How to Report MIPS as a Behavioral Health Professional

Doctor Working On Computer

Step 1 : Are you a MIPS-eligible clinician or group?

Psychologists are eligible clinician types to receive the MIPS payment adjustment for the 2021 reporting year. Licensed Clinical Social Workers are not eligible for the MIPS payment adjustment, but can optionally report MIPS to get feedback on performance.

MIPS Eligibility Exemptions

1

Participation in an Advanced Alternative Payment Model (APM)

Eligible clinicians part of an Advanced APM, are exempt from MIPS reporting. Current examples of APMs are certain Accountable Care Organizations (ACO) and bundled payment models.

2

MACRA Quality Payment Program Low-Volume Threshold

Eligible clinicians or groups will be exempt from MIPS reporting if they bill ≤ $90,000 or provide care for ≤ 200 Medicare Part B patients or if they have ≤ 200 covered professional services. Clinicians that do not meet one or two (but not all three) of these criteria may opt-in to be eligible for MIPS penalties and incentives..

3

Newly Enrolled in Medicare

If a clinician enrolls in Medicare in the middle of a performance year, they do not have to participate in MIPS reporting that year. For example, if a clinician was to enroll in Medicare on February 6, 2021 would be exempt for the 2021 performance year (January 1, 2021- December 31, 2021).

Step 2: Why Report?

The MIPS Payment Adjustment

Much like the sunset Value-Based Payment Modifier Program (VM), MIPS determines each eligible clinicians’ payment adjustment based on how they rank versus their peers. The score that is used to determine the performance threshold for MIPS is called the MIPS Composite Performance Score, or the MIPS final score. This score is calculated on a scale from 0 to 100 and is comprised of the aggregated performance from the four MIPS performance categories.

Unlike past quality initiatives, a clinician's MIPS payment adjustment will now follow them even after they depart from the TIN they reported under. In 2021, the MIPS payment adjustment has reached +/-9% of your Medicare Part B charges.

Physician Compare

In addition to impacting eligible clinicians financially, MIPS performance has the potential to effect the reputation of eligible clinicians and groups. Scores will be publicly posted to Physician Compare as soon as the informal review period closes following the performance year. 

Column 1

MIPS Payment Adjustment On Clipboard

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Step 3: MIPS Performance Categories

Quality: 

To successfully report Quality, participants must report 6 measures (one of which is an outcome measure) over a full calendar year for at least 60% of the applicable patient visits.

Promoting Interoperability: 

Psychologists are exempt from Promoting Interoperability.

The Promoting Interoperability Performance Category is Meaningful Use updated to be more flexible, customizable, and focused on patient engagement and interoperability. To receive credit in PI, participants must attest to all base score PI measures. Full credit will only be awarded to participants who also report performance score measures in addition to base score measures.

Improvement Activities: 

The Improvement Activities Performance Category is a new concept introduced by MIPS reporting and rewards eligible clinicians for participating in activities related to their patient population. Clinicians and groups can choose to participate in activities most relevant to both their practice and patient population. 

Cost: 

The Cost Performance Category score is the average performance total for the Medicare Spending Per Beneficiary (MSPB) measure, the Total per Capita Cost measure, and 18 episode-based measures (when applicable). Cost is computed at a clinician group level, based on meeting minimum episode thresholds for each measure. All Cost measures are automatically captured through administrative claims. * You will likely be exempt from Cost, but please confirm with CMS.

85 %
MIPS Quality
0 %
Promoting Interoperability
15 %
Improvement Activities
0 %
Cost


MIPSPRO Dashboard On Computer

Step 4 : Get Started with MBHR

Under MIPS, performance matters! It's no longer enough to just report quality data. In 2019, CMS penalties and incentives will reach 7%. Although Medicare quality reporting is complicated, MBHR makes the reporting process easy with an intuitive system and a quality reporting team to guide you through the MIPS reporting process and to success!

MBHR delivers key features to ensure your success:

  • Real-time Dashboards
  • ​MIPS Quality, PI, IA, & Cost for all specialties and all measures
  • MIPSPRO adapts to your practice
  • Choose your pace of reporting
  • Integrated data
  • Data Validation & Support