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MIPS
  • MIPS Performance Category Weights
  • MIPS Participants

MIPS Reporting Under MACRA and QPP


Benefits of using OneView for your MIPS Reporting:

  • Capture data for Eligible Clinicians who bill for Part B services in an Acute Care setting
  • Aggregate data from third party vendors
  • MEDITECH Collaborative Solutions Vendor
  • Performance Dashboards to monitor your MIPS Score daily
  • Clinical Informaticist resources for workflow and nomenclature mapping optimization
  • Near real time data with nightly updates
  • Direct Submission Vendor with conceirege service including optimization, testing and submission
  • Education Resources
  • A trusted partner with experience in producing accurate data

Quality Payment Program

The signing of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) into law changes the revenue cycle model by shifting from service based care to value-based care. Value-based care relies heavily on the reporting of quality measures to determine the quality of care provided to patients including patient outcomes. Patient service revenue will be based on value-based care which will be determined by quality of care and patient outcomes.

Merit-based Incentive Payment System (MIPS)

MACRA required the establishment of a Merit-based Incentive Payment System (MIPS) which consolidates certain aspects of various quality measurement and federal incentive programs for Medicare physicians and other providers into a more efficient framework. MIPS was created to consolidate the disparate CMS incentive and penalty programs that exist today: Meaningful Use for Eligible Professionals (EPs), Physician Quality Reporting System (PQRS), and Value-Based Payment Modifier (VBPM). MIPS data can be reported individually or with a group of eligible clinicians.

As defined by MACRA, MIPS consists of four performance categories all linked to quality and value of patient care. The four categories are:

  • Quality (replaces PQRS)
  • Clinical Practice Improvement Activities (referred to as ‘Improvement Activities”)
  • Advancing Care Information (replaces Medicare EHR Incentive Program/Meaningful Use)
  • Cost (replaces Value-Based Modifier)

The following pie chart includes the performance category weights for 2017 MIPS reporting. Based on 2017 reporting, eligible clinicians will see a positive, neutral, or negative adjustment of up to 4% on Part B services furnished in 2019.

MIPS Performance Category Weights

*Cost has a weight of zero percent for 2017 reporting

 

Quality Reporting

The Quality category replaces the Physician Quality Reporting System (PQRS). The Quality category requires eligible clinicians to report clinical quality measures that best reflect their practice.

Under MIPS, eligible clinicians must report on 6 measures, including one outcome measure for full participation. If an outcome measure is not available, then the clinician must report on another high priority measure. Eligible clinicians also have the option to report one specialty-specific measure set.

Quality measures will be selected annually through a call for quality measures process. CMS will publish a final list of quality measures in the Federal Register by November 1 of each year.

Advancing Care Information Reporting

Advancing Care Information replaces Meaningful Use for Eligible Professionals.

Meaningful use of certified EHR technology is referred to as "Advancing Care Information" under MIPS and the measure criteria is streamlined with emphasis on interoperability, information exchange and security measures. Advancing Care provides greater flexibility in meeting reporting requirements allowing eligible clinicians to choose which best objective and quality measures fit their practice.

Beginning in 2017, eligible professionals who currently participate in the Medicare EHR Incentive Program (Meaningful Use) will no longer report or attest for this program and will instead report through MIPS. In 2017, eligible clinicians have the option of using a 2014 edition or 2015 edition certified technology. In 2018, eligible clinicians will be required to utilize 2015 edition certified technology.

The five required measures are:

  • Security Risk Analysis
  • e-Prescribing
  • Provide Patient Access
  • Send Summary of Care
  • Request/Access Summary of Care

Eligible clinicians can choose to report up to 9 measures for additional credit.

Improvement Activities Reporting

In this new performance category for 2017, clinicians are rewarded for care focused on care coordination, beneficiary engagement, and patient safety. Eligible clinicians will choose from a list of more than 90 activities, and determine which ones best suit their practice.

There are 9 subcategories of Improvement Activities listed below. Each subcategory contains different activities, and eligible clinicians can earn points by completing those activities.

The 9 subcategories are:

  • Achieving Health Equity
  • Beneficiary Engagement
  • Care Coordination
  • Emergency Preparedness and Response
  • Expanded Practice Access
  • Patient Safety and Practice Assessment
  • Participation in an APM
  • Population Management
  • Integrating Behavioral and Mental Health
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