Scoring the MIPS Program

MIPS have become effective from this year, in the month of January. MIPS has been clearly explained and reviewed by medicare and the importance of MIPS and QPP have been given in detail. Clinicians decided to participate in MIPS will get performance based incentives and payments for their medicare payments. This medicare payment will be started from the year 2019.

Through MIPS, it ensures that clinicians give quality care to the patients and the performance of the clinicians are weighed with scores. The scores given to the clinicians based on the performance is called Composite Performance Score. Following are the simple and easy steps to understand the MIPS score. Using this step the clinicians will be able to calculate the score, evaluate and monitor the score as per their performance.

MIPS score categories

Following are the performance categories used in MIPS score

• Advancing Care Information (ACI) – 25%
• Cost – 0%
• Improvement Activities (IA) – 15%
• Quality – 60%

Each of these categories has some value added to it and summing the entire category will be the total value for 100. Points will be awarded for the clinicians in each category and it will be calculated for the total value based on which MIPS payment will be done.

Reporting

Individual clinician is a person with a single National Provider Identifier combined with single Tax Identification Number. A group of clinicians use a common TIN and it is not depended on the location or any other factors. Both the individual and the group have to report with appropriate number to Medicare regarding their MIPS.

• Information to report for individual
• Data for each MIPS category
• Payment adjustment
• Data reporting through HER and clinical data registry
• Reporting through medicare claims
• Information to report for group
• Report group level data to MIPS
• One payment adjustment as per group’s performance
• Data reporting through HER and clinical data registry
• Reporting through medicare CMS web interface

Specialty

The requirements for the clinicians required by MIPS are same for all the categories of specialties. Totally 6 quality measure are used in the specialty for the individual and the group.

Improvement activities

The new performance category for clinicians is clinical performance improvement activities. It rewards the clinicians for the quality of care they have delivered for the patients.

• Care coordination
• Patient engagement
• Patient safety

Improvement activities scoring

• Maximum score of 40 points given for the improvement activities.
• Medium and high weight scores are awarded in this category

Advancing care information

It is a replacement for MUIP – Meaningful Use Incentive Program.

ACI measure set selection

• It includes the measures and objectives that should be reported to the MIPS.
• Use EHR editions for reporting
• Report Advanced Care Information Transition Objectives and Measures

ACI scoring

The scoring system is quite different here though MUIP is replaced.

• Base points
• Performance points
• Bonus Points
• Registry bonus
• Improvement Activity bonus