The transition year of MIPS is drawing to a close. Soon it will be submission time and time to get ready for the new performance year 2018. As we stand at the threshold of 2018, I want to give you three good reasons to give your MIPS score one last push.
1. 2017 MIPS Score and The Related Payment Adjustment Will Follow You in 2019
MIPS Score is Linked to the NPI. The MIPS score earned in 2017 will be linked to your NPI and used in 2019 to apply the payment adjustment even if you change the TINs or switch from reporting as an individual to a group, begin reporting as a part of virtual group, or become an APM participant. Hence, your efforts will not be wasted.
Highest MIPS Score Used to Determine Payment Adjustment. If you happen to have multiple MIPS scores for 2017 owing to participation in multiple groups or participating in an APM while being part of a group, the highest of all the applicable MIPS scores for your NPI will be used to apply the payment adjustment in 2019.
2. 2017 Quality Achievement Points Will Be Used to Determine the Improvement Bonus in 2018
The Quality performance improvement bonus will be calculated from 2018 onward based on the improvement in Quality category performance as compared to 2017. However, it must be remembered that only the achievement points earned for the reported measures would be taken into account and not the high priority and CEHRT bonus points.
30% Considered as Base. 30% of the maximum possible quality score for an eligible clinician will serve as the base for calculating improvement. For most providers, this would be 18 points (30% of 60 points). In this instance, if a provider has less than 18 achievement points in 2017, the improvement would be determined by comparing the 2018 achievement percent to an assumed 30% in 2017. As an illustration, let us consider the following scenario for an eligible clinician who earns 3 achievement points (minimum required) in the Quality category in 2017, and 30 points in 2018.
2017 quality achievement points = 3 points = 5% Quality Performance Category Percent Score [(3/60) x 100]
2018 quality achievement points = 30 points = 50% Quality Performance Category Percent Score [(30/60) x 100]
This results in Improvement of 20% [50% - 30%] as 30% is considered to be the base
Rate of Improvement = 20%/ 30% = 0.67
Improvement % = 0.67 x 10% = 6.7%
This 6.7% would be added to the Quality category percent score to calculate the Quality Category Performance Score.
No Score, No Bonus. So, if you don’t report on the Quality category in 2017, improvement score can’t be calculated as your Quality category score would be ZERO in 2017. You would lose the opportunity to earn an improvement bonus in 2018. This bonus could be instrumental in getting your MIPS score in the 70+ range to be eligible for additional Exceptional Performance Payment Adjustment.
Don't Forget the ACI Reweighting. Submit at least one measure for Quality category in 2017 to be eligible for Quality performance improvement bonus in 2018. This is even more important for Non-Patient-Facing clinicians, Hospital Based clinicians, clinicians in Ambulatory Surgical Centers, and clinicians whose EHR was decertified as they Advancing Care Information Category will be reweighted to ZERO and the weight allocated to the Quality category, making it count for 85% of the MIPS score.
3. Higher MIPS Score Translates to Higher Payment Adjustment
This is no secret. By now, almost everyone who is an eligible clinician and will be participating in MIPS knows this. If you are considering participating in 2017 at test pace, I would urge you to consider participating in ACI or/and IA performance categories as well.
Submitting IA is Easy. If you belong to a Small Practice (1-15 clinicians) and utilize a 2014 or 2015 edition certified EHR, CMS has made it very easy to participate and earn points under these two performance categories. Small practices get double the points for both the medium and high weight activities, and can earn 100% score in IA category by just reporting one High Weight activity, some of which are eligible for bonus points in ACI category if reported via the EHR.
Exclusions are Available for ACI. Small practices can also utilize the exclusions available for the ACI category for the required base measures. Exclusions are available for all the measures if the denominator is less than 100 except for the Security Risk Analysis.