Monday, 13 January 2020

Optimize Compliance to Maximize Reimbursements with MIPS Reporting

Written by Sarah Reiter of Health eFilings, the national leader in automated MIPS compliance and ClinicTracker’s trusted MIPS compliance partner.

The Merit-based Incentive Payment System (MIPS) requires providers to transition from a volume-based care model to a value-based one or face significant financial penalties and even reputational harm. With the end of the 2019 MIPS Reporting Period and the start of the 2020 Reporting Period, it’s clear that the stakes have been raised yet again making it even harder to avoid significant penalties, further increasing the stress, burden and financial risk for a healthcare practice like yours. To be specific, failure to comply or earn enough points for the 2019 reporting period will result in an automatic 7% penalty on every Medicare Part B claim paid in 2021 – this equates to a minimum of a $6,300 per provider hit to the bottom line, and the penalty will increase to 9% and a minimum of $8,100 per provider for the 2020 reporting period.

MIPS implications


Given the financial risk, all health systems, regardless of size or specialty, must evolve the way they approach handling compliance in order to assure their financial viability. For behavioral health practices, there are additional challenges including the addition of Clinical Psychologists as an eligible clinician type for the first year in 2019. There are many commonly misunderstood aspects and nuances with the MIPS program, particularly in how points are earned. For a behavioral health practice, it can be challenging to know exactly what you need to do to earn points, optimize your score, and protect your Medicare reimbursements.

One tangible way a practice can impact their MIPS performance is by selecting the right reporting method. Therefore, it’s very important to understand the various reporting methods and the differences between them so you can choose the best methodology and partner for both tracking and reporting.

cft benefits

When choosing a method, know that CMS is continuing to incentivize practices to use technology (i.e. software) also known as a CEHRT (i.e. an end-to-end electronic solution) for reporting. Using a CEHRT improves efficiency and effectiveness in reporting for MIPS as CMS has determined that the data submitted via technology is more complete and accurate. Reporting via a CEHRT is the best approach because it also optimizes the points that can be earned and therefore maximizes Medicare reimbursements.

Health eFilings, a CEHRT, is ClinicTracker’s compliance partner and has proprietary ONC certified software that fully automates the tracking and reporting of MIPS for any size practice or healthcare organization regardless of specialty. Working with Health eFilings has many advantages versus any other reporting methodology, including:

  • Seamless integration with ClinicTracker
  • No IT or Administrative resources needed from you
  • Tracks and reports for all MIPS categories
  • eCQMS deciles earn more points than registry deciles
  • Benchmarks performance versus peers based on CMS standards
  • Earn bonus points because Health eFilings is an “end to end electronic solution”
  • Proprietary algorithm evaluates 9 million combinations to select best quality measures to optimize score
  • Electronically submits all data to CMS

A final important and timely reminder – there IS still something you can do for 2019 reporting:

Even though the end of the 2019 reporting period has passed, you do not need to accept that you must take the automatic penalty for 2019. Health eFilings can support you with reporting for the 2019 reporting period and also advise you on your situation for 2020 reporting so you are able to optimize your score. But time is of the essence. You must act now!

Watch the recorded message from Sarah Reiter of Health eFilings.



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