Why Should Medical Practices Consider Group MIPS Participation?

When two or more MIPS eligible clinicians have the same TIN (Tax Identification Number) for billing, they can report as a group for MIPS reporting.

Advantages of MIPS Data Submission as a Group

MIPS (Merit-Based Incentive Payment System) is a way to receive incentives and bonuses for quality healthcare services to patients. Yes! Physicians can choose to report as individuals. However, there are more chances to succeed in MIPS 2020 reporting when you report as a group. Moreover, the administrative load is lesser and is shared among all parties.

CMS (Centers for Medicare & Medicaid Services) report says that with each passing year in MIPS 2021 reporting, more and more clinicians are interested in becoming a group.

How MIPS group reporting works? Is it feasible for MIPS-eligible clinicians? Is it beneficial for medical practices? Let’s have answers to these questions.

How Does MIPS Group Data Submission Work?

The primary criterion to form a MIPS group is to have two or more physicians in a medical practice under the same billing TIN.

Compound data was collected from all group participants, which CMS assesses on behalf of the group.

Each clinician will receive the same MIPS score at the end of the performance period. Moreover, everyone will receive the same payment adjustment. 

It is to remember that if you choose to report individually and in a group, CMS will evaluate your performance on both fronts. However, the payment adjustment will be awarded based on the high-scoring MIPS reporting method.

It Is Easier to Surpass the Performance Threshold with Group MIPS Reporting!

With each passing year, the performance threshold is also rising. Hence, MIPS reporting as a group makes it easy to target goals.

Group Reporting is Less Hectic!

For group MIPS data reporting, medical practices do not have to cater to the administrative load of everyone. Instead, they can hire a MIPS Qualified Registry to submit high-performing MIPS Quality Measures.

The paperwork is less, and you can manage data easily without stress.

Here is the overview of all the MIPS performance categories for groups.

 

Performance Category	Group Reporting Requirements
Quality	To report 6 Quality measures for the TIN P.s: You do not have to choose quality measures that relate to all clinicians of the multi-specialty practice.
Performance Interoperability (PI)	Group attestation: Data aggregated in 2015 Edition CEHRT The clinician not using the CEHRT still receives benefits of using one.
Improvement Activities (IA)	Group attestation: At least 50% of the clinicians have to perform the improvement activity at any given time of the year for continuous 90 days.
Cost	CMS measures performance by itself.

Improved Performance in QPP MIPS Group Reporting

MIPS reporting in a group is particularly useful when any clinician fails to meet the performance threshold.

Financial Benefits for MIPS Group Reporting

When you report as a group, the payment incentives spread across the whole group. Even if any clinician had failed to target incentives while reporting individually, they would still qualify for the payment adjustment.

CMS estimates that clinicians can receive a maximum bonus of up to 6.25% if they receive a 100% score. Thus, a medical practice can stay ahead in financial matters if they choose to report MIPS data in a group.

Conclusion

There are numerous advantages of MIPS reporting as a group if many physicians bill under the same TIN. The bottom line is medical practices can save time and effort from investing in the administrative burden from group data submission. We suggest consulting a MIPS Qualified Registry for the quality and timely MIPS data submission to CMS.

New Drug Prescription Cost Rule Allows Negotiation against Patient Outcomes

CMS promised to address rising healthcare expenses, administrative burden, and the lack of quality systems, and they are gradually settling every concern that is restricting progression. In the same context, recently, we heard the great news, especially for medical billing and QPP MIPS reporting.

CMS has decided to base prescription drug payments on the patients’ outcomes. They proposed a rule on June 17 to counter rising drug prescription prices.

What Statistics Say About Drug Prescription Spending?

Statistics reflect that the average growth spending of 5.7 percent on national health is expected between 2020 to 2027. However, the new rule will help establish a system with lesser regulations on Value-Based Purchasing (VBP). 

How CMS defines VBP?

The proposed rule will allow commercial payers to negotiate with manufacturers under new rules. However, the deal is that Medicaid beneficiaries always get the best price. The new rule will also ensure to pay the price that aligns with both objectives:

• New types of payment models

• Situations under which prices are negotiated

This value-based purchasing rule intends to accommodate new changes in the healthcare industry while giving details to stakeholders.

In actual terms, CMS defines it as and I quote:

“An arrangement or agreement intended to align pricing and/or payments to an observed or expected therapeutic or clinical value in a population (that is, outcomes relative to costs) and includes (but is not limited to):

• Evidence-based measures: linking drug expense of a drug to the effectiveness of the product, and/or
• Outcomes-based measures: linking expense of a drug to the product's actual performance in a patient or a population as compared to the other medical expenses.”

It will offer flexibility to medical billing services, Medicaid, insurance companies, and drug manufacturers.

Current Drug Regulation Rules Lack Flexibility

Seema Verma, the CMS administrator, states that the rules for Medicaid receiving the competitive price for drug prescription have not been updated in nearly thirty years. 

With no new rules to accommodate the changing environment, healthcare leaders lack the opportunity to design new payment models for physicians.

How the New Drug Prescription Rule Facilitates Physicians?

As the new proposed rules will come into action, drug manufacturers will have more say in the payment arrangements. In addition, the patients' outcomes will make clinicians accountable for their services, and they can invest in opportunities to earn more revenue, particularly via QPP MIPS.

Right now, the payment arrangements are made on the quantity of the product rather than the quality of the product. 

In such circumstances, it is impossible to move towards innovation; consequently, medical billing companies can't drive value to the claims nor can payers promote access to innovative therapies or drugs due to cost prohibitions.

The Effect on Healthcare Industry

The new proposed rule is, however, like a breath of fresh air that will support all private and governmental healthcare stakeholders based on clinical outcomes. Providers can prescribe new medicines for better results, enhancing their QPP MIPS reporting performance.

The connection between the payment and the quality of drugs will eventually create paths for innovative medical treatments, and the effectiveness of medication and therapies is likely to increase - An effective way to promote MIPS quality measures.

The Effect on Opioid Crisis 

The high consumption of opioids has led to a crisis in the country. The acting secretary of Health and Human Services (HHS) says that around seventy percent of drug overdoses are related to opioids. Thus, the misuse of this drug has been alarming.

CMS counters this situation via the proposed rule, as there would be a safe passage for drug prescription, which will eventually reduce misuse or abuse of opioids.

The Future of Drug Prescription

Luckily, CMS has settled concerns that were raised by medical billing services. Moreover, the proposed drug prescription rule caters to everyone for easy access to quality healthcare, promoting QPP MIPS while reducing expenses.

We hope that this rule when implemented properly fixes many payment-related issues and reimburse physicians via value-driven methods.