Quality payment programs have changed the way physicians offer their services. The reimbursements now facilitate clinicians as per fee-for-quality rather than fee-for-service. Therefore, you need to know how you can avoid a 9% penalty in case of poor MIPS 2021 data submission to CMS (Centers for Medicare and Medicaid Services).
MIPS reporting has
been a part of the US healthcare system for five years now. Years before,
physicians could even pay a little attention to it, and it was enough. But now,
one thing is certain; the lesser you focus on quality healthcare, the lesser
points you will receive, and even will have to suffer a penalty.
What Can Physicians Do?
We can see a significant increase in Medicare patients. You
have to therefore perform to the best of your abilities while implementing technology
for the ease of the process. It comes with a lot of stress and anxiety.
However, QPP MIPS also
brings a disguised opportunity, which can help you improve your financial
situation.
What Caused the Change of Reimbursement Models?
Realistically, we could see healthcare expenses have been
increasing, but the compromise on quality was out of the question. The
healthcare authorities thus advise clinicians to strive for quality rather than
volume. These expectations have created an impact on the quality, where
Medicare patients are the most crucial beneficiary.
Here are a few things that you should know to successfully
complete the QPP MIPS reporting.
MACRA is Not the Replacement of the ACA Act
Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)
is NOT the Affordable Care Act. ACA, aka Obamacare, governs the insurers or the
individuals who pay. It particularly states that healthcare coverages must meet
certain standards. In an otherwise case, companies would have to bear penalties
for non-compliance.
Whereas, MIPS
& MACRA addresses the healthcare delivery reforms against
coverage offered by the government. Sustainability and innovation are the most
focused aspects of these programs. Clinicians must perform improvement
activities in four major sectors, and based on the submitted data, authority
rewards score. Ultimately, the score decides if the clinician is qualified for
positive or negative payment adjustment.
Thus, for successful MIPS reporting, medical practices must
consider what components can get them more scores in the end.
Know Your Reporting Options
Clinicians must know their reporting options in order to
succeed. It is to remember that MIPS only caters to the physician's payments,
namely PART B Medicare payments. So, healthcare workers have several options to
get their services recognized by the authorities (MIPS, APP, ACO reporting).
Based on the medical specialty or the method of care
delivery, one can choose a suitable method of data reporting. Generally,
a MIPS Qualified Registry assists
with successful and timely data submission as the administrative load and
compliance issues are quite hectic.
Moreover, clinicians have the option to report as an
individual, group, or virtual group. For group or virtual groups, participants
need to assign their billing rights to a single Tax Identification Number.
Don’t Wait for the End Period to Report
Clinicians can successfully target MIPS incentives. However, they need to
stop thinking and act now, otherwise, they could risk up reimbursements up to
5%. In a favorable condition, they can easily qualify for even the $500 million
bonus.
Moreover, this flexible program allows many adjustments in
unfortunate circumstances.
Many things could go wrong if you are not careful. For instance, you have to report data for Improvement Activities for at least 90
days. Failed to do so, and you will not receive any point.
Conclusion
We must know that CMS rewards points and payment adjustments
are based on your performance and not the amount of data submitted. So, you can
be a potential winner of the program only if you consider the dynamics of
Quality Payment Programs as per the CMS requirements. MIPS consultants can also be of
great help in this regard.
So clinicians! If you want to recognize in the Physicians’ Portal and receive positive payment adjustments or incentives for exceptional performance, ensure a thorough understanding of QPP to benefit your RCM.
