How to Raise Your MIPS Score

2017 is the first performance year of CMS’s Merit-based Incentive Payment System (MIPS), and now is the time to prepare.

MIPS replaces existing quality reporting programs in Medicare Part B. It integrates the current Medicare quality and value programs and establishes a combined performance score. Each year, a performance threshold will be set. If your previous year’s average score equals that performance threshold, your Medicare Part B payments will not be affected. However, if you fall below that threshold, you will face a negative payment adjustment. Conversely, high performers can potentially receive significant bonuses.

With the possibility of both increased revenue with a higher MIPS score as well as penalties for falling below the threshold, it is important that you look at 2016 as a rehearsal year for MIPS and do everything you can to improve your score now. So, let’s break down MIPS into its component parts and learn how to raise your score.

Part #1 – Meaningful Use (MU)
For performance year 2017, MU will be 25% of your MIPS score, making it a significant factor in your reimbursement levels. Fortunately, MU is a category that many practices have already been working on. The first step of MU is to successfully attest to demonstrating meaningful use of certified electronic health records (EHRs).

Eligible professionals (EPs) can participate in the Medicare program or Medicaid program. This is the last year to initiate the Medicaid program to access MU incentives. 2014 was the last year to start the Medicare program and receive incentives. For practices that have not attested, penalties on Medicare payments began in 2015 and will increase each year. Since there are increasing penalties and participation impacts your MIPS score, there is value in starting in 2016 and continuing to attest. To learn more about determining eligibility and attesting, visit the Kareo Meaningful Use resource Center.

Part #2 - Physician Quality Reporting System (PQRS) / Value Based Modifier (VBM)
The Physician Quality Reporting System (PQRS) and Value-Based modifier (VBM) Quality portion will account for an additional 50% of your MIPS score for performance year 2017. If you have not been reporting PQRS measures, now is the time to start. You will need to select 2017 PQRS measures and start monitoring.

VBM borrows from the PQRS program to set minimum reporting requirements. To achieve the highest VBM score, you will need to either (1) register and report as a PQRS Group Practice Reporting Option (GPRO) or (2) report at least 50% of the group’s eligible professionals (EPs) for PQRS on an individual basis.

The GPRO method is available to practices with two or more eligible professionals billing Medicare and operating under the same tax identification number (TIN). The benefit of choosing GPRO reporting is that if at least one member of the group has eligible patient visits to report, every member of the group will avoid the penalty for non-reporting. GPRO method reporting is due June 30, so be sure not to miss your deadline if you choose to self-nominate for GPRO.

Part #3 – VBM Cost
A maximum of 10% of your MIPS score will be determined by VBM cost measures. There are no minimum reporting requirements with respect to your VBM cost measures since they are calculated by CMS based on submitted Part B claims.

Part #4 – Clinical Practice Improvement
Clinical Practice Improvement (CPI) is the new addition in the quality improvement efforts introduced by CMS with MIPS. It will be 15% of your score for 2017. The best way to improve your MIPS score in this area is to apply for or renew your status as a Patient Centered Medical Home (PCMH). PCMH certified practices automatically receive the full 15 points in this category, making it a great option for improving your overall score.

2016 is the year to prepare for MIPS. A higher MIPS score means higher Medicare Part B payments, potential bonuses for high performers, and increased revenue for your practice. With at least 75% of your first year’s score based on MU and PQRS/VBM measures, adopting a certified EHR and participating in MU and PQRS should be your first steps. Next, consider applying for PCMH status to take advantage of the 15 points it guarantees in the Clinical Practice Improvement category. 90% of your MIPS score is found in these three areas. Focusing on improving these areas will maximize your payout.