You know that the healthcare landscape is continually evolving, where “evolving” really means, among other things, staying informed about regulatory changes.
One of the most significant legislative reforms in recent years was the Medicare Access and CHIP Reauthorization Act, which introduced the Merit-based Incentive Payment System—in other words, our old friends, MACRA and MIPS.
Here, we’ll explore the critical aspects of MACRA and MIPS but focus on the latest updates for 2024 and beyond and what healthcare providers need to know to maximize their Medicare reimbursements.
Re-Introduction to MACRA
A quick revisit: MACRA was enacted in 2015 to reform the then-current Medicare payment system, shifting the focus from volume-based reimbursement (repetitive visits to address the same issue) to value-based care, where health issues would be treated more comprehensively to avoid repeat visits and even readmissions.
The Sustainable Growth Rate (SGR) formula, which had previously been used to calculate Medicare payment updates for healthcare providers, was replaced by MACRA.
Re-Introduction to MIPS
A quick revisit: MIPS was established as one of the payment tracks under MACRA.
It (MIPS) was designed to determine how doctors would be reimbursed for treating Medicare patients based on various performance factors, including how healthy they keep their patients, how well they manage illnesses, and patients’ feedback.
MIPS scores, ranging from 0 to 100, influence providers’ Medicare Part B payment adjustments.
MIPS Performance Categories
MIPS evaluates providers based on four performance categories:
- Quality (30%)
- Cost (30%)
- Promoting Interoperability (25%)
- Improvement Activities (15%)
Each category’s specific weight contributes to the provider’s overall MIPS score.
MIPS Scoring and Payment Adjustments
As mentioned, a provider’s MIPS score would determine that provider’s Medicare Part B payment adjustment, which could be positive, negative, or neutral. That adjustment would apply to the second year’s reimbursements.
For example, a 2024 score between 0 and 18.75 in 2024 would result in a -9% adjustment, while a score between 75 and 100 could lead to a positive adjustment of more than 0%, either of which would be reflected in 2026’s reimbursements.
Key Updates to MIPS for 2024
Several significant updates have been made to MIPS for 2024:
- Data Completeness Threshold: Increased to 75%.
- Virtual Groups: Must have submitted their election to participate by December 31, 2023.
- Collection Types: Clinicians can choose the collection type that best suits their data collection methods and reporting capabilities.
MIPS Performance Score Impact
A provider’s MIPS performance score above 75 can reward that provider with an up to 9% increase in their Medicare reimbursements. This score portrays the provider’s commitment to high-quality care. Conversely, scores below this threshold may result in penalties and reduced Medicare payments.
Other “FYI” Proposed Rules for CY 2025: Stay Ahead of the Game
The CMS has proposed several changes for CY 2025, including:
- Telehealth Flexibilities: Some elements have been made permanent.
- Behavioral Health Services: Expanded payments and extended telehealth flexibilities.
- Conversion Factor: Proposed cut by 2.8% to $32.36 in CY 2025.
Telehealth Waivers and Extensions
CMS proposes to extend certain telehealth waivers through 2025. These include:
- Reporting Practice Addresses: Providers can report enrolled practice addresses instead of home addresses for telehealth services.
- Federally Qualified Health Centers and Rural Health Clinics: Can bill for telehealth services.
Summary: Key Points and Updates
Understanding MACRA and MIPS is crucial for healthcare providers to help ensure that ideally, (1) they’re reimbursed as maximally as possible or (2) that they at least maintain their scores as neutral, but (3) to not be penalized!
Conclusion
MIPS compliance plays a crucial role in improving healthcare delivery and patient outcomes.
By understanding and implementing its measures, healthcare providers cannot only enhance their practice and benefit from incentive payments, but also avoid penalties and contribute to better patient care.
Get on Track with MIPS
Using the ONC-certified MedicsCloud EHR, either as an outsourced billing/staffing services client with ADSRCM, or as an in-house platform from ADS through their MedicsCloud Suite will help you calculate your scores to be as financially productive as possible.
And our team of MIPS experts will help guide you in your quest to achieve MIPS greatness!
