MACRA/MIPS 2022 Update: Don’t Leave Money on the Table

Summertime means that it’s time to start preparing your MACRA and MIPS compliance for the year. This is important, because healthcare practices can qualify for reimbursement from Medicare—up to 9% of claims paid—for submitting high-quality outcomes and compliance with all MIPS categories.

While reporting compliance for MACRA and MIPS is not difficult, it does require careful attention, especially since there are changes this year. Marina Verdara, Kareo’s Senior Training Specialist and expert on CMS Incentive Programs, provides tips to make compliance easier.

What are MACRA and MIPS?

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) reformed the Medicare payment system. It created a Quality Payment Program, allowing Medicare to reward clinicians for focusing on value outcomes rather than volumes of procedures. Its Merit-based Incentive Payment System (MIPS) streamlines quality programs, and gives financial bonuses to clinicians for participation.

How do practices meet MIPS requirements?

There are five steps:

  1. Confirm MIPS eligibility for all practitioners in the practice
  2. Complete training on MIPS
  3. Track MIPS progress for all providers
  4. Gather all supporting documentation
  5. Attest performance by submitting documentation.

Why should practices and billers participate?

Who doesn’t like extra money? By merely submitting MIPS documentation, practitioners can earn a substantial bonus on Medicare payments. But staying on top of the program can be a hassle. That’s why billing companies often assist their clients with compliance activities – bringing in extra revenue for clients and also earning a portion for their services.

What has changed in 2022?

The basics remain the same. However, you’ll want to be aware of the following changes in case they impact reimbursement possibilities.

  • Cost Performance Category: Episode-based measures have been added, for melanoma resection, colon/rectal resection, sepsis, diabetes, asthma/chronic obstructive measures. There is no change to the small practice bonus.

  • Quality Measure Performance Category: Group-level scores can only be submitted if your practice submits data as a group. Bonus points are no longer given for reporting additional outcome, patient experience, high-priority measures beyond the one required, or measures meeting end-to-end electronic reporting criteria.

  • Promoting Interoperability Performance Category: Small practices are automatically reweighted to 0%. It is no longer necessary to report Promoting Interoperability data, or to submit a Hardship Exception Application to be reweighted. There’s a new SAFER Guides attestation measure. Immunization Registry Reporting and Electronic Case Reporting measures are now required. Bonus points can be earned for reporting optional measures.

  • Performance Thresholds: 75 points are now needed as a minimum final score to avoid a negative adjustment in 2024. 89 points are required for exceptional performance. This is the last year that additional payments will be made for exceptional performance.

  • Final Score Recalculation: Points are redistributed for small practices to give more weight to improvement activities.
  • What should you do now?

    Make sure you’re on top of the process, monitoring progress every two weeks. Don’t let negative adjustments take you by surprise. Use Kareo’s software tools to streamline compliance requirements, including an action plan checklist to get you started and stay on track. The tools interface seamlessly with Kareo EHR, making it easy to extract reliable data and automate a lot of the procedure.

    Attend the free MACRA/MIPS Update webinar

    Don’t miss Kareo’s free webinar "MACRA/MIPS 2022 Update: Don’t Leave Money on the Table." Hosted by Kareo’s MACRA/MIPS expert Marina Verdara, it covers everything you need to know to keep your clients or practice in compliance and maximize returns this year. Register here. The webinar is Wednesday, August 10th at 10am PT/1pm ET, and will be recorded, so you can also sign up for access at a later date and review information whenever you like.

    About the Author

    Alesa Lightbourne is a prize-winning author, professor and former dean of an international business school. As a freelance writer, her clients have included Fortune...

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