What Is MIPS Reporting, and Why Is MIPS Reporting Important?

Over the years, the Centers for Medicaid and Medicare have launched several incentive programs designed to enhance service delivery for patients. These incentive programs stemmed from Meaningful Use requirements that were originally designed to promote the utilization of EHR software. EHRs are widely adopted, but unfortunately, not all EHR software supports MIPS reporting — and providers may be penalized if they don’t track and report on data appropriately. 

What Is MIPS Reporting?

The Merit-based Incentive Payment Program, or MIPS, was formed to create incentives for providers to offer high-quality services at a low cost. Each year, participating providers can file MIPS reports and seek reimbursement for Medicaid and Medicare-funded services. 

Any providers that bill Medicare Part B claims or any eligible MIPS users are required to report on the quality of services offered. Eligibility is rooted in several criteria including: the allowable costs that they accrue, changes in their provider type or specialty code, and segment changes depending on the MIPS period of determination that they fall within.

Providers can learn about their eligibility and participation status on the Centers for Medicare & Medicaid Services website.

MIPS reporting is filed annually and focuses on the four main pillars of performance, all aimed toward providing better care to patients. Once all data has been collected and reviewed, practices will receive a score on a scale of 0-100 that determines how much compensation they are eligible for. 

Four Pillars of MIPS

With little impact on day-to-day operations, MIPS reporting indicates adherence to value-based care initiatives. By offering incentives to practices that directly tie into the data collected in these reports, practices are challenged to achieve a score that reflects a commitment to comprehensive patient care. MIPS reports evaluate the following categories:

  • Quality of care. CMS grades practices based on the quality of services delivered to patients. This category is typically weighted the highest.
  • Cost. Are the services you’re providing affordable?
  • Promoting interoperability. Interoperability allows for enhanced data sharing between providers and patients, and even from one platform to another across a medical practice.
  • Improvement activities. Patient engagement significantly impacts outcomes, and this category focuses on incentivizing patient interaction.

Why Your Practice Should Prioritize MIPS Reporting

While MIPS participation is mandatory for those that have opted-in, these numbers have been down in recent years, even considering that providers that aren’t meeting the low minimum threshold for eligibility have the option to voluntarily report their data. 

Though filing MIPS reports may seem like a daunting task, taking the extra time to demonstrate compliance encourages patient engagement,  yields financial benefits, and can optimize practice efficiency.

Potential for Patient Outcome Improvement

MIPS was developed with the intent to provide patient care while reducing the overall cost of services. Provider participation was meant to be increased by incentivization, directly impacting what matters most — the health of your patients.

While there is no direct correlation between MIPS and patient outcomes, the incentive challenges providers to evaluate if they are offering accessible, affordable care without compromising on quality. 

Monetary Incentives (and Penalties) Are Hard to Ignore

When providers file MIPS reports, they can avoid unnecessary fees and even receive reimbursement from the government for eligible services tendered to patients.  If a clinician earns higher than the minimum scoring threshold, they could qualify for a 10% price adjustment increase. In best-case scenarios, Medicare claims could yield an additional 17% adjustment throughout that year, depending on the practice’s score.

On the flip side, if clinicians don’t file MIPS reports, they can be faced with hefty fines. For example, an eligible physician participating in MIPS is required to report any essential data associated with your practice. A physician that is not compliant could receive an adjustment of -9% for Part B medicare payments.


Streamline Operations by Consolidating Data and Workflows

Keeping up with MIPS reporting can yield surprising benefits to overall practice efficiency. When each interaction needs to be logged, tracked, and eventually reported on in highly specific ways, practices usually adopt stringent protocols to ensure no detail slips through the cracks. Plus, software interoperability can allow staff members to save time inputting and exporting data. 

A Benchmark Solutions Solution Can Help

While MIPS reporting can be a tedious process, the right mixture of solutions can make accessing the data you need a breeze. Benchmark EHR can be configured alongside Benchmark PM to easily create powerful reports so your MIPS filing is quick and seamless. 

Benchmark Solutions software solutions are designed to be intuitive and user-friendly. With support for over 40 different specialties and flexible support, Benchmark Solutions makes MIPS reporting simple to understand and easily done. Get started by seeing how our EHR software works or schedule a personalized demo.

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