How to Best Prepare Your Practice for MIPS Scoring?

MIPS is shaking up the healthcare system, and physicians are among the thousands of practitioners wondering, “How will we be scored?”

A physician performance scoring system is central to the Merit-based Incentive Payment System (aka, MIPS). These scores will drive the new Medicare value-based reimbursement program.

Every point will count toward future reimbursements – or penalties.

Your take-home message is clear: Physicians who start preparing now for this new paradigm will be successful when MIPS takes effect in 2017

Composite Performance Scores (CPS)

CPS scores are the fulcrum of the MIPS reimbursement plan.

Based on these scores, physicians and practitioners will receive positive, negative, or neutral adjustments to their financial rewards.

These CPS scores allow Medicare clinicians to be paid for providing high-quality, efficient care through success in four performance categories:

Composite Performance ScoresQuality – 50% of your CPS score

Advancing Care Information/Meaningful Use – 25%

Clinical Practice Improvement Activities- 15%

Cost/Resource use – 10%

Each practitioner helps determine their success by identifying and following the specific quality measures and activities that will be used in calculating these scores.

The CPS earned by a clinician for a given performance year will determine payment adjustments in the next calendar year.

The Good News:

  • If a clinician earns a CPS of 100 points, then the incentive is 4%.
  • An additional “exceptional performance bonus” escalates up to 10%.

The Bad News:

If a clinician has a CPS of zero, the penalty assessed is 4% — the maximum penalty.

Bottom Line:

Every ranking in-between is possible. The top-to-bottom MIPS potential impact on Part B payments for 2017 is likely to range from a 14% incentive bonus down to a -4% penalty.

MIPS Scores Will Be Public

CMS will release each clinician’s annual CPS performance to the public.

For the first time, consumers will be able to see their providers rated on a scale of 0 to 100. They will see how their providers compare to peers nationally.

This is certainly new. It goes beyond existing programs such as VBM (Value-Based Modifier) which calculates quality and resource use scores -- but does not publicly show the results.

Start preparing now

Independent Physicians who familiarize themselves with the details of reporting and revenue cycle tools will be better positioned to succeed when MIPS becomes operational in 2017.

Any experience you can gain with VBM, Meaningful Use and Physician Quality Reporting System (PQRS) will give you an advantage over practices that aren’t yet engaged in these programs.

Watch for MIPS updates

At this printing, MIPS is scheduled to take effect January 1, 2017. The department of Health and Human Services has until November 1, 2016 to publish the quality measures. However, what you’ve just read is the most recent and accurate information we’ve gathered to date.