The Healthmonix Advisor

How To Avoid the 5% MIPS Penalty This Year

Posted by Usman Safdar on June 14, 2018

In 2018, CMS is pushing even harder for the shift toward value based care. The minimum MIPS reporting score has increased from 3/100 to 15/100, and failing to report results in an automatic 5% reimbursement penalty. But if your practice or organization isn’t in a position to invest the kind of time, money, and resources that it takes to really go all in on VBC, you might be wondering: “what’s the minimum I can do to avoid the penalty?”

There is no one answer to this question, but the good news is that your practice has several options for how to report to earn a score of at least 15/100.

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Minimal Quality Reporting

For small practices (15 clinicians or less)

In order to meet the minimum score, your small practice must select at least 6 Quality measures (although if possible, we recommend selecting more than the minimum), and must report on at least one eligible instance that meets the performance for each Quality measure (10 to 20 eligible instances recommended to be safe). This will result in a score of at least 3/10 in each Quality measure, or a total of 18/60 in Quality if you report on 6 measures. In turn, a Quality score of 18/60 is re-weighted to a final MIPS score of 15/100. Also note that for 2018, small practices are also eligible to receive a MIPS bonus worth 5 points.

For large practices (16 clinicians or more)

In order to meet the minimum score, select as many Quality measures as possible (we recommend at least 6 to be safe). Then, report on at least 60% of patient visits from 2018. This enables you to score at least 15/100. If you choose this method and score higher, you may also receive a small incentive!

 

IA Attestation

For small practices (15 clinicians or less)

Select 1 high-weighted activity or 2 medium-weighted activities to earn full 20 points in this category. Then, attest to the completion of your selected activities. This results in a score of 20/20 in IA, which is re-weighted to a final MIPS score of 15/100.

For large practices (16 clinicians or more)

Select 2 high-weighted activities, 4 medium-weighted activities, or 1 high-weighted activity and 3 medium-weighted activities to receive full 40 points in this category. Then, attest to the completion of your selected activities. This results in a score of 40/40 in IA, which is re-weighted to a final MIPS score of 15/100.

So don’t take the hit! Instead, be proactive and get started with MIPS reporting today—your bottom line will be glad you did. In the meantime, if you are interested in learning more about your MIPS reporting options, talk to a member of our quality reporting team today.

Free "What is MIPS?" 2018 Fact Sheet - Download Now!

Topics: MACRA and MIPS, MIPS