Why Physician Practices Need a MIPS Expert on Staff

Posted on April 16, 2018 I Written By

The following is a guest blog post by Marina Verdara, Sr. Training Specialist for CMS Incentive Programs, Kareo.

Healthcare providers go to school to learn how to care for patients, and that’s what they do best. However, billing processes, performance-based payment adjustments, and payment incentives are typically not included in this education. Being responsible for today’s regulatory complexities and workload may not have been what providers envisioned for their career. And it’s taking a toll. Nearly half of physician practices spend more than $40,000 per full-time physician per year on complying with Medicare payment and incentive programs, according to an MGMA survey. These costs factor in loss of physician productivity and staff training needs, along with IT expenses.

Independent practices must find a way to streamline the CMS incentive program reporting process. One important way to do this is by designating a “MIPS expert” among your staff. This could be your lead clinician or another manager who has oversight of patient encounter documentation.  While 2017 reporting is done, now is the time to specify the MIPS expert so they can ensure compliance throughout all of 2018.  Don’t wait until 2018 is done to specify your MIPS expert.

MIPS Recap

In 2015, The Department of Health and Human Services (HHS) announced new goals for value-based payments in Medicare that changed your practice’s payment structure. The Medicare Access and CHIP Reauthorization Act (MACRA) and the Merit-based Incentive Payment System (MIPS) introduced a system where providers receive payment based on the value and quality of services provided, not the volume. These changes repealed the Sustainable Growth Rate Formula, streamlined multiple quality reporting programs into MIPS, and provided incentive payments for participation in Advanced Alternative Payment Models (APMs).

HHS made these changes as the first steps to creating a Medicare for healthier people. Their goals are to create a Medicare system that will be here for generations to come while also providing open, flexible, and user-centered health information.

Navigating The System

This sounds like a great plan, right? But, how do you keep up with the frequent MIPS changes and alerts while maintaining a successful private practice?

You need a MIPS expert.

You wouldn’t leave your busy practice in the hands of a mechanic, and you shouldn’t leave your billing and incentive payments in the hands of someone who doesn’t understand MACRA and MIPS. You need an internal staff member who is your MIPS champion. This is the person who can partner with your EHR vendor to ensure that the eligible providers in your practice earn the highest incentive available, as well as avoid any negative penalties. In my role of training practices on implementing a streamlined CMS reporting system, I can tell you that practices with a designated MIPS expert are much more successful and efficient in their MIPS reporting process—and these are the practices that are earning the highest possible score.

Invest in the education and training of your internal MIPS expert so you can be confident that your practice is among the highest earners.

3 Reasons You Need a MIPS Expert at Your Practice

1. A MIPS expert will help maximize your payments. MIPS is all about streamlining your practice to become more efficient in how you diagnose and improve patient outcomes. When you do this well and report your data, you increase your chances of earning a positive payment adjustment.  

Participating in MIPS earns you a payment adjustment according to evidence-based and practice-specific quality data. The better the quality of your data, the better your chances of earning a positive payment adjustment.  

Your MIPS expert will understand the details of the MIPS program. They should be familiar with the activities and measures that are most meaningful to your practice. Your MIPS expert can help your eligible clinicians select measures that best apply to the specialty to prove their performance and maximize their payments.

2. A MIPS expert will be your education partner. This staff member should stay educated and informed of the latest regulatory details. Here at Kareo, we notify eligible clinicians and the designated MIPS expert of ongoing education opportunities. These are offered on a set schedule and as needed with new changes to MACRA and MIPS.

3. A MIPS expert will mobilize your practice staff and clinicians. To successfully meet MIPS requirements, the entire practice needs to be engaged. The MIPS expert can partner up with your EHR vendor to ensure that eligible clinicians in your practice understand the MIPS requirements and know how to navigate through the system. In this process, your practice can identify areas where any given workflow should be modified to earn the highest possible score and receive maximum payment for the great care they deliver.

Resources for Your MIPS Expert

As we mentioned above, MIPS experts at independent practices must stay up to date on all MIPS alerts and resources available to you through the Quality Payment Program. They should take time to educate themselves, understand changes, and read all alerts provided by Medicare or by their EHR vendors.

Your MIPS expert should be able to find an education partner using one or both of these paths:   

  1. Your Regional Extension Center: Contact them to ask questions and get connected with a MIPS education partner.
  2. Your Electronic Health Record company: As an example, Kareo has MIPS training specialists who can partner with your MIPS expert to help maximize payments, stay up to date on the latest changes, and provide support. We have training sessions and ideas for implementation of new workflow processes.  

Don’t be intimidated by the complexity of MIPS. Take time to designate a MIPS expert on your staff and get them connected to their education partner today.

About Marina Verdara
Marina is a Sr. Training Specialist guiding Kareo customers to higher levels of success with their CMS Incentive Program reporting, including MIPS and Meaningful Use. Marina has over seven years of experience working directly with several hundred small practice clinicians on a variety of projects specializing on CMS Incentive programs such as Meaningful Use, PQRS, and MACRA. Kareo is a proud sponsor of Healthcare Scene.