Does your medical practice service patients covered by Medicare Part B? If so, you are automatically part of MIPS: Medicare's Merit-based Incentive Payments System. How MIPS affects you depends on how you manage the care of your Medicare patients, and how compliant you are with specific reporting standards.
The highest level of MIPS achievement is to be classed as an Exceptional Performer. Exceptional Performers receive financial incentives for achieving high MIPS scores, and continually improving their standards of patient care. Happe-Analytics can be your path to achieving this status and qualifying for the significant incentive that comes with Exceptional Performance.
What is Happe-Analytics?
Most of the mandated reporting for MIPS consists of data that can be extracted from your patient EHR system. However, for data to be accurate, your EHR must be set up correctly. Your practice workflows, data input methods and documentation must be aligned for your data to be trustworthy and current at each collection point.
Tangible Solutions' proprietary Happe-Analytics software measures your quality outcomes, delivers a clear, comprehensive evaluation of your MIPS score, and helps you perfect your data reporting. When you select Happe-Analytics as your MIPS solution, you gain deep visibility into each performance category, and can easily identify areas ripe for improvement at both a practice-wide and practitioner-specific level.
The Happe-Analytics process
First, we complete a deep dive into your practice, identifying how your practice collects, inputs and stores your patient data. We meet and collaborate closely with your practice staff and physicians, to evaluate workflows, documentation and data input methods.
Since Happe-Analytics works with multiple EHR systems, we can customize your solution and recommend input changes that will increase your extractable data for reporting purposes. This refined data becomes your trusted point of reference for MIPS reporting, and will be the baseline you can use to improve your score and maximize your positive adjustment.
Practices and practitioners who utilize the Happe-Analytics reporting system have an improved chance at maximum positive adjustments in the years ahead; in fact, all those currently using Happe-Analytics are on track to become Exceptional Performers, and receiving the highest incentives for quality patient care.
Categories that affect Exceptional Performance status
A points system determines the impact of MIPS on your revenues. If you didn't know about MIPS, or haven't been participating in mandated data reporting, you have probably been losing money each year since the program began implementing negative and positive financial adjustments.
According to the Quality Payment Program website, by collecting and reporting data based on measures of how you provide care, and continually improving your care across four key performance categories, you can avoid penalties and achieve scores that qualify you for financial rewards. The four categories include:
- Physician Quality Reporting System (PQRS, measures quality of care)
- Promoting Interoperability (PI, measures use of electronic health records)
- Value-Based Payment Modifier (VBPM, measures cost of care)
- Improvement activities (IA, measures implementation of activities to improve care)
Those who maintain the highest level of excellence achieve Exceptional Performer Status. This is the top ranking for the MIPS program, and the goal of every participating practice as participants at this level are eligible for the largest MIPS incentives.
Happe-Analytics helps doctors and practices achieve better reporting, and highlight areas of patient care and practice administration that are in need of improvement. With Happe-Analytics on your side, you can raise your scores year over year, reaching Exceptional Performer Status and receiving the highest possible incentives.
Scoring, payment adjustments and Exceptional Performer bonuses
Eligible clinician (EC) scoring changes slightly every year. According to the Journal of the American Health Information Management Association, for the year 2020, scores were weighted accordingly:
- Quality (45%)
- Promoting Interoperability (25%)
- Cost (15%)
- Improvement Activities (15%)
Scores range from 0 to 100. ECs receive payment adjustments that are negative, neutral or positive. In 2021, MIPS-eligible clinicians will need to have an MIPS score of at least 60 points to avoid a penalty of up to 9% in 2023, and the Exceptional Performance bonus threshold is 85 points. The scores are released the year after they are gathered, and the payment adjustments applied the year after that (ECs evaluated in 2021 will receive their scores in 2022, and the payment adjustments will be applied in 2023).
The negative and positive adjustments applied to your practice can be found on the annual Explanation of Benefits (EOB.) If you haven't been receiving the maximum positive adjustment for exceptional performance, you need to identify where your practice is falling short and why.
Happe-Analytics can help you improve your score so that you can receive the Exceptional Performance bonus each year for your practice's commitment to patient care and high level reporting. One of our customers increased their MIPS score from 68 to 99.8 in 2020, elevating them in the space of just one year from a score barely high enough to escape negative impact, to one qualifying for Exceptional Performer Status and the accompanying positive adjustment.
Alternative Payment Models (APMs) may exempt a practitioner or practice from MIPS, relieving them of the concerns over a negative adjustment, but these ECs will also be ineligible for a MIPS positive adjustment. Reporting is still required, although participation thresholds are lower. Other exemptions from MIPS include new Medicare enrolled clinicians, who are exempt from MIPS until the next performance year, and clinicians with a low volume threshold. In case of the latter, the provider must meet one of the following measures:
- Billed less than $90,000 in Medicare beneficiaries in a designated period
- Provided care for less than 200 Medicare patients a year OR less than 200 covered services
While such providers are not subject to MIPS, reporting is still a valuable way to identify gaps in care and implement cost-saving measures.
Happe-Analytics can help beyond MIPS
MIPS isn't the only value-based incentive program for health care providers. There are multiple other programs covering different areas of medicine and aspects of care, cost savings and EHR use. Happe-Analytics integrates with almost any EHR for accurate reporting that can be leveraged to qualify for additional incentives through other programs, without additional cost.