Whether a term used to ensure organizations are meeting the needs of the customer, or a measure of excellence, quality is a term that is generally used to describe a trait or characteristic. The Institute of Medicine defines health care quality as "the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge."; Keeping these definitions in mind, let's look at quality the Merit-based Incentive Payment System (MIPS).
According to the Centers for Medicare & Medicaid Services (CMS), the Quality Payment Program makes Medicare better by helping you focus on care quality and the one thing that matters most making patients healthier. MIPS is one of the two tracks participants can choose from under the Quality Payment Program, and "quality" is perhaps the most important category.
Under MIPS, Quality replaces the Physician Quality Reporting System (PQRS) and in 2017, Quality makes up 60 percent of participants MIPS Performance Score. Because Quality is arguably the most important category under MIPS, here are 5 MIPS Quality Facts we think you should know about:
- Most providers will report on up to 6 quality measures, including an outcome measure, for a minimum of 90 days; or will select a specialty measure set from 30 specialty sets.
- If fewer than six measures apply to the individual MIPS eligible clinician or group, then the MIPS eligible clinician or group will only be required to report on each measure that is applicable.
- Unlike the Physician Quality Reporting System (PQRS), the MIPS Quality Performance category allows individual MIPS eligible clinicians and groups the flexibility to determine the most meaningful measures and reporting mechanisms for their practice when reporting for the Quality Performance category.
- Measures can be reported by individual MIPS eligible clinicians via claims, qualified clinical data registry (QCDR), qualified registry, Electronic Health Record (EHR) or by administrative claims, which require no data submission.
- Measures can be reported by groups via QCDR, qualified registry, EHR, CMS web interface (for groups 25+), Consumer Assessment of Health Providers and Systems (CAHPS) for MIPS, or by administrative claims. Although Clinicians can choose to report one measure in the quality performance category and avoid a negative MIPS payment adjustment, Healthcare Compliance MIPS Plus participants are encouraged to participate and achieve the exceptional performance threshold. Our MIPS Specialists are dedicated to help you and your practice success in the CMS Quality Payment Program.
Do you have MIPS questions? Contact us by email [email protected] or by phone 855-427- 0427.