The start of a new year is always a time to seek improvements in your personal and professional life, and while some new habits might not make it to St. Patrick’s Day, there is one change many of you should adopt all year: working to improve your Merit-based Incentive Payment System (MIPS) score. For rehab therapists participating in MIPS, maximizing your score is vital to maximizing your Medicare payments. But even clinicians who have been participating in MIPS for a few years struggle to make sense of all the scoring and weighting requirements and permutations. That’s why we’ve put together this handy guide on how to improve your MIPS score for 2023 and beyond.
Quality Measures
For the 2023 performance year, quality measures make up 85% of a rehab therapists’ final MIPS score. According to the Quality Payment Program (QPP), reporting quality measures requires:
- Collected data for six quality measures, including one outcomes measure (or a high priority measure in the absence of an outcomes measure) or a complete specialty measure set; and
- Performance data for 70% of cases for that quality measure to meet data completeness requirements.
If you’re looking to maximize your Quality Measures points for CY 2023, there are a few things you can do. The reporting requirements offer you the opportunity to cherry-pick your data, and you should take advantage of it. Choose your best quality measures and outcomes measures for reporting to CMS, and limit your reporting to those six measures. As an important aside, the Outcomes and High-Priority Bonus for reporting additional outcomes or high-priority measures were discontinued in the 2023 final rule, so there’s no benefit to going above and beyond reporting requirements.
In addition to reporting your best measures, make sure that you’re meeting or surpassing the 70% threshold for data completeness, and that you’re meeting the case minimum criteria—which is 20 cases for most measures. If you’re failing to hit those marks, your score for that measure will be zero. Conversely, there are up to 10 additional percentage points available to clinicians that improve in the Quality Measures category, so there’s incentive to not only meet the minimum but improve upon your own previous performance.
a bonus to your Quality Measures score if you fall within the QPP’s Special Status policy definition of a small practice, which is a practice of 15 or fewer providers under that practice’s TIN. Small practices receive six bonus points for submitting at least one quality measure.
Improvement Activities
Improvement Activities will make up 15% of a clinician’s final MIPS score in 2023. In order to receive full credit for this category, providers will have to submit data on either:
- Two high-weighted activities;
- One high-weighted activity and two medium-weighted activities; or
- Four medium-weighted activities.
So where can clinicians look to up their score? For a start, you’re able to select the 90-day period of data to report to CMS, so you can choose your clinic’s best-performing period. There’s also the option to mix and match high and medium-weighted activities to find what would create the best score. Unfortunately, as with quality measures there’s no bonus for reporting additional improvement activity measures, so it’s prudent to select the best combination of activities to fulfill the requirement.
It’s also worth reviewing the full list of improvement activities to select the activities you plan to track that are best suited to your practice and specialty. You might also come across activities you’ve already implemented into your own practice under a different name.
If you’d like to boost your score even higher, there are opportunities for bonus points for qualifying clinicians and practices. Any individual, group, virtual group or Alternative Payment Model (APM) entity can earn double points for any high or medium-weighted activities they submit if they’ve qualified for special status under the QPP. Special status is determined during one of the two MIPS Determination Periods, and is displayed on a clinician or group’s QPP Participation Status Tool or on the Eligibility & Reporting page of their profile on the QPP website. Some special status groups include small practices, providers working in a Health Professional Shortage Area (HPSA), or providers working in a rural area.
Promoting Interoperability
The Promoting Interoperability (PI) category is something that rehab therapists don’t need to worry about, as PTs, OTs, and SLPs are exempt from reporting PI data for the 2023 performance year.
Cost
The Cost Performance category is calculated by CMS from claims data—and is another category that PTs, OTs, and SLPs won’t have to concern themselves with for the 2023 performance year, as their cost data won’t affect their final score.
Improving your MIPS score might require a few changes to align your clinic with value-based care, but it’s mostly about collecting the right measures and activities that demonstrate the quality care you’re providing to patients on a daily basis. And you can make your own MIPS experience easier by using a Qualified Clinical Data Registry (QDCR) like Keet to collect and submit clinical data to CMS on your behalf, so you can focus on performance.
