MIPS, MACRA, CMS, ACA—the healthcare industry loves a good acronym, and if all those floating around out there about MIPS and MACRA have you confused about what it means for your small medical practice, there are a few things you should know about these requirements. As frustrating as it can be, not keeping your practice up to speed with the requirements for quality reporting can put a dent in your revenue.
What are MIPS & MACRA?
MACRA – Medicare Access and CHIP Reauthorization Act of 2015
- The law that reformed the Medicare payment system, replacing the previous formula for calculating reimbursement rates with a value-based payment system.
- Introduced quality measurements with the goal of moving away from a strictly fee-for-service model, with an increasing percent of reimbursements tied to quality.
- You choose either the MIPS or the APM (Advanced Payment Model) track.
MIPS – Merit-based Incentive Payment System
- A key component of the MACRA quality payment program (QPP).
- Consolidated several quality reporting programs into one: Meaningful Use (MU), Physician Quality Reporting System (PQRS) and Value-Based Modifier (VBM).
- Goals include improving quality of care, reducing costs, promoting greater interoperability, and participating in improvement activities.
What Changed
Last November the 2020 Physician Fee Schedule Final Rule came out with information about what is required for MIPS this year. Some of the biggest changes to be aware of include:
- Changes to the performance threshold – practices now must early at least 45 points (out of 100 total) to avoid a reduction in their Medicare reimbursement rates for the year 2022. Failing to meet this requirement can have a significant impact on rates, with the potential to incur a maximum penalty of -9%. A score of 85 will get you an “exceptional performance” designation.
- Categories and weights remained the same – quality accounts for 45% of the score, cost reduction and improvement activities are each 15%, and promoting interoperability at 25%.
- Complete Quality Metrics – you must submit at least 6 quality metrics to earn full quality points, but the completeness threshold has increased to 70%.
- Choosing a value pathway – in 2021 you can choose a MIPS Value Pathway that aligns more closely with your scope of practice, rather than a broader measurement that applies to everyone.
Why it Matters for Your Practice
Value-based payments and systems are not going away anytime soon, so practices must find ways to comply. If you are already struggling with a reduction in Medicare reimbursement rates from missing out on quality reporting in a prior year, now is the time to change the trajectory for your future reimbursements. The right technology and systems can make reporting the correct metrics easier, so you have one less administrative task to think about.
Learn more about our MIPS & MACRA reporting capabilities and find out how AdvancedMD can help your practice succeed in a value-based world.
