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MIPS 2024: A Comprehensive Guide for Healthcare Practitioners

MIPS 2024 Latest Updates From CMS Comprehensive Guide For Healthcare Practitioners

With the ever-evolving landscape of healthcare, it is crucial for healthcare practitioners to stay informed about the latest payment systems and regulations. One such system that practitioners need to be familiar with is the Merit-based Incentive Payment System (MIPS). In this comprehensive guide, we will delve into the key aspects of MIPS 2024 and provide healthcare practitioners with the knowledge they need to navigate this payment system effectively.

What is MIPS?

MIPS, short for Merit-based Incentive Payment System, is a program implemented by the Centers for Medicare and Medicaid Services (CMS) as part of the Quality Payment Program (QPP). It aims to incentivize healthcare practitioners to provide high-quality care by tying payment adjustments to performance and quality measures. MIPS consolidates and replaces several previous programs, including the Physician Quality Reporting System (PQRS), the Value-Based Payment Modifier (VBPM), and the Medicare Electronic Health Record (EHR) Incentive Program.

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MIPS Collection Types

To participate in MIPS and report quality measures, healthcare practitioners have various collection types to choose from. Let’s explore these collection types in detail:

1. eCQMs (Electronic Clinical Quality Measures)

eCQMs are quality measures that are electronically calculated using certified Electronic Health Record Technology (CEHRT). Healthcare practitioners who use technology that meets the CEHRT certification can report eCQMs. It is essential to ensure that the CEHRT is updated to collect the most recent version of the measure specification.

2. MIPS CQMs (MIPS Clinical Quality Measures)

MIPS CQMs are quality measures collected by third-party intermediaries on behalf of MIPS eligible clinicians. Healthcare practitioners can choose to work with a Qualified Clinical Data Registry (QCDR), Qualified Registry, or Health IT vendor to report MIPS CQMs. Alternatively, they can submit the measures themselves.

3. QCDR Measures (Qualified Clinical Data Registry Measures)

QCDRs are CMS-approved entities that can develop and track their own quality measures. These measures are approved during the self-nomination period. QCDR measures are a great option for clinicians and practices that provide specialized care or have difficulty finding relevant MIPS quality measures. Healthcare practitioners need to work with a QCDR to report these measures on their behalf.

4. Medicare Part B Claims Measures

Medicare Part B claims measures are collected and calculated by CMS through administrative claims. No additional data submission is required outside of routine Medicare billing. These measures are automatically calculated for MIPS eligible clinicians who meet the measure requirements. It’s important to note that these measures do not count as one of the six required quality measures.

5. CAHPS for MIPS Survey Measure (Consumer Assessment of Healthcare Providers and Systems)

The CAHPS for MIPS Survey measure assesses the experience of patients receiving primary care services. It is most appropriate for healthcare practitioners who provide primary care services. This survey measure must be administered by a CMS-approved survey vendor.

6. Administrative Claims Measures

Administrative claims measures are outcomes-based measures available in select MIPS Value Pathways (MVPs). They are calculated by CMS through administrative claims data and do not require additional data submission. These measures are evaluated based on the administrative claims measure selected during MVP registration.

MIPS Quality Measures, Improvement Activities, and Promoting Interoperability Measures

Quality measures play a critical role in MIPS. They assess the quality of care provided by healthcare practitioners and contribute to their overall MIPS score. Let’s explore some of the MIPS quality measures added and removed for the CY 2024 performance period/2026 MIPS payment year.

Added MIPS Quality Measures by CMS for 2024

  • Quality ID 494: High-Priority (Outcome) eCQM
  • Quality ID 495: High-Priority (Outcome) MIPS CQM
  • Quality ID 496: MIPS CQM
  • Quality ID 497: Patient-Reported Outcome-based Performance Measure (PRO-PM)
  • Quality ID 498: Patient-Reported Outcome-based Performance Measure (PRO-PM)
  • Quality ID 499: Patient-Reported Outcome-based Performance Measure (PRO-PM)
  • Quality ID 500: MIPS CQM
  • Quality ID 501: MIPS CQM
  • Quality ID 502: Patient-Reported Outcome-based Performance Measure (PRO-PM)
  • Quality ID 503: Patient-Reported Outcome-based Performance Measure (PRO-PM)

Removed MIPS Quality Measures by CMS for 2024

  • Quality ID 014: MIPS CQM
  • Quality ID 093: MIPS CQM
  • Quality ID 107: MIPS CQM
  • Quality ID 110: MIPS CQM
  • Quality ID 111: MIPS CQM
  • Quality ID 112: MIPS CQM
  • Quality ID 113: MIPS CQM
  • Quality ID 128: MIPS CQM
  • Quality ID 138: MIPS CQM
  • Quality ID 147: MIPS CQM
  • Quality ID 283: MIPS CQM
  • Quality ID 324: MIPS CQM
  • Quality ID 391: MIPS CQM
  • Quality ID 402: MIPS CQM
  • Quality ID 436: MIPS CQM

Added Improvement Activities by CMS in MIPS 2024

  • IA_BMH_14: Behavioral/Mental Health and Substance Use Screening & Referral for Pregnant and Postpartum Women
  • IA_BMH_15: Behavioral/Mental Health and Substance Use Screening & Referral for Older Adults
  • IA_MVP: Practice-Wide Quality Improvement in MIPS Value Pathways
  • IA_PM_22: Improving Practice Capacity for Human Immunodeficiency Virus (HIV) Prevention Services
  • IA_PM_23: Use of Computable Guidelines and Clinical Decision Support to Improve Adherence for Cervical Cancer Screening and Management Guidelines

Removed Improvement Activities by CMS in MIPS 2024

  • IA_BMH_6: Implementation of co-location PCP and MH services
  • IA_BMH_13: Obtain or Renew an Approved Waiver for Provision of
  • Buprenorphine as Medication-Assisted Treatment for Opioid Use Disorder
  • IA_PSPA_29: Consulting Appropriate Use Criteria (AUC) Using Clinical
  • Decision Support when Ordering Advanced Diagnostic Imaging

MIPS Performance Threshold and Data Completeness Threshold

To determine performance scores, MIPS has set thresholds for both performance
and data completeness. Let’s explore these thresholds for the CY 2024
performance period.

Performance Threshold

The performance threshold for the CY 2024 performance period remains at 75 points. MIPS eligible clinicians need to reach or exceed this threshold to avoid a negative payment adjustment.

Data Completeness Threshold

The data completeness threshold for the CY 2024 and CY 2025 performance periods is set at 75% for electronic clinical quality measures (eCQMs), MIPS clinical quality measures (CQMs), Medicare Part B claims measures and QCDR measures. It is crucial to ensure that the required percentage of data is submitted for these measures to meet the data completeness threshold.

MIPS Value Pathways (MVPs)

MIPS Value Pathways (MVPs) were introduced in 2020 to streamline and simplify MIPS reporting. MVPs consist of a set of measures and activities that are relevant to a specific specialty or condition. For the CY 2024 performance year, five new MVPs have been introduced, and modifications have been made to the twelve previously finalized MVPs through the MVP maintenance process.

Reporting MIPS Measures

Reporting MIPS measures can be done through various collection types, as discussed earlier. Healthcare practitioners can choose the collection type that aligns with their data collection methods and reporting capabilities. It is important to review the measure specifications and follow the reporting instructions accordingly.

Conclusion

As healthcare practitioners, staying informed about MIPS and its updates is crucial for providing high-quality care and maximizing reimbursement. With the introduction of new measures, removal of outdated measures, and the availability of different collection types, MIPS 2024 presents both challenges and opportunities. By understanding the collection types, quality measures, improvement activities, and thresholds, healthcare practitioners can navigate MIPS successfully and optimize their performance scores. Stay updated with the latest MIPS guidelines and leverage the available resources to ensure a seamless reporting experience.

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