MIPS - What Practices Need to Know to Avoid Financial Penalties
Date Posted: Monday,
September 27, 2021
By law, CMS is required to structure the MIPS program such that 1 out of 2 clinicians will be penalized each year. Non-compliance, submitting inaccurate or incomplete data, or failing to meet the points threshold and category requirements will result in significant financial penalties and a reduction in a practice's Medicare reimbursements. To be specific, failure to comply or earn enough points for the 2021 MIPS reporting period will result in an automatic 9% penalty – this equates to a reduction of $9,000 for every $100,000 billed to Medicare, a risk that most practices can't afford to take.
Needless to say, given the financial risk, all healthcare practices, regardless of size or specialty, must evolve the way they approach handling compliance in order to assure their financial viability. The stakes have been raised every year and the increased complexity and challenges further heighten the stress, burden, and financial risk.
For a healthcare practice, it can be challenging to know exactly what to do to earn MIPS points, optimize their MIPS score, and protect their Medicare reimbursements. One tangible way a practice can impact their MIPS performance is by selecting the right reporting method.
When choosing a reporting method, know that CMS is continuing to incentivize practices to use technology (i.e., software), also known as a Certified Electronic Health Record Technology – CEHRT (i.e., an end-to-end electronic solution), for reporting. Using a CEHRT improves efficiency and effectiveness in reporting for MIPS, and 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 MIPS points that could be earned and therefore maximizes Medicare reimbursements.
Companies that have proprietary ONC (Office of the National Coordinator) certified software can fully automate the tracking and reporting of MIPS for any size practice or healthcare organization regardless of specialty.
Working with these companies has many advantages versus any other reporting methodology:
- Seamless integration with certified EHR or billing system
- No IT or Administrative resources needed from the practice
- Tracks and reports for all MIPS categories
- eCQMS (Enterprise Quality Management Systems) deciles earn more points than registry deciles
- Benchmarks performance based on CMS standards
- Electronically submits all data to CMS
It is critical to select the right methodology and partner who can help a medical practice maximize reimbursements and protect their bottom line. The 2021 reporting period is coming to a close, but there is still time to comply and avoid penalties; however, practices must act quickly.
I would like to thank Health eFilings for providing context for this article.
Doug Graham, Senior Management Consultant, and Director of Concierge Medicine Services
With over 25 years experience in the healthcare industry, Doug has an innate ability for helping physicians create operational efficiencies, improve profitability, and position their practices for growth. With his breadth of knowledge and careful attention to detail, Doug's assistance frees his clients to dedicate their time and energy on delivering high-quality patient care. Doug also brings a great deal of value to practice managers, coaching and supporting them in creating efficient workflow, as well as helping them manage and develop employees.