#103 Don't miss out on extra payments

Are you leaving Medicare money on the table? In this episode of the NatrevMD Podcast, Dr. Heather Signorelli unpacks the Merit-Based Incentive Payment System (MIPS) and how your practice can benefit. From eligibility thresholds to performance categories, learn how to avoid penalties and earn bonus payments by staying compliant and proactive. 

✅ Practical tips
✅ Who needs to report
✅ How to check your eligibility 

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Transcript

PART 1: INTRODUCTION 

0:03: Welcome to NATREV MD, a podcast where we share tips on optimizing medical billing and improving practice efficiency, so you can have the business of your dreams.  
0:13: I'm your host, Doctor Heather Signorelli, founder of Narev MD.  
0:17: Let's get started.  

PART 2: WELCOME & TOPIC PREVIEW

0:23: Good afternoon.  
0:24: Welcome back to the Narev MD podcast.  
0:27: I am excited to have another week with you guys and talk all about MIPS.  
0:32: And before we get into MIPS and really how you can use certain quality metrics in order to earn more from Medicare or potentially lose less from Medicare, depending on what you're doing today and how we can kind of get you guys organized so that it's always the earn more side of things...  

PART 3: ABOUT NATREVMD 

0:49: I wanted to talk a little bit about NarevMD.  
0:52: Why started and who we are.  
0:54: Just so if you're new to the podcast, you're a new listener, I can give you a little background.  
0:58: So, as you may all know, if you have been listening, I'm a pathologist, my background, a physician who's been working on the business side of medicine for over 12 years.  
1:07: I actually started consulting on the business side of healthcare during residency and fellowship, even had some moments where I was flying out to other countries, doing evaluations of different healthcare companies.  
1:18: And most recently, I've led clinical laboratory...  
1:21: and overseeing the kind of the business side of medicine in a large healthcare system when it comes to clinical laboratories.  
1:27: Now we started NarevMD, which is a full service medical billing company over 3 years ago, really because we saw a need for education, a reliable service, and data metrics, which is a pathologist, I'm a huge data nerd, and we love fixing workflow and operational issues.  
1:42: And as I talked to friends and colleagues, they really struggled with being able to piece all of this together, whether they had an in-house team or whether they were outsourced, and we really have a passion within our team, and that is our promise to our clients to be more than just a revenue cycle manager, but to truly understand the workflow issues in the office that may be impacting billing and help address those together.  
2:02: We have over 25 practices that we build for today and a team of over 70 members.  
2:06: We've grown steady over the last few years and would be excited to help your team.  
2:10: If you are missing out on regular meetings or good communication with your current team, or you don't have metrics that you can trust, please reach out through our website, NatrevMD.com.  
2:19: That's N A T R E V MD.com to see if we may be a good fit.  
2:24: we've helped many practices just this year increase their revenue over 25% and excited to potentially help you and your team.  

PART 4: INTRODUCING MIPS 

2:32: All right, so today's topic is gonna be one that makes most practices really, you know, glaze over, right?  
2:38: It's not the most exciting thing.  
2:40: It's with most things with billing, right?  
2:41: It's not what we're taught, it's not what we're trained, it may not be what we're passionate about, but MIPS, which stands for merit-based incentive payment...  
2:49: System is really important and it's important for you to know what is MIPS, who qualifies, what counts as Medicare Part B, and how you actually make money with the MIPS system.  
2:59: So we'll end the podcast with 5 things every practice should be doing right now, so that you can understand how to make MIPS work for you and your team.  
3:08: And if you are seeing Medicare patients and you're not paying attention to MIPS, you could be really seriously leaving out money on the table or worth setting yourself up for a penalty.  

PART 5: UNDERSTANDING QPP & MIPS CONTEXT 

3:16: All right, so before we dive...  
3:18: In MIPS, I think it's important to understand the broader framework as it belongs to this Quality Payment program or QPP and with regards to, to Medicare. 
3:27: So this was established under the Medicare Access and CHIP Act of 2015, MacR is actually what it stands for.  
3:35: And this QPP, so again thatual payment program aims to basically improve Medicare by helping clinicians focus on care quality and patient outcomes rather than just the volume of services.  
3:46: Now, I know the In me is like, well then pay us more, which I get, not here to debate that today.  
3:51: I think really right now just really focus on, OK, there is this system within Medicare, how do we manage up to it?  

PART 6: MIPS VS. APM PATHWAYS 

3:58: So this QPP program, right?  
4:01: With Medicare offers two tracks for participation.  
4:04: Today, we're gonna focus on MIPS, which is the merit-based incentive payment system.  
4:08: So this is what tracks adjustment payments based on performance in 4 different areas, which is what we'll cover partly today and then we're gonna do a part two of this.  
4:16: A lot of material.  
4:17: So again, MIPS is kind of that first pathway.  
4:20: The other pathway is called Advanced alternative payment models APM, and these models provide added incentives for clinicians to deliver high quality, cost efficient care.  
4:31: And so by participating in one of these two pathways, clinicians can contribute to basically a more patient centered healthcare system, at least that's the intent with the idea that you have the potential to earn positive payment adjustments up to 9%.  
4:45: So again, we'll talk a little bit about each of these pathways.  
4:49: First, focusing on MIPS, we'll talk high level today.  
4:52: We'll get more into detail on part two, and then if there continues to be interest around this, I'm happy to do more around that advanced alternative payment models.  
5:01: Again, these are very detailed programs.  
5:04: There's a lot of information, really good data, and PowerPoints and tools you can use on the CMS website.  
5:09: So again, as always, this is educational purposes from the materials that are off the Medicare website.  
5:15: so please head there if you want more detailed information.  

PART 7: WHAT IS MIPS? 

5:17: All right, so let's start with the basics.  
5:19: MIPS stands for merit-based incentive Payment System.  
5:23: It's basically how Medicare decides whether to reward or penalize clinicians based on how well they're delivering care, not just if they're delivering care.  
5:32: So, of course, If it's not documented and in this case not reported, it's not done.  
5:36: So it was basically created to replace previous programs that were out there that had value-based modifiers and meaningful use and basically rolls them all up into one big program.  
5:46: Now, MIPS is part of that quality payment program that we that we talked about earlier, and basically it's just a way for them to say, we'll pay you more if you do a good job and document it, right?  
5:57: And we'll pay you less if you don't, which is annoying, but it is reality.  
6:00: So not here to debate that today, just really here to show, you know, talk about these, these programs.  

PART 8: MIPS PERFORMANCE CATEGORIES 

6:06: So, MIPS has 4 different qualities that you are scored in: quality, promoting interoperability, improvement activities, and cost.  
6:14: So, quality is about clinical outcomes based on measures like blood pressure control or diabetes.  
6:20: And these are, again, things that we'll talk about in more detail in part two.  
6:25: And there are tools on for you to be able to select and say, OK, these are the tools I'm going to use.  
6:30: These are the ones that I'm going to submit.  
6:32: Now, promoting interoperability, basically use, are you using your EHR effectively and securely?  
6:38: Then there's improvement activities.  
6:39: So what are you doing to improve care process or outcomes, and then cost, how expensive is the care you're providing compared to your peers?  
6:46: And then at the end of the year, you'll get a MIP score out of 100, which is then basically what is used to affect future Medicare payment.  
6:53: So, for example, a provider who gets a score 88 might have a positive payment adjustment where somebody with a score of 50 could get a penalty.  

PART 9: WHO QUALIFIES FOR MIPS? 

7:01: Important that we're talking about Medicare Part B with physician services, outpatient services, lab tests, diagnostic imaging, even DME like walkers or CPAP machines.  
7:11: So basically, if you're in an office, you do take care of of Medicare patients, you may even do minor procedures or chronic care management or even telehealth visits, then if you're billing for these services to the insurance, then you are likely potentially for, for MIPS and we'll talk about qualifications.  
7:28: There are some, some kind of thresholds in terms of whether you're required to participate in MEPs.  
7:33: And so if you meet all three of these thresholds, then you may be required.  
7:38: And you can actually check your using your MPI number, whether you're required.  
7:41: You can just go on to the CMS MIPS website and actually at the very bottom, there's a place where you just type in your MPI number and it'll tell you whether or not you're required.  
7:50: So, number one is you bill more than $90,000 a year to Medicare Part B.  
7:54: You see more.  
7:54: More than 200 Medicare Part B patients in a year or you provide 200 or more covered professional services annually.  

PART 10: EXAMPLES OF MIPS ELIGIBILITY 

8:02: So some examples like this are: a solo family medicine doc who sees 10 to 15 Medicare patients a week, a multi-specialty group where each provider sees a decent volume of Medicare patients, or even a specialist who doesn't see many Medicare patients but bills a lot in testing or procedures—those are all potentially qualifying.
8:21: So again, if you hit all three of those—more than $90,000 billed, more than 200 patients, more than 200 services—you’re in.

PART 11: OPTING IN AND GROUP REPORTING

8:27: Now, some practices might not meet those thresholds, and that’s okay, but you still may want to participate, and that’s where opt-in comes in.
8:34: So if you meet at least one of those thresholds, but not all three, then you can choose to opt in and still try to earn an incentive.
8:42: You’re not required, but you can.
8:44: Just keep in mind—once you opt in, you're in for the whole performance year and whatever payment adjustment you get applies.
8:51: And there’s also group reporting, so if you’re part of a TIN (tax ID number), and that TIN meets the thresholds, even if you individually don’t, the group can choose to report together.
9:01: That’s where some providers get caught off guard—maybe you didn’t meet it on your own, but your group did, and now you’re lumped in.

PART 12: PAYMENT ADJUSTMENTS  

9:11: So let’s talk about what this means financially.
9:13: MIPS can impact your Medicare payments by up to plus or minus 9%.
9:19: So imagine you’re billing, let’s say, $200,000 a year to Medicare.
9:23: If you’re in MIPS and you perform well, you could get $18,000 more.
9:28: But if you ignore it or underperform, you could lose $18,000.
9:32: That’s not a small amount, especially for small practices, and I think sometimes this gets overlooked.
9:38: Maybe you think it’s not worth the time or effort, but in reality, this is money already being decided—it’s just whether it goes to you or someone else.

PART 13: STRATEGY: HOW TO APPROACH MIPS

9:47: So how do we win at MIPS?
9:49: First, know your numbers—know if you're eligible, know your score, and know where your gaps are.
9:54: Second, choose the right quality measures that make sense for your specialty.
9:59: If you’re a cardiologist, you probably don’t need to be reporting on mammograms.
10:03: Make sure you pick things that fit your workflow, are easy to document, and where you’re likely to score well.
10:10: Third, don’t wait until the end of the year.
10:13: You need to be reporting these things throughout the year or have a system that does it for you.
10:17: Fourth, use your EHR to your advantage—most of them are certified and have tools built in for MIPS reporting.
10:23: And fifth, get help if you need it.
10:25: Whether it’s your billing company, a consultant, or someone on your team, don’t try to go it alone if it’s overwhelming.

PART 14: WRAPPING UP & NEXT STEPS 

10:33: All right, we’re going to dive into the specific MIPS categories and scoring in part two of this podcast, so be sure to subscribe or follow so you don’t miss that.
10:41: Again, we’ll go into each of the four categories—quality, promoting interoperability, improvement activities, and cost—with real examples and what we see in practices that are successful with MIPS.
10:52: If this podcast has been helpful, please consider leaving a review—it really helps us reach more practices and help more physicians optimize their billing and operations.
10:59: And if you need help with MIPS or billing in general, you know where to find us—NatrevMD.com.
11:05: That’s N-A-T-R-E-V-M-D.com.
11:08: We’re always happy to do a free consult and see if we can support you.

PART 15: CLOSING 

11:12: All right, have a wonderful week, and I’ll see you next time on the Natrev MD podcast.