The merit-based incentive program (MIPS) went into effect at the beginning of 2017. Many institutions spent the year deciding which measures to report on and setting up infrastructures to provide those reports.
This new program has had many changes over the course of the last year and will continue to see changes this year as well. Not meeting the required measures means healthcare organizations will not receive maximum benefits and may even face penalties.
Read this article to learn about the three most important upcoming MIPS deadlines and ensure your institution, clinic or practice can meet them.
Advancing Care Information Performance
On December 31st of 2017, the first performance period came to a close. In light of recent tragic natural disasters, the CMS has rolled out a new policy to address these circumstances.
This policy allows clinicians to file for a hardship exception if they were incapable of using their implemented EHR. This includes healthcare institutions affected by hurricanes, earthquakes, and wildfires.
The applications for these exceptions for 2017 were due on the last day of the year, but healthcare organizations can expect that there will be other MIPS deadlines for exceptions in 2018.
January 1st, 2018 marked the second deadline for year two of MIPS deadlines and reporting. The reporting period of 2018 directly affects the physician fee schedule payments for the year of 2020.
The CMS requires an entire year of MIPS data to begin scoring clinicians for the cost. The weight of the cost category has changed from 2017 to 10 percent of the total MIPS score.
The CMS will calculate the cost associated with measured performance. Although this deadline has passed, the reporting period of 2019 will be eligible at the end of this year.
Payments under Physician Fee Schedules
The next MIPS deadline is set for March 31, 2018. If a clinician isn’t granted the hardship exception after application, they must submit all their 2017 performance measurements to avoid reductions in PFS payments.
If they don’t submit this data, they could see a decrease in payments by 4% in 2019. The MIPS deadline includes information about payment services such as diagnostic tests, preventative care, therapy, surgeries and regular office visits.
Having an awareness of MIPS deadlines and a calendar to ensure the organization doesn’t miss a deadline will help to reduce large federal reporting fees and maximize incentives.
The requirements for 2018 require a lot more planning and thought from the institution on how they are collecting and reporting on their data. Trying to throw something together at the last minute won’t work for this.
Some of the areas that MIPS deadlines are covering changes are payment adjustment increases, low-volume threshold increases, category weight changes, virtual groups participation and hardship exceptions.
Increases in Payment Adjustments
Based on provider’s performance, they can see a negative or positive impact on their Medicare reimbursements. Healthcare institutions can receive up to 4% back or lose 4%.
Your performance is one of the reasons it’s important to have accurate and consistent reporting. If your reporting and performance are poor, it’s likely you are going to have a hefty penalty in 2020.
Weight Changes in Categories
Cost is one of the biggest changes in reporting for MIPS deadlines in 2018. Cost is now weighted at 10% of a healthcare organization’s overall performance score.
In the first year of MIPS reporting, quality rated at a high percentage. This year, quality score has dropped down to 50% because of the change in the cost percentage.
Other categories that are important to make note of, but did not change for 2018 are the IA and ACI categories. ACI remains at 25% and IA remains at 15%.
Participation in Virtual Groups
Participating in virtual groups is now an option for smaller clinics and institutions. Group reporting enables 10 or fewer groups to come together and report on MIPS. This prevents smaller clinics from having to sell their practice in order to enable MIPS reporting functions.
Virtual groups don’t require participants to be in the same field or the same specialty, but just that they report on MIPS the same way a larger organization would.
There is one reporting score given across the board to all members of the group and they each receive the same payment adjustment. The deadline for joining in with virtual groups was December 31, 2017. If you didn’t have time to apply but would like to in the future, the following year deadline would be December 31, 2018.
Hardship Exemption for MIPS Deadlines
In 2018, the CMS will allow the hardship rule to apply. This applies to any natural disaster such as a hurricane, earthquake, wildfire or flood. Healthcare organizations may lose temporary or permanent access to their EHR in the midst of a natural disaster.
If a natural disaster occurred for an organization in 2017, relief will have been applied if they met the MIPS deadline of December 31st.
The hardship exemption allows affected institutions to bypass submitting any reporting or performance data. If they do in fact have data to submit, they will be scored for performance based on their submission. If they are lacking the full data, their categories will be weighted to compensate.
As you can see, reporting on value-based care is becoming important in healthcare. In order to provide quality patient care, organizations must be meeting the standards laid out in the appropriate MIPS categories.
Taking the time to set up the appropriate systems to measure accurately and efficiently will help to maximize performance-based incentives and avoid hefty penalties. Staying up to date on what the CMS is changing in the reporting guidelines from year to year will help.
Having an equipped EHR system, great MIPS reporting tools, and the right people to guide the reporting process will ensure your healthcare organization gets the best benefits. If you’re interested in learning more about how to improve your practice, contact us today.