Hacking MIPS: 2017

Hacking MIPS 2017 - do not exclude all the Eligible Clinicians in your group who do not meet the low-volume threshold without evaluating the impact on Medicare Part-B payment adjustment. The MIPS calculations shown in the example are based on CMS estimates. We have a MIPS100 program to help you get to a MIPS score of 100. 

There is good hacking and bad hacking. We all know about bad hacking: breaking into computer systems, fooling parking meters, identity theft.  But is there a good side of hacking? You bet. One definition of the term is to “modify in a skillful or clever way”. So, let’s take a look at MIPS and examine one potential hack that falls into the “skillful or clever” category.

Group Reporting Can Increase Your Practice Value

What is involved in this MIPS strategy is a scenario where a multi-specialty practice with a large amount of Medicare Part B reimbursement has Eligible Clinicians (ECs) in the practice that do not have to report data under MIPS. By including those ECs in the MIPS strategy, and including their MIPS scores, something remarkable could happen. This simple tweak could bring substantially more Medicare Part B reimbursement, elevated professional reputation (due to the fact the MIPS scores are public), and increased value of the practice if there a buyout.

Reporting as a Group Can Significantly Increase the Total Positive Payment Adjustment

Below is a graphic from MyMipsScore, a MIPS analysis tool that you can use for analysis and leverage it to build a strategy for achieving the highest possible MIPS score for your practice. In this example submitting as individuals using the EHR submission method the estimated positive adjustment totals $19,352,14. Reporting as a group and including those ECs that do not have to report, the estimated positive adjustment is $36,969.66. In this case, the positive payment adjustment almost doubled. Depending on the variables of a specific practice, the adjustment numbers could be significantly higher.

The take away from this hack is that knowledge and careful analysis can turn a lemon into lemonade. When those MIPS exclusion letters went out, there was a collective sigh of relief. It might be a good idea for practices to go back and review whether it might be best to include those excluded ECs into their reporting group or consider reporting as a group. This type of analysis is not for the faint of heart but is certainly worth the effort.

Identify more such high-leverage opportunities that can make a big impact on your financial bottom line.

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