8 Tips for Merit Based Incentive Payment System (MIPS) 2019 Reporting 

8 Tips for Merit Based Incentive Payment System (MIPS) 2019 Reporting 

by Joseph D'Allegro, November 27, 2019

Healthcare Innovation Solutions (HCIS), the for-profit arm of the New Jersey Innovation Institute’s (NJII) Healthcare Division, hosted a webinar on last-minute reporting tips for clinicians preparing for 2019  Merit-based Incentive Payment System (MIPS) reporting.

MIPS Advisors Patrick Cordes and Madelin Hernandez led the conversation, which drew more than 140 registrants. “Our goal is to make it as simple as possible to maneuver the constant changes in reporting that come on an annual basis,” said Cordes.  

MIPS Reporting Tips for 2019

  1.   Pick Quality measures that have performance benchmarks. Not all measures have benchmarks. By picking measures that do, clinicians can maximize points.
  2.   Follow the Reliable Scoring Criteria for Quality Measures. Clinicians must meet three criteria such as collecting data for at least 60% of the measures eligible denominator.
  3.   Choose Quality Measures Wisely. Practices can earn bonus points by reporting on additional outcomes and high-priority measures. Use our Specialty Tip Sheets to select measures specific to your practice and those documented often.
  4.   Report the required Promoting Interoperability measures or claim exclusions, if applicable. Remember that Security Risk Analysis must be completed by December 31, 2019.
  5.   Don’t forget about your Patient Portal! Patient encounter data must be sent to the portal within four business days.
  6.   Recommended Public Health and Clinical Data Registries. Consider applying to the National Health Care Surveys Registry through the Centers for Disease Control and Prevention. Also check with your medical and specialty societies for clinical data registries that your practice/clinicians are eligible for.
  7.   Practices can apply for the Promoting Interoperability Hardship Exception. Small practices (those with less than 16 clinicians) that are unable to meet Promoting Interoperability requirements may apply for an exemption at qpp.cms.gov. Large groups having electronic health record issues can apply for a “Vendor Issues” exemption until December 31, 2019.
  8.   Make sure you earn the maximum amount of points for the Improvement Activity performance category. Contact us at qpp.njii.com for help.

You can hear the entire webinar at this link and view accompanying slides here. 

What is MIPS? 

The Centers for Medicare and Medicaid Services’ (CMS) created MIPS in 2017 by blending and modernizing elements of earlier initiatives, including the Medicare EHR Incentive Program for Eligible Clinicians, the Physician Quality Reporting System (PQRS), and the Value-Based Payment Modifier. MIPS uses payment incentives to push practices to adapt value-based care.

MIPS measures performance in four weighted categories – Quality (45%), Improvement Activities (15%), Promoting Interoperability (25%), and Cost (15%). Points from each category are added together to give you a MIPS Final Score which determines if a practice receives a positive, negative, or neutral payment adjustment from CMS. This year, the maximum adjustment is 7% and adjustment payments or penalties will be distributed in 2021.

Who is eligible for MIPS in 2019?

To participate in MIPS, clinicians and practices must meet three volume thresholds. These include having at least 200 Medicare Part B patients and $90,000 in associated medical billing in a given year, plus covering more than 200 professional services during the performance period.

They also need to be one of the following types of clinicians, most of which are new this year.

  • Physicians
  • Physician Assistants
  • Nurse Practitioners
  • Clinical Nurse Specialists
  • Certified Registered Nurse Anesthetists
  • Clinical Psychologists (new for 2019)
  • Physical Therapists  (new for 2019)
  • Occupational Therapists  (new for 2019)
  • Speech/Language Pathologists  (new for 2019)
  • Audiologists  (new for 2019)
  • Nutrition Professionals  (new for 2019)

This year, for the first time, MIPS-eligible clinicians that do not meet the volume thresholds outlined above are allowed to opt-in to the program and subject themselves to performance requirements in exchange for payment adjustments.

CMS will accept 2019 performance-year data until March of 2020, though clinicians are encouraged to submit early, beginning in January of 2020. MIPS payment adjustments will then start the following year, beginning January 1, 2021.   


How can the NJII HCIS MIPS team help? 

NJII’s Healthcare Division launched HCIS in 2018, and has served as a CMS-qualified data registry since 2011. Our MIPS team helped more than 4,300 providers and 620 practices submit care data to CMS for the 2018 reporting year, ensuring they received $6 million in incentive payments and avoided $25.9 million in penalties. 

Since our program began, we have helped more than 10,000 clinicians from New Jersey to Alaska. Our experience includes small and large practices, health systems, and a wide variety of billing and EMR/EHR vendors.  

You can learn more by visiting our pricing and services page. You can also get started with our submission and/or consulting services by registering online.  

Still have questions? Contact the HCIS MIPS team over the phone at (973) 642-4055 or via email at qpp.njii.com.