MACRA & MIPS
MIPS in healthcare not only brings incentives and bonuses but also builds a strong reputation for your practice. The only alternative is the other track – Advanced Alternative Payment Models (APMs). If you are eligible, you must submit MIPS to avoid penalties, which can cut thousands from your Medicare reimbursements. Hardship exceptions still apply, especially for practices in rural or underserved areas.
Quality
Replaces PQRS
Cost
Replaces VBM
Promoting interoperability
Replaces MU
Improvement Activities
New Category
MACRA
What is MACRA?
MACRA is the law that governs several programs, and the QPP is no exception. QPP combines the Physician Quality Reporting System (PQRS), the Value-based Modifier (VBM) and Medicare Electronic Health Record (EHR) program into one program that we know as the Merit-based Incentive Payment System (MIPS). Thus, allowing MACRA & MIPS to be inseparable. Value-based care navigates through the veins of the healthcare system via the MIPS program. Centers for Medicare and Medicaid Services (CMS) defines MACRA as an enactment of the new payment order that rewards clinicians for demonstrating better care instead of looking after more patients. Furthermore, MIPS suggests clinicians perform in four performance categories such as Quality, Promoting Interoperability (PI), Improvement Activities (IA) and Cost. A high MIPS final score depends on all of them as each category has measures to support and report. MIPS Quality measures are the common factor as they are similar in number (usually six) for practices.
Taking A Trip Down Memory Lane
MIPS Performance Year 2017
- 84% clinicians earned positive payment adjustment for exceptional performance
- 12% clinicians earned a positive payment adjustment
- 4% received neutral payment adjustment
- 0% received negative payment adjustment
MIPS Performance Year 2018
- 84% of clinicians earn an exceptional performance adjustment
- 13% of clinicians receive a positive payment adjustment
- 0% of clinicians receive a neutral payment adjustment
- 2% receive a negative payment adjustment
MIPS Quality Reporting Steps
Step 1
Understand Your Reporting Requirements
Step 2
Choose Your Quality Measures
Step 3
Collect Your Data
Step 4
Submit Your Data
Step 5
Review Performance Feedback
CONTACT US
Worried About Selecting the Right MIPS & MACRA Measures?
Get expert consultation to choose the right MIPS & MACRA Value Pathway for your practice.
Since each of the MIPS performance categories has to undergo reporting for a specific period, Medientsky Billing Solutions, Ontario, CA knows what it takes to report them. We are not only a medical billing service but have undergone PQRS successfully in the past before 2017.
As a plastic surgeon, dentist, orthopedic, pediatric, family medicine physician, physical therapist, urologist, psychiatrist, ophthalmologist, nephrologist, neurologist, pain specialist, optometrist, gastroenterologist, cardiologist, chiropractic, pathologist, cardiothoracic surgeon, radiologist, physiologist, gynecologist, obstetrician, rheumatologist, endocrinologist, and public health specialist, reporting MIPS is the easiest through a MIPS Qualified Registry such as ours.
MIPS data submission requires you to choose one of the collection types first. With us, clinicians get to choose MIPS CQMs (Clinical Quality Measures) to report ahead. Proper validation and verification of the measures to report have to happen to score above 75. That is where the incentives are, with bonuses to follow.
As a third-party intermediary, MedSky follows tradition with excellence and submits on behalf of practices. You have an option to report CMS MIPS Quality measures as an individual or a group. CMS recognizes registries and approves them year after year based on set standards criteria. On the whole, a MIPS consulting firm, which is also a registry, is your answer to care-free and accurate submissions. In this way, you do what you are meant to do, i.e., look after your patients.
MIPS 2025 Specifications
- The quality performance category for MIPS 2025 is measured over the entire year.
- The cost category accounts for 30% of the total MIPS score but does not require any data submission.
- Clinicians must complete Improvement Activities (IA) for a minimum of 90 consecutive days.
- Clinicians must complete Promoting Interoperability (PI) for a minimum of 180 consecutive days.
- The MIPS data submission deadline is March 31, 2026.
- CMS provides performance feedback to 2025 participating clinicians in 2026.
- MIPS payment adjustments (positive, negative, or neutral) are applied to each claim starting January 1, 2027.
MIPS 2024 Specifications
- The quality performance category for MIPS 2024 is measured over the entire year.
- The cost category accounts for 30% of the total MIPS score but does not require any data submission.
- Clinicians must complete Improvement Activities (IA) for a minimum of 90 consecutive days.
- Clinicians must complete Promoting Interoperability (PI) for a minimum of 180 consecutive days.
- The MIPS data submission deadline is March 31, 2025.
- CMS provides performance feedback to 2024 participating clinicians in 2025.
- MIPS payment adjustments (positive, negative, or neutral) are applied to each claim starting January 1, 2027.
MVP 2025 Overview & Key Info
What Is MVP (MIPS Value Pathways)
MVPs are a newer reporting path under the MIPS (Merit-based Incentive Payment System), designed to better align measures and improvement activities by specialty, clinical condition, or patient population. MVP participation is voluntary in 2025. The same four performance categories still apply: Quality, Cost, Improvement Activities (IA), and Promoting Interoperability (PI). In addition, MVPs include a foundational layer made up of population health measures and PI measures that are common across MVPs.
MVP 2025 Enrollment / Registration Deadlines
From the CMS 2025 MVP Registration Guide:
- Registration opens April 1, 2025.
- If you plan to include the CAHPS for MIPS Survey as part of your MVP, you must complete registration by June 30, 2025 (8 p.m. ET).
- For participants not submitting CAHPS, the registration deadline is December 1, 2025 (8 p.m. ET).
- Note: registration may be edited or deleted until that closing deadline.
FAQS
Frequently Asked Questions
In 2025, eligible clinicians get to choose and report out of 199 MIPS Quality measures. These measures are available through a range of collection types, one of which is a MIPS registry. As a MIPS consultant, it is on us to report most efficiently for you to score high and handsome. In short, it is a burden-free MIPS data submission method leveraging ease, peace of mind, and incentives at the same time.
In 2022, while we submit your data before the deadline, you can expect up to 5% incentives with MedSky Billing Solutions.
Because it is hassle-free. You don’t have to take the burden of reporting, instead, it is the registry that takes the stress on your behalf. CMS-recognized registries establish, verify, and validate data as per the requirements of your specialty or practice.
First, your eligibility has to confirm. Second, you have to share your input in selecting measures. MIPS full form in healthcare returns profits on your Medicare reimbursement resulting in increased revenue. Give us a call; we won’t take much of your time and get right to it.
Not at all. It’s pretty easy on the pocket. However, it is not a one-size-fits-all thing with the pricing. Since your practice may have more than one clinician who has to report MIPS, prices vary. Besides, they also vary from specialty to specialty. Therefore, it is best to leave your info such as NPI, the best time to call, whom to talk to at info@medskybilling.com; and, we’ll try to back to you as soon as we can.