Healthmonix Advisor

Will 2021 MIPS Finally Bring Significant Financial ROI for Providers?

Posted by Matthew Major on November 24, 2020

Improved ROI of MIPS 2021

Clinicians participating in the Merit-Based Incentive Payment System (MIPS) are set to finally receive a worthwhile financial return for 2021 reporting. Providers have been unsure whether incentive returns of less than 2% justifies shifting focus to achieve a high score in the program. A provider collecting $400,000 in Medicare Part B payments in 2020 will only receive $6,700 for scoring well in 2018 quality payment program (QPP) performance. While this does produce a positive return on investment, it may cause practices to question whether it is worth the effort required to track and report measures.

Things may be about to change in 2021. Though the maximum reimbursements of 7% and 9% predicted in the 2019 and 2020 reporting years respectively were never achieved, CMS predicts the incentive for 2021 MIPS reporting will be 6.89% for exceptional performance. Such a shift would clearly make the case for necessary investments in time and resources to reach the high-performance threshold. That same provider collecting $400,000 would now see a return of $27,560, almost 40 times the cost it would take to invest in a streamlined MIPS process that dramatically minimizes the time and effort needed to participate.


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CMS knows that clinicians need to see a significant return on investment for the program to be successful. Much has been learned through the first four years to make significant rewards a reality. They are aware that failure to do so will cause too much uncertainty on the Medicare Triple Aim and achieving value-based care goals. As we enter the fifth year, participants should finally start seeing the returns they have been promised.

To guarantee the extra revenue, providers will need to begin tracking their MIPS performance in January 2021. Identifying gaps in care as the year progresses, will allow enough time to act and maximize measure scores. Access to live dashboards with the ability to generate gaps in care reports will be a key difference maker in reaching the high-performance threshold. Clinicians who take this approach will earn significant financial rewards while simultaneously providing higher quality care to their patients. Head over to the MIPSpro page to learn how to assure a high MIPS score and maximize future revenues for your practice.

Topics: MACRA & MIPS, Policy