Maximize Your Quality Performance Score in MIPS 2021

QPP MIPS 2021 is an incentive program that helps you cash on lots of financial opportunities. For instance, MIPS eligible clinicians can avoid penalties of up to 9% as CMS (Centers for Medicare and Medicaid Services) has made it compulsory for every clinician to participate in this program.

Failure to submit data cab lead clinicians to incur the penalty but also lose the opportunity to earn incentives.

A Background to MIPS 2021 Quality Requirements

MIPS is one of its kind programs accessible to MIPS qualified clinicians for gathering and revealing information about their value-based healthcare services. Today, we will talk only about the Quality category that estimates medical care cycles, results, and patient encounters in general.

Quality Caters to 40% of Final Score 

This percentage change almost every year because of Exception Applications or Alternative Payment Model (APM) Entity investment.

Clinicians can consult MIPS consultants to demonstrate the true potential of their performance to CMS. 

Moreover, for general details, you can read this article. 

What Quality Data Should I Submit?

• There are 6 assortment types for MIPS quality measures

• Electronic Clinical Quality Measures (eCQMs)

• MIPS Clinical Quality Measures (CQMs)

• Qualified Clinical Data Registry (QCDR) Measures

• Medicare Part B claims measure

• CMS Web Interface measures

General Detailing Prerequisites for MIPS 2021 Data Submission (for those not revealing through the CMS Web Interface)

You'll ordinarily have to submit gathered information for no less than 6 measures (counting 1 result measure or high-need measure without an applicable outcome measure), or a complete measure set.

You'll have to report data for basically 70% of the patients who fit the bill for each action.

You can submit measures from various collection types (except CMS Web Interface measures) to satisfy the prerequisite to report at At least 6 quality measures.

CMS will compute and score the performance of individuals, groups, and virtual groups on 2 new regulatory case estimate when the individual, groups, or virtual groups meets the case least, and clinician the necessity for the measure

Medical clinic Wide, 30-Day, All-Cause Unplanned Readmission (HWR) The rate for the Merit-Based Incentive Payment Program (MIPS) Eligible Groups (This action is supplanting the All-Cause Hospital Readmission (ACR) measure, Quality ID 458).

Hazard normalized Complication Rate (RSCR) following Elective Primary Total Hip Arthroplasty (THA) as well as Total Knee Arthroplasty (TKA) for Merit-based Incentive Payment System (MIPS).

How Are Measures Scored?

CMS decides to measure MIPS 2021 performance based on measure performance as per the benchmark.

If an action can be dependably scored against a benchmark, it for the most part implies:

• A benchmark is accessible.

• Has no less than 20 cases.

• The data fulfillment standard is for the most part 70%.

CMS Web Interface measures are scored against the Shared Savings Program benchmarks.

Criteria for Bonus Points

• You can acquire quality extra focuses in the following manner.

• Submit at least 2 results or high-need quality measures.

• This reward isn't accessible for the first, the required result, or high-priority quality measure.

This reward isn't accessible for measures needed by the CMS Web Interface, however, is accessible to MIPS eligible groups that report the CAHPS for MIPS overview notwithstanding the CMS Web Interface measures.

The Easy Formula for Maximizing MIPS Quality Performance Score

What you should and shouldn’t do to maximize your MIPS Quality score is mentioned above. But a detailed formula is given below to help strategize accordingly.

Select Only the Best Specialty-Specific MIPS Quality Measures

When you or your MIPS Qualified Registry is in the measure selection phase, make sure you select more than 6 measures to report to the CMS.

Earn Up to 10% of Bonus on the Quality Score with CEHRT Bonus

If MIPS eligible clinicians go for end-to-end MIPS reporting 2021, they are qualified for 10% of the MIPS bonus concerning the CEHRT bonus. It means that you can earn 1 point per submitted measure.

Performance Benchmark Requirement

QPP MIPS quality measures that do not come with a performance benchmark do not grant more points than 3. 

Data Completeness Rule

For MIPS 2021 data submission, eligible clinicians must fulfill the data completeness rule. You are required to submit 70% of the data complied with the eligible cases.

Small medical practices have the flexibility that even if they don’t meet the data completeness rule, they still can receive 3 points for each MIPS Quality measure. However, this option is not valid for large or established medical practices.

Case Minimum Requirement

To maximize performance in the MIPS quality category in 2021, clinicians must meet the case minimum criteria of 20 cases per MIPS quality measure. Only this way, you can receive more than 3 points per measure.

Use the certified version of EHR innovation (CEHRT) to gather measure information and meet the electronic reporting requirements.

Six extra bonus points are added to the quality performance score for clinicians in little practices who submit 1 measure, either exclusively or collectively or in virtual groups. This reward isn't added to clinicians or gatherings who are scored under facility-based scoring.

You can likewise target up to 10 extra rate focuses dependent on your improvement in the quality performance from the previous year. You can also consult MIPS Qualified Registries for streamlined MIPS reporting.

CMS Issued Final Rule on Technology Access for Seniors!

CMS (Centers for Medicare and Medicaid Services) published a final rule to support innovation and technology for Medicare beneficiaries.  This rule comes under Medicare Coverage of Innovative Technology (MCIT).

The result is expected high pace in the healthcare innovation and easy access of technology to seniors. Undoubtedly, it will be a step to involve technology for value-based care services and to reduce the administrative load. Indeed, it promotes the agenda of QPP MIPS.

How Healthcare Industry Uses Technology Today?

As of now, technology implementation comes with a lengthy process. When FDA approves a device, it comes with a price of time consumption. So, when a medical practice adopts a technology, the majority of time is spent on getting approval from the authorities.

Result? Technology incorporation that can save the administrative load or potentially save a life during the Medicare coverage gets delayed.

How does MCIT Rule Help?

The new rule helps restrict the lag time for all stakeholders, be it for seniors and innovators. It is helpful for medicalbilling companies in  USA as well as for QPP MIPS reporting. Moreover, FDA will approve the innovative product on an expedited basis.

It also improves the quality of care by opening ways to revolutionary mechanisms. For instance, to conduct gene-based tests in life-threatening situations. We can say that advancements in Improvement Activities (IA) and Promoting Interoperability (PI) for QPP MIPS become easy.

The Impact on the Healthcare Industry 

• MCIT rule assigns approval from FDA with national Medicare coverage for four years. After the expiration date, CMS will reevaluate the patient outcomes that emerged from the adopted technology among the Medicare beneficiaries.
• During this time, the innovators can develop or collect more evidence in support of the applicability of the product. Moreover, QPP MIPS eligible physicians can ensure their quality care to target MIPS incentives.  
• MCIT, when providing coverage, also aligns with the local coverage determination (LCD) process. It promotes easy access for seniors no matter their location.

How CMS Grants Permission?

Currently, healthcare providers have to ask each of the Medicare Administrative Contractors (MACs) for the LCD coverage. However, with the new rule, innovators do not have to seek permission from individual MACs.

The Larger Trend

The rule also specifies the standards that CMS uses to determine if Medicare covers a product or not. Moreover, we can also see the explanation for the requirements to diagnose or treat an illness. All this briefing will be subject to the understanding of CMS requirements from the innovators. Consequently, clinicians can promote the quality of care, adding to their QPP MIPS 2021 Data reporting.

Why You Should Start Planning for QPP MIPS 2021 Reporting Now?

Planning today for QPP MIPS  is going to benefit your reporting process in the long run. There will be lesser time to stress over the hectic data submission process because you already had figured out every detail.

Moreover, you can pick out the most relevant and useful MIPS reporting strategy for your medical practice, provided you start early.

MIPS Planning Is Not Easy!

As a MIPS eligible clinician, especially, if you already had participated in the previous years, you might think that MIPS reporting is easy.

However, you would also know that reporting requirements change every year, and if we do not comply with them, we are simply risking our financial responsibilities.

Hence, nowadays, devising a plan of action should be your priority, for which MIPS consultants can also help you.

Things to Consider While Strategizing MIPS Reporting Plan

As you go through the MIPS reporting process, you will encounter many issues that you have to surpass through your strategy. Also, if your reporting strategy has a solid base, it will maximize your MIPS score.

Here is an overview of the performance categories upon which clinicians’ scores will be judged.

Quality, Improvement Activities (IA), Promoting Interoperability (PI), and Cost are the four major performance categories. 

Based on the submitted data, MIPS eligible clinicians would receive 9% of positive or negative payment adjustments from Medicare.

• In MIPS 2021, the performance threshold is 61 points to at least maintain the neutral position. 

• For exceptional performance, clinicians have to score at least 85 points. 

• To target these goals, physicians or MIPS Qualified Registries must report data for all categories except for the Cost one.

·         For PI category data submission, you must have the certified Electronic Health Record (EHR).

The following are the brief details regarding each MIPS performance category.

Quality

This most workable and the highest weighted category require a lot of work. If you mean to target exceptional results out of this category, clinicians must report at least 70% of the eligible cases for both Medicare and non-Medicare patients.

Otherwise, you can receive zero points for the data completeness constraint.

However, there is a QPP MIPS 2021 reporting flexibility for small medical practices that even if they send data for less than 20 eligible cases, they can still receive 3 points.

Improvement Activities

The last day you can start performing improvement activities is October 03, 2021. You can check from the list of IA measures to see if you are already performing some activity or not.

Moreover, you have to devise a strategy to ensure accurate documentation of each IA activity. Otherwise, you might lose major points there only because you could not support your efforts in a systematic order. 

Promoting Interoperability

As mentioned above, if you want to report MIPS data for promoting interoperability, you must have a 2015 certified EHR system.

This category also has to perform for at least 90 days, just like the IA category.

Cost

Although CMS (Centers for Medicare and Medicaid Services) does not require data submission for cost; however, a solid strategy must be in place by MIPS consultants to add points into this category.

There is a 5% increase in the cost measurement performance. So, it can add to a fruitful total of the MIPS score.

If You Prepare Today for MIPS Reporting, You Are More Likely to Target Successful Medicare Payment Adjustment

QPP MIPS reporting is a challenge that does not come in handy if you want to maximize your score. Especially, when it comes to making a fruitful strategy for successful MIPS reporting, physicians cannot do it on their own. They need professional assistance for going about the best approach to collect, compile, and report data to CMS.

Therefore, it’s better to find the right MIPS Qualified Registry and start as early as possible to improve MIPS performance.