Navigate MIPS with Confidence

Optimize MIPS Outcomes with Professional Support

Is Your Practice Prepared for successful MIPS participation?

In the Merit-Based Incentive Payment System (MIPS), your Medicare reimbursement hinges on your ability to deliver high-quality, cost-effective care. It focuses on evaluating your performance in relation to that of your peers. If your practice is eligible your participation is mandatory, and we’re here to help you navigate the complexities of MIPS and ensure your practice thrives.

MIPS criteria

MIPS Eligibility Factors

How is Eligibility Determined?

Eligibility is determined based on your clinician type and NPI/TIN combination meeting or exceeding a low volume threshold. The low volume threshold is comprised of the following items:

  • Bill more than $90,000 for Medicare Part B covered professional services, and

  • See more than 200 Medicare Part B patients, and

  • Provide more than 200 covered professional services to Medicare Part B patients

Providers could be eligible to report under multiple TINs.

If you reassign your billing rights to multiple TINs, you’ll have multiple TIN/NPI combinations. CMS will evaluate each TIN/NPI combination for MIPS eligibility and use TINs to evaluate practices for eligibility.

Why mips matters

MIPS is a crucial part of how your Medicare reimbursements are determined.

Your performance in MIPS impacts your bottom line, with potential adjustments that can significantly affect your revenue. By delivering high-quality, cost-effective care, you can maximize your incentives and ensure your practice stays competitive.

MIPS Consulting

The Cost of Noncompliance: Understanding MIPS Penalties

Noncompliance with MIPS can lead to significant financial penalties. If you fail to meet MIPS standards, your practice could face up to a 9% negative adjustment in Medicare reimbursements.

This could result in up to a $45,000 loss for every $500,000 billed to Medicare.

  • patient care

    Quality of Care

    MIPS encourages the delivery of high-quality, cost-effective care. By focusing on key performance areas, you not only improve patient outcomes but also enhance your practice’s reputation.

  • MIPS consulting

    Future-Proof Your Practice

    As the healthcare landscape continues towards value-based care, excelling in MIPS positions your practice for future success. What you do today impacts your practice in two years.

  • MIPS Reimbursements

    Financial Impact

    Your MIPS performance directly influences your Medicare reimbursements. Achieving a high MIPS score can increase your revenue, while a low score can result in significant penalties.

  • doctors in office

    Regulatory Compliance

    MIPS is integral to maintaining compliance with Medicare regulations. Adhering to MIPS requirements protects your practice from financial penalties and ensures you meet federal standards.

MIPS scoring graph

MIPS Scoring

In 2024, failing to meet MIPS standards could result in up to a 9% reduction in payments. Your MIPS score is a composite of 4 categories. Each of these has its own measures, requirements, scoring metrics, and timelines. A minimum score of 75 is needed to avoid a negative adjustment in your 2026 Medicare part B reimbursement.

MIPS Scoring

MIPS scores are calculated from four performance categories:

Quality: Measures the standards of care you provide to patients.

Cost: Evaluates how efficiently you manage resources and control costs.

Improvement Activities: Assesses your efforts to enhance care processes.

Promoting Interoperability: Focuses on your use of certified EHR technology to coordinate patient care.

Accurate tracking and reporting are crucial to maximizing your MIPS score.

MIPS Guidance

Transition to MVPs

Starting in 2023, MIPS Value Pathways (MVPs) provided a streamlined alternative to traditional MIPS reporting. MVPs simplify the process by focusing on specific measures tailored to particular specialties or medical conditions.

What is an MVP?

An MVP is a set of targeted measures and activities designed for specific specialties or conditions. This focused approach simplifies reporting and offers a more integrated assessment of care quality, leading to better performance feedback and more relevant peer comparisons.

Why transition to MVPs?

  • Focused measures reduce the administrative load by narrowing the reporting requirements to the most relevant metrics for your specialty. This targeted approach not only saves time but also allows for a more applicable measure selection, allowing you to concentrate on what truly impacts patient care.

  • Get enhanced feedback within your specialty. This focused comparison provides more relevant insights, helping you identify specific areas for improvement and excel in the quality of care you provide.

  • Early adoption positions you well for the shift away from traditional MIPS by aligning your practice with the latest reporting standards.

Ready to Simplify Your MIPS Reporting?

Let our experts guide you through the shift to MVPs, ensuring your practice is optimized for the future of value-based care.

Your Questions Answered

  • No, MIPS (Merit-based Incentive Payment System) isn't going away just yet. Traditional MIPS will be sunset in the future, although a specific date has not been announced. It continues to be a key element of CMS's (Centers for Medicare & Medicaid Services) strategy to enhance healthcare quality and manage costs. Healthcare providers should stay informed about MIPS guidelines and requirements in the meantime.

  • No, MVPs (MIPS Value Pathways) are not mandatory as of now. They are an alternative reporting framework under MIPS designed to simplify the program’s complexity. However, it’s beneficial to familiarize yourself with MVPs, as they will become more prominent in the future. In fact, MVPs are currently slated to become mandatory for multispecialty groups in 2026.

  • MIPS (Merit-based Incentive Payment System) and APMs (Alternative Payment Models) are two separate tracks under the Quality Payment Program (QPP). While both aim to improve healthcare quality, there are key differences. MIPS measures individual performance based on certain criteria, while APMs focus on overall care delivery and payment models. Additionally, participating in an APM can exempt providers from reporting under MIPS.

  • MIPS uses a composite score to determine payment adjustments. This score combines performance in various categories, including Quality, Cost, Promoting Interoperability, and Improvement Activities. Each category has specific measures, and the overall performance influences the payment adjustments received.

  • You need to start collecting data at the beginning of the performance year, which starts on January 1st. Consistent and timely data collection is essential for accurate reporting and maximizing your performance score.

  • CMS updates participation requirements annually, typically releasing these updates in the fall prior to the new performance year, which starts on January 1st. These updates are communicated through proposed rules, final rules, and various guidance documents. It is essential for providers to review these changes promptly to ensure compliance and optimize participation in MIPS

MIPS Guidance

Take the Next Step with KRK

At KRK, we’re about making value-based care work for you. We see MIPS as an important part of this approach, helping you deliver top-notch, cost-effective care while also boosting your Medicare incentives. With our guidance, you can navigate MIPS confidently, knowing that we’re here to support you every step of the way.