The Quality Payment Program’s (QPP) Merit-based Incentive Payment System (MIPS) has introduced changes that could significantly influence practice management and billing strategies. The updates apply to all MIPS performance categories – quality, cost, promoting interoperability, and improvement activities – for calendar year 2023, as outlined in the final rule from the Centers for Medicare and Medicaid Services (CMS).
Here’s a summary of the changes likely to affect NewCura clients:
MIPS Final Rule Overview Noteworthy modifications include:
Penalty Avoidance: Physicians must achieve a minimum score of 75 out of 100 to prevent a penalty that could reach 9%. Scores below this threshold will impact 2025 reimbursements.
Performance Bonuses: The exceptional performer bonus has been discontinued as of 2023. Positive payment adjustments are still possible but will not be granted as bonuses.
MIPS Value Pathway (MVP) Reporting: Opting for MVP reporting requires registration with CMS from April through November 2023.
MIPS Category Updates
Quality: The quality measures have seen the addition of nine new measures and removal of 11. Changes of special note include the removal of flu and pneumonia measures from traditional MIPS, with retention in some MVPs. Scoring for measures with benchmarks can now result in fewer than three points, a shift from the previous minimum. Data completeness requirements stand at >70% for 2023, with a rise to 75% anticipated for 2025.
Cost: The cost category will once again be scored after a hiatus due to COVID-19. Physicians should have seen final 2022 scores in late summer 2023.
Promoting Interoperability: A 2015 Edition Cures Update certified EHR is mandatory for submitting Promoting Interoperability measures for 2023. The requirement to query prescription drug monitoring programs has become mandatory, extending to include schedule 2, 3, and 4 medications, although certain circumstances may warrant available exemptions.
Improvement Activities: This category sees minor alterations, with four new activities added, five modified, and another five removed. Activities prioritized include the development of language access plans and improvements in care for LGBTQ patients.
Navigating the complexities of the updated MIPS program is crucial for maintaining the efficiency and financial health of your practice. Adhering to the 2024 changes will require careful planning and a proactive approach. By leveraging available resources and seeking expert guidance, when necessary, healthcare providers can continue to deliver quality care while optimizing their MIPS performance and maximizing potential reimbursement benefits.
Key 2024 performance year resources are listed below: