Understanding MIPS: How to Achieve a High Score in Your Ophthalmology Practice

By Austin Stone December 22, 2020

When you hear MIPS, do you get a slight twinge in your stomach? I know I do; it can be a daunting task to monitor performance for an entire year that will directly impact your financial compensation. If you are not familiar with MIPS, it is a Merit-based Incentive Payment System that Medicare has established for healthcare providers. Medicare has set a standard of care for several areas in each specialty. Based on data in your EMR system, providers are measured against the standard of care. Medicare takes the data from the provider and compensates them based on the score at the end of the year. 

Whether your practice is large or small, this can be a difficult area to manage. When I first took over the MIPS program within my office, I was pretty confident they were speaking a different language. However, once I identified the key areas and needs, we scored high and received additional compensation.Now I’m paying it forward in hopes that you practice will have the same success. 

First things first, make sure you have an advisor with your EMR company. They should have quarterly meetings with you to discuss your progress and identify any system issues and areas your team needs to address. These meetings are highly impactful, and you’ll be happy for the help. Make sure your Iris Dashboard is set up with the AAO, this will house your Ophthalmology specific areas and track the progress. 

Second, start a binder on January 1, seriously! Whether you set up a hard copy or a virtual binder make sure it is secure and easily accessible. Your practice is subject to audits, as it is with any other program or health plan contract you hold. Documentation is KEY, I cannot stress enough that you have an organized and accessible system. You will want to document meetings with your staff, rollouts of the areas you are focusing on, patient interaction, and quarterly printouts to identify your best three months you wish to report. 

Improvement activity is an area you will want to discuss with your providers, this is where the patient engagement documentation comes in. Some options are holding a free seminar for patients to come in and discuss the importance of an annual eye exam (the provider must host this); other options are engaging in your feedback from appointment reviews. Whichever you choose, be sure that you are documenting, documenting, documenting!

Meet with your team quarterly, if you keep your team engaged this won't be a burden on just you or your quality department. Your team will want to know their hard work is paying off or what potential change they can make to see the improvement. When we keep the conversation open, it allows for a better experience for the entire team.

It is imperative to monitor your progress throughout the year. If you see you are not meeting/exceeding in an area that you may have been doing so last quarter, you will want to address it to correct it right away. A few troubleshooting ideas would be:

  1. Is it a system issue? If you had a recent update, maybe the lines that were reported previously changed and will need to be corrected. 

  2. Is it a documentation error? Has your provider changed what they are documenting without notifying you? You will need to review their charts with them so it can be addressed quickly and changed to put you back into the meeting/exceeding category. 

  3. Is it a workflow issue? Maybe you have newer staff and they have missed a few steps causing the data to be incorrect. Make sure this is addressed

Often the reports that come out of your EMR system provide patient data that is negatively impacting your score. Export these and dive into them. See if you can find a theme or a connection. For example, we had an issue with eRx. I followed the process with my provider and we identified a system issue. When you hit "Send/Print", it counted against itself as the system counted the RX as a printed prescription rather than going through the eRx portal. We submitted a ticket and the problem was resolved quickly, so we no longer receive poor marks on our score. 

Finally, you have reached the end of the year and all your hard work will pay off, but you must certify your information. This is something you will need to complete with your MIPS advisor, but you will need the following information:

  1. Practice TIN

  2. Provider AAO member ID

  3. Improvement activity start and end date

  4. PI best 90-day performance report (remember you printed these out each quarter so you know which date selection you will be reporting!)

Once your information is finalized, you will receive a score out of 100. In 2019, your score could be no less than 30 to receive a negative reimbursement adjustment to your financial compensation. A score over 75, will result in a positive reimbursement adjustment. Remember, this is a marathon, not a sprint. 

Austin Stone

As a practice manager in the ever-changing field of Ophthalmology, I am excited to be apart of a community of support. I have been in the industry since 2017 with a focus on Revenue Cycle and Practice improvement. I have managed multi-specialty clinics and surgery centers down to single-provider practices looking to grow. I look to bring my passion and knowledge to this community to help your practice grow into everything you want it to

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