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For physical therapists committed to delivering top-notch patient care, the Merit-based Incentive Payment System (MIPS) provides an avenue to receive recognition and reward for their efforts and support the transition to value-based healthcare. However, understanding MIPS, Qualified Clinical Data Registries (QCDRs), and Qualified Registries (QRs) can be challenging. Fortunately, this guide is designed to simplify these concepts for practitioners.
MIPS emerged as a component of the Medicare Access and CHIP Reauthorization Act of 2015. Its inception aimed to establish a value-driven healthcare framework, incentivizing eligible clinicians to deliver exceptional care, enhance patient outcomes, and receive increased reimbursements. Initially introduced in 2017 for qualifying providers such as Medical Doctors and Doctors of Osteopathic Medicine, this budget-neutral initiative expanded in 2019 to encompass allied healthcare professionals like Physical and Occupational Therapists.
Comprehending MIPS reporting is essential for healthcare providers engaged with Medicare, as it enables them to maximize reimbursements while delivering outstanding care.
The Merit-based Incentive Payment System or MIPS is a program from the Centers for Medicare & Medicaid Services (CMS) that ties a portion of your Medicare Part B payments to performance in four key categories.
Each year, eligible Medicare Part B clinicians and organizations gather and submit data across these four categories, forming the basis for MIPS to compute a score on a 100-point scale known as the Composite Performance Score (CPS). This score directly influences Medicare reimbursements, with higher scores resulting in payment bonuses and lower scores potentially triggering payment adjustments.
It's worth noting that historically, allied healthcare professionals (such as PTs, OTs, SLPs) were evaluated solely on the Quality and Improvement Activities categories, while physicians were assessed across all four performance categories.
However, in light of the 2024 CMS Final rule, allied healthcare professionals in large practices are now accountable for the Promoting Interoperability category and the Cost category as well.
To participate in MIPS, you need to report your performance through a Qualified Clinical Data Registry (QCDR) or a Qualified Registry. Both collect and submit data to CMS, but with some key differences:
Consider your practice setting, data collection preferences, and the measures you want to focus on. Research different QCDRs and registries, speak with colleagues, and choose the one that best aligns with your needs and goals.
Limber’s QCDR, Advancing Musculoskeletal (MSK) Care & Rehabilitation QCDR, offers white-glove support to give you the tools necessary to participate in MIPS, regardless of your practice size successfully.
The MIPS reporting periods run from January to December, with final submissions taking place Jan-March of the following year. But remember, MIPS is an ongoing process. It’s important to continuously analyze your results, identify areas for improvement, and adjust your approach to achieve success.
Participating in MIPS can be valuable for physical therapists who want to be at the forefront of quality healthcare and value-based payment. By choosing the right QCDR or registry, collecting meaningful PROs, and continuously improving your performance, you can thrive in the evolving healthcare landscape.
