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Demystifying MIPS

You’ve heard MIPS is coming, but what exactly is it? What is MIPS vs MACRA in the jungle of government acronyms?

MACRA (Medicare Access and CHIP Reauthorization Act of 2015) was the latest and largest change in how Medicare clinicians were paid.

MIPS is the workhorse for the MACRA program.

MIPS stands for “Merit-Based Incentive Payment System” – and yes, financial incentives are at the heart of MIPS.

MIPS = Better Patient Care = Financial Incentives

MIPS is focused on improving patient care – that’s the overarching goal. In the process, that will involve revamping payment structures and incentives for physicians. The government’s emphasis on healthcare information technology will dramatically shift as well.

  • With MIPS, the emphasis moves toward excellence in patient care, supported by better-connected EHR technology.
  • MIPS will absorb three reform programs, namely Meaningful Use (MU), Physician Quality Reporting System (PQRS) and Value-Based Modifier (VBM).
  • MIPS changes how Medicare reimburses physicians. MIPS links fee-for-service payments with quality of patient care and value – instead of quantity.

Who is affected (or not) by MIPS

MIPS applies to Medicare Part B clinicians, including physicians, physician assistants, nurse practitioners, clinical nurse specialist, and certified registered nurse anesthetists.

Medicare Part B clinicians may be exempt if they are:

  • First-year Medicare participants.
  • Ineligible alternative payment models who qualify for the bonus payment.
  • Below the low-volume threshold.

The eligibility net for MIPS will expand during the first years to certified registered nurses, physical and occupational therapists, speech-language pathologists, audiologists, nurse midwives, clinical social workers, clinical psychologists, and dietitians/nutritional professionals.

That’s the flyover view of MIPS. Stay tuned for more details, and a game plan to help your practice survive and thrive through these changes.

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