In light of the fact that the Merit-Based Incentive Payment System (MIPS) program is about to enter its fourth year, businesses are being forced to reevaluate the manner in which they approach their plan of action. The performance standards for the 2022 Performance Year are the most stringent ever established, both in terms of meeting the requirements necessary to avoid the penalty and to earn the rewards. In addition, because CMS is now actively publicizing the Quality results from MIPS on the Physician Compare website, the success of your organization in MIPS will have an effect on the professional ratings that are assigned to it.
In light of the aforementioned circumstances, it would be beneficial for businesses that employ MIPS-eligible professionals to investigate the potential benefits of collaborating with a MIPS Consultant, who is able to assist in effectively navigating the greatly increased MIPS difficulty.
In this blog post, I will walk you through the processes to analyze the Return on Investment (ROI) of engaging with a MIPS Consultant for the 2022 MIPS Performance Year. This evaluation should be done before interacting with a MIPS Consultant. To put it another way, should your company investigate whether or if purchasing a MIPS insurance policy will be beneficial to its bottom line?
The Climb to the Top of the MIPS Mountain: Obstacles and Prerequisites
Let’s take a closer look at the changes that have been made to MIPS for the 2022 Performance Year. Over the course of the past several years, the Centers for Medicare & Medicaid Services (CMS) has increased the amount of “incline” that an Eligible Clinician (EC) is expected to achieve in order to avoid an ever-increasing financial penalty.
The following is a list of the significant updates made to the program:
- The penalty for failing to disclose MIPS data has increased from -7% to -9% as of 2021.
- In order to avoid the -9 percentage point penalty, a MIPS Composite Score of at least 45, up from 30, is required.
- In 2021, a minimum Composite Score of 75 was required to be eligible for the Exceptional Performance bonus pool; this requirement increased to a minimum of 85 in 2022.
- In order to be evaluated based on the benchmarks, you will need to have a Data Completeness of 70% for the quality metrics, which is an increase from the previous requirement of 60%. If the score is below 70%, the practice will receive a score of three on the measure, whereas group practices with more than 15 ECs would receive a score of zero.
- Adjustments to the Quality Measures’ benchmark are made on an annual basis. This means the metric you recorded in the past may not score as well in 2021.
- For the year 2022, a bonus of five points in the PI system was taken away for having executed opioid agreements with patients. Therefore, ECs will need to find alternative means to make up for these lost points.
Your Choices When It Comes to MIPS Consulting
There are many different MIPS Consulting models available to you if you decide that it would be useful for your firm to use some guidance with MIPS. You can pick from a monthly payment for basic services to a tiered approach as you add capabilities. There are even settings that are limited to submissions exclusively. The level of difficulty has been raised to a new level beginning with the 2021 Performance Year. In addition, the following years, 2021 and 2022, are going to be considerably more challenging. To that end, engaging with a P3Care Consultant will offer a complete full-service program that covers all the facets of MIPS reporting, from assessing eligibility to data submission.
Our Unique Approach
By utilizing our one-of-a-kind P3Care software, P3Care mixes subject matter expertise with analytics to help clients in establishing the optimal plan to meet their monetary and care-quality objectives for the performance year.
