Medicare Value-Based Payments: What You Should Know About MIPS
February 25, 2021 12:00 - 1:00 PM EST
Applying for nursing and CEU credits
MIPS Overview: Performance Categories, Quality, Promoting Interoperability, Improvement Activities, Cost
Why Should MIPS Matter to You: Effects on the organization/practice/clinicians, Benefits from learning more about MIPS
Brief Summary of the Presentation:
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) mandated that CMS implement value-based reimbursement for all Medicare Part B payments. MACRA created the Quality Payment Program (QPP) to satisfy this requirement. Within the QPP, there are two participation paths – the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). We will be focusing on MIPS since this is the more common pathway and most participants in APMs are already aware of the requirements/impact (which are similar to MIPS). The QPP aligns all previous CMS program (PQRS, Meaningful Use, and the Value Modifier Program) into one large, complex program. Clinicians who bill Medicare and reach certain thresholds are required to participate in MIPS to avoid a penalty on their Medicare reimbursement rate. In 2021, the maximum penalty a clinician could receive is 9%. Participation in MIPS can also result in an incentive if they perform well. Since the QPP is a budget-neutral program, the incentive rate will depend on the dollars collected from the penalties, however, there is a cap of 9%.
While there are only certain clinicians who are actually required to report MIPS, healthcare employees working alongside these clinicians have a huge impact on their performance. The benefits and consequences of MIPS participation (or lack of) can be felt throughout the organization/practice. We will discuss how various healthcare employees can maximize these benefits, as well as, how MIPS education can add to your marketable skills.
Emily serves on the MAHQ Board of Directors as a Director-at-Large. She earned her Bachelor’s degree from Michigan State University in Human Biology, and her Master’s of Science degree from Central Michigan University in Healthcare Administration. She has ten years of experience in various roles and departments in healthcare. She has been at Medical Advantage TDC Group for the past three years as a Quality Payment Program Advisor. She has experience working with thousands of practices and clinicians to help them understand and improve their Merit-based Incentive Payment System (MIPS) reporting for Medicare. She is dedicated to helping clinicians and practices improve their delivery and quality of care.