iPatientCare Blog - Estimating your Revenues under MIPS

Estimating your Revenues under MIPS

With MIPS replacing the PQRS and EHR Meaningful Use Incentives, what healthcare providers want to know is “How is my today’s performance going to affect my cash flow beginning 2019?” Unlike PQRS and EHR incentive program, MIPS does not award fixed positive or negative payment adjustments – the adjustments vary from provider to provider based on their performance. It is, therefore, crucial to familiarize with the new payment model and its financial implication on your practice.

With an aim to help healthcare providers participating in MIPS to estimate its financial impacts, iPatientCare has developed a MIPS Financial Calculator. MIPS Calculator is a free tool, which takes simple inputs of dependent variables and provides a breakdown of how it will contribute to the final score, and its implication on payment adjustments, which could be positive and negative. You can access the MIPS Financial Calculator from the given below button.

MIPS Financial Calculator

Estimating your Revenues under MIPS

In order to estimate your financial impact, you need some basic inputs:

  1. No. of providers: How many MIPS eligible Clinicians are there in your practice?
  2. Average Annual Medicare Part B billing per provider: Review last year’s claims to find out how much you billed Medicare Part B FFS last year.
  3. Your estimated score for Quality: Review your last year’s PQRS submissions and compare your performance rate against the deciles published in the 2017 quality benchmark (benchmarks can be downloaded from https://qpp.cms.gov/docs/QPP_Quality_Benchmarks_Overview.zip ). Identify the outcome and high priority measures from the list of 9 PQRS measures submitted in 2016. Add up the scores of 6 measures that give you maximum score (including one outcome or high priority measures). If you have more than one outcome or high priority measure in the list, add 2 points for each additional outcome and 1 point for high priority measure. If your EHR is capable of submitting the data to CMS electronically, add 1 point per measure. This would give you the estimated score for Quality.
  4. Your estimated score for Improvement Activities: Review the list of Improvement Activities and select up to 4 activities you can perform. Give yourself 10 points for medium weighted activity and 20 for high weighted activity. If you are non-patient facing physician, serve in rural or health professional shortage area or are a group of 15 or fewer providers, double your score. This is your projected Improvement Activity score.
  5. Your estimated score for Advancing Care Information: Review your last year’s Meaningful use submission against the 2017 Advancing Care Information Transition Measure set. Did you perform all the 4 required measures? Give yourself 50 points.  Review your performance rates for the performance-based measures and give yourself additional points as per the performance rate. Do you submit data to immunization registry? Add 10 more points. Do you submit data to any other Public Health Registries? Add up 5 more points.  Review your selected Improvement Activities. Do they carry bonus points for using CEHRT? Are you able to perform those using CEHRT? Add up 10 more points. This is your total Advancing Care Information Score.

Once you have the above information, simply put the data in the MIPS Financial Calculator and hit the calculate button. It will calculate your composite MIPS score and estimated incentives including exceptional performance incentives for 2019 through 2022.

Now that you know your projected incentives, you can work backward! Set a goal and determine how much more points you need to score under each performance category to achieve your goal.  Create an action plan to increase your performance rates for each of the measures. Review your performance on regular basis, put in your actual score in the MIPS Financial Calculator to see how far you stand from your goal and what needs to be done to bridge the gap.


About the Author:

Arnaz Bharucha is the R&D Lead for Quality Improvement and Senior Software Architect with over 17 years of experience in designing and supporting healthcare IT products for Electronic Health Record, Quality Reporting for MIPS, Meaningful Use, PQRS, PCMH, DOQ-IT etc., and professional & institutional medical billing systems. She has shouldered key responsibilities of understanding the US Healthcare industry standards, designing iPatientCare suite of products in compliance with the ONC’s Meaningful Use, designing and implementing interoperability and other healthcare Quality Reporting initiatives requirements. Under her leadership, iPatientCare has been a Qualified Registry for submitting quality measures to CMS since 2014.


Related Post

Request a Consultation

Feel free to get in touch with us in order to get any guidance/consultation related to healthcare IT solutions you are looking for.

0 0 votes
Article Rating
Notify of
Inline Feedbacks
View all comments
Would love your thoughts, please comment.x