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Are you Maximizing the Bonus Available Through MIPS?

  • Stephanie Denham

As a non-patient-facing physician, your Merit-based Incentive Payment System (MIPS) score is largely comprised of quality reporting (formerly known as PQRI or PQRS). Did you know that claims-based quality reporting could be causing you to miss out on some of the MIPS bonus available to you?

There are multiple factors to consider when making a determination regarding a quality reporting method. Careful consideration of each of the below items can help to ensure you are maximizing your profitability as it relates to MIPS.

Claims-based reporting has no additional direct cost associated. However, reporting through a registry will require a fee. This fee may be easily recovered through recognizing some of the benefits available through registry reporting. Therefore, direct cost associated with a registry should be one factor considered in determining the best reporting mechanism for your group, but it should not be the only factor.

To achieve the maximum 10 points per measure, more than 20 Medicare Part B claims must be filed for that measure. If an individual practitioner does not have that volume of claims alone, group reporting may help to maximize the score and, therefore, the bonus. Group reporting is only available through a Qualified Clinical Data Registry (QCDR), not through claims-based reporting. Through reporting available with XIFIN RPM, your practice can determine volumes of eligible claims by provider to identify opportunities to increase your MIPS score for higher revenue from this program.

Claims-based reporting is required for only Medicare Part B eligible claims. CMS requires that registry reporting encompass all payors. Therefore, submitting QDC through a registry could result in a significantly higher volume of claims being reviewed by your group for QDC assignment, which could result in additional cost incurred related to the QDC assignment. Ensure that your billing system can easily report on eligible claims and QDC assignment. Additionally, confirm that your billing system can easily interface with the registry, if you choose to move to registry reporting.

CMS requires that a minimum percentage of eligible claims be submitted with the associated QDC to achieve the maximum available points for quality. When submitting QDC through claims-based reporting, the QDC must be included on the initial claim submission. If the QDC is omitted from the initial claim, there is no recourse available to correct the omission. Registry reporting is typically done by batch which allows for review of all claims to ensure complete capture of QDC prior to submission. It is imperative that your billing system have robust reporting around eligible claims and QDC assignment. XIFIN RPM allows for detailed reporting on these outcomes to help your practice ensure successful reporting and the highest possible positive MIPS adjustment. 

When determining the optimal method of reporting MIPS Quality for your practice, be sure to consider all of the above factors. Does the additional bonus potential from higher data completeness and achieving minimums through group reporting outweigh the cost of joining the registry and any potential increased cost for assigning QDC for all payors’ claims?

If you opt to move to registry reporting for quality, carefully select a registry partner based on knowledge in your specialty, ease of submission, functionality, reporting, and cost. Carefully consider costs and associated benefits as well as direct return on investment. As always, your team at XIFIN is available to help you navigate the MIPS program.

For more information and help with your MIPS program, contact us.


Published by XIFIN
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