What is MIPS in healthcare and why it is so important for Physicians?
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First Helper Paul7001
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replied March 21st, 2019
Experienced User
MIPS in healthcare
MIPS in healthcare is a value-based reimbursement model which obliges the eligible clinicians (ECs) with rewards based on their performances. It stands for Merit-Based Incentive Payment System.
What is a value-based reimbursement model?
If you need more clarity on the term, the web has unlimited resources on it. Go for the data available on the CMS government portal because it is the most authentic!
Briefly, a value-based reimbursement model is something that appreciates quality and progresses on positive patient-related outcomes. These outcomes are the feedbacks of customers after a service or procedure. If a clinician cares for the patient, fixes them, and reports to CMS keeping the healthcare costs to a minimum, they have complied with this model.
In cases of non-compliance and lack of reporting, there is a penalty, for instance, if ECs don’t submit data for MIPS 2018 by April 2nd, which is under two weeks’ time, they will have to face 5% negative payment adjustments in 2020. And, if they do submit the measures against each performance category, there is an equally balanced reward of +5% Medicare payment adjustments in 2020.
There are two tracks of the QPP, one is MIPS and the other one is the Advanced Alternative Payment Model (APM). Selecting any one of them is your choice but you can’t choose both at the same time.
Go for MIPS data submissions through NPI/TIN number via a MIPS Qualified Registry like P3 Healthcare Solutions, Inc. if you want to remain on the higher side of the MIPS final score. Above or equal to 70 out of 100 will earn you bonuses from the $500 million pool.
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