The Healthmonix Advisor

MIPS Hacking for Psychologists: Turbo-boost your ROI With This One Simple Trick.

Posted by Mike Lewis on August 1, 2019
Find me on:

In last week’s blog I laid out the case for opting into MIPS, an option that allows clinicians and groups to still receive a MIPS payment adjustment if they exceed 1 or 2, but not all, elements of the low-volume threshold. Although this option can be beneficial for a wide range of clinician types depending on their situation, today I want to focus on psychologists in particular. Because in my experience, they provide some of the most striking examples of this “MIPS hack” in action.

Almost every single psychologist I talk to is not eligible for MIPS, but can opt-in. And the reason is because most of them don’t see more than 200 Medicare patients. So for example, a psychologist might see 150 patients a week. But because he sees those same 150 patients every week, he’ll never reach the 200-patient threshold, even though he might reach over 200 visits and will most likely far surpass the $90,000 threshold.

So let’s say our psychologist has 500 visits between his 150 Medicare patients, and he bills $200,000 of Medicare. If he doesn’t opt-in to MIPS, that value stays neutral, so he makes $200,000.

But what if he does opt-in, and chooses to only report the minimum? In that case, not only is he able to receive a payment adjustment, but he has another advantage: because psychologists are on the list of new clinician types, and because that list is exempt from Promoting Interoperability, his score will be reweighted so that the Quality category is much higher.

In fact, in our hypothetical case, he doesn’t have the required case minimum to qualify for the Cost category either, so his score will reflect a 0% weight for Cost and PI, and that 40 points all goes into Quality. So now his Quality score is weighted at 85% of his total score, with IA comprising the other 15%. With the extra points in the Quality category, he ends up with a 1-2% increase, for doing essentially nothing.

But, say our hypothetical psychologist decides to do more than just the minimum, and aims to maximize his incentive. With 150 patients, his MIPS reporting process takes far less time than that of other clinicians who surpassed the threshold, and in the end he’s looking at, say, a 4% increase on his reimbursement. If he makes $200,000, that 4% increase adds up to a whopping $8,000. And if he chooses to use a reporting program like MIPSPRO, which makes it easy to navigate complicated Medicare requirements and maximize MIPS incentives, he can drastically minimize his reporting burden with hardly a dent in that incentive. So in the end his revenue increase is still around $7,800, with minimal effort, because he chose to opt into MIPS.

($200,000 in charges x 0.4 adjustment) - $200 est. cost of software = $7,800

And this is all before accounting for the ways he might maximize his ROI by opting in to report as a group, if that option is available to him.

For most psychologists I talk to, once we dig into the numbers like this, the choice is obvious.

RELATED: Disillusioned About MIPS Incentives? Here’s Why You Shouldn’t Be.

To check whether you are eligible to opt-in, enter your National Provider Identifier (NPI) on the QPP Participation Status lookup tool, or sign in to to review eligibility for all clinicians associated with your practice. And if you have more specific questions about how the opt-in policy could impact you, don’t hesitate to reach out! Schedule time with me here, or get in touch via email ( or by phone (215-330-5256).

Download your free MIPS Roadmap!

Topics: PRO Tips, MACRA & MIPS, Eligibility, Small Practice, VBC, ROI