10 MIPS Facts That Matter Most

  1. If Your Practice Volume Is Below the Minimum,
    You’re Not Required to Participate in MIPS

    1. Your practice is exempt from MIPS:
      • If your practice was paid less than $90,000 from Medicare in 2018, or
      • If your practice treated fewer than 200 Medicare patients in 2018
  1. If Your Practice Qualifies for MIPS, You Can’t Submit on Paper
    1. Qualifying paper-based practices are guaranteed to be hit with the MIPS takeback
  1. In 2020 You Can’t Use “Just Any EMR.” MIPS Requires That You Use A “Certified” EMR
  1. PQRS without a certified data registry is a losing proposition
    1. Only 5 codes can be submitted via claims-based PQRS submission vs. 6 allowed with a certified data registry
  1. “Quality” Represents 50%, or more of the MIPS score
    1. Do you know your therapists’ outcomes by body region?
      • Today, many practices are focused on improving progression stats. You need to do the same, or you’ll fall behind
  1. The CMS Is emphasizing interoperability and is pushing the industry toward electronic data exchange 
    1. Interoperability is the ability to share data, electronically, with healthcare providers and payers
    2. Most EMRs are not interoperable
  1. Small Practices That Are Excluded from MIPS Should Not Celebrate
    1. Referring doctors will quickly become reliant on real-time, interoperable data, and will avoid fax-based practices
  1. Commercial Payers Are Expected to Join APMs and may participate with MIPS in the future
    1. The CMS is said to be encouraging the major commercial payers to also adopt MIPS protocols
  1. The MIPS Takeback Is 75% Larger Than What You’re Thinking
    1. For years, the term “4% takeback” has been used to describe MIPS
    2. Be aware, in 2019, the MIPS takeback is 7%
    3. The takeback increases to 9% from there, and remember, major commercial payers will be included
  1. The MIPS Tsunami Is Just Beginning
    1. MIPS is designed to segregate outpatient rehab into winners and losers.
    2. And the Losers will pay the winners
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