methodologies and reporting, clinicians can focus more on patient care and less on administrative tasks while enhancing their overall performance in the MIPS program. Understanding the 2024 MIPS updates, actively participating in MIPS reporting, and harnessing the power of technology ensures clinicians not only comply with MIPS requirements and avoid potential penalties but also improve their practice's performance and, most importantly, patient outcomes.
Listen to our webinar, Don’t Miss the Mark: Hitting the MIPS Reporting Bullseye, to learn more and hear from Dr. Michael Lipscomb, Chief Quality Officer at ApolloMD on optimizing performance and maximizing revenue. Contact us for assistance with effectively navigating the MIPS reporting changes.
Author
Suhas Nair
