mips consulting

What Reporting is required under MIPS?

What Reporting is required under MIPS?

MIPS requires that reporting is done either under a group or as an individual. This reporting is guided by the MACRA statute guidelines on the working of physicians. The reporting is done according to the individual physician’s choice on their participation in the MIPS. The reporting programs for quality previously guided that individuals could only participate in the group reporting and PQRS for larger practices. MACRA has changed everything significantly in that individuals can now report collectively for MIPS data if they exist in groups of two or more. In this way, sub-specialists benefit a lot from this reporting and can succeed in MIPS, (MIPS Program: Choosing Individual Vs. Group Reporting). Moreover, administrative issues for many practices can be successfully eased with time. The practice specialty a physician also matters and is a determinant of the reporting method. The method of reporting whether individual or group depends on the type of practices that a physician is engaging in. MACRA has successfully changed the way that medical care is being offered through its new regulations that have been passed into law. The method of integrating quality measurement into payment has been changed by the new law all thanks to MACRA. Alternative models of defrayment offer incentives on participation all thanks to MACRA.

Operation of groups under MIPS

Most AMCs employ group reporting under MIPS. Depending on the performances of the group reporting, eligible clinicians can get adjustments of payments. If the group is performing well then the payment is adjusted to be better and vice versa for an underperforming group. Alternatively, there is a choice for EC to join APMs to offer services and where they are supposed to offer services responsibly. The tactic is consequential for the type of services being offered to any beneficiaries depending on the quality and cost, (Cohen and Crane, “CMS Releases MACRA Final Rule, Easing 2017 Reporting Requirements – Health Law & Policy Matters”). All the consequences are determined by the ability of the participants in the APMs to meet a certain threshold of standards. This tactic ensures that there are consequences if a group is failing where it should be performing well. There is an APM special scoring standard used to maintain the performances of the ECs. These standards are used to rate how the different ECs are doing in their respective positions. There are also standards or thresholds that are specially maintained for checking in on the performances of the individual ECs.


The CMS has just released a report on how to take care of key qualities that a medical organization should provide while at the same time paying accordingly. The payment should always be done according to the quality of service being delivered from the medical department offering the services. The MIPS reporting currently include offering information on the quality, advancing care, and any improvement activities present or being conducted by the company. The PQRS bears similarities to MIPS. The similarities go up to around 60% of those found the MIPS program, (MIPS Program: Choosing Individual Vs. Group Reporting). Due to criticisms, CMS tries to ensure that all ECs are given more flexible to enable them to report properly to the QRS. Moreover, there are key requirements for the MIPS to work properly. The clinicians are supposed to report at least 6 key measures of quality that they have taken. Any PQRS has an obligation to report on any quality measure which is not specified in the MIPS. Moreover, there are sets of NQS which are to exist but not in the MIPS program. Such an arrangement assist in fostering competition for the benefits of improving the quality. Clinician claims assist ECs to report the MIPS measures. The bottom line is that CMS has now decided to streamline the programs for payment and quality.

Final rule for MACRA by CMS

CMS has plans to make the year 2017 a year of transition by reducing the requirements for reporting and focusing on widespread participation goals and more education for the clinicians. The final rule by CMS for MIPS assists in offering the program more flexibility as opposed to what was present before. Thus, any clinicians who are trying to avoid adjustments by MIPS also have alternatives. The can do full reporting, minimum reporting or minimum submission. Hence, more is concentrated on the services that the clinicians are supposed to offer rather than on reporting by the clinicians. For full reporting, moderate payment is a guarantee as long as the clinicians keep reporting continuously for three months’ periods, (Cohen and Crane, “CMS Releases MACRA Final Rule, Easing 2017 Reporting Requirements – Health Law & Policy Matters”). This reporting is also paid for according to the score of the clinicians. For the partial reporting, the clinicians can only choose one quality measure and report on it. In this reporting option, the clinicians usually do not receive any payment adjustment. In case there is a payment, it is usually very small according to the score that they have attained. For the last reporting alternative, minimum submission, one quality measure and activity in the category of improvements is reported. Unlike the other reporting options, this alternative does not have to be reported continuously. Clinicians operating under this option are never evaluated for positive increases as well as fines.

Work cited

—. “CMS releases MACRA final rule, easing 2017 reporting requirements – health law & policy matters.” Accountable Care Organizations. Health Law & Policy Matters, 18 Oct. 2016. Web. 16 Feb. 2017. https://www.healthlawpolicymatters.com/2016/10/18/cms-releases-macra-final-rule-easing-2017-reporting-requirements/
“MIPS program: Choosing individual vs. Group reporting.” n.d. Web. 16 Feb. 2017. http://www.ascrs.org/sites/default/files/Group%20vs%20%20Individual%20Reporting%20Guide%20.pdf.


iHealthOne in 2017

What We Do

Working with medical professionals for these last few years has been extremely rewarding to both our company and the medical practices we’ve partnered with. Our focus has been in assisting the doctors and dentists that need it the most. With many changes constantly piling up in the healthcare industry surrounding the areas of compliance that we deal with the cost can add up quickly. Every single one of our solutions comes at a fraction of the cost that our competitors offer same or similar services at. We’ve had such great success working with medical providers in the areas of Electronic Health Record Funding, Dental EHR Software, & Consulting under MACRA that we’ve managed to build the most cost effective way for our clients to get the help they need.


Why We Do It

Most of the clients that we work with accept medicare or medicaid and see a significant amount of patients that use these types of insurance. Working with these patients can create budgetary constraints that make it hard to grow with new technological demands. We feel that the smaller the practice is the harder it can be to adapt and grow to meet updates in patient care. With the financial burden of electronic health records for example we’ve came up with a solution for dentists that starts with zero setup cost and for a small practice can cost as little as a couple hundred a month. In comparison to other systems that cost tens of thousands to implement this software is also the only fully integrated, cloud based electronic health record software on the market at this time.

With the Electronic Health Record Stimulus Funding Program ending soon, it’s more important than ever that you receive this funding if your office is eligible. We help our clients receive this funding at no up front cost to your office. You can receive up to $63,750 to offset the cost of implementation and training surrounding adopting the usage of electronic health records for your office. Keep in mind that with our cost effective solutions readily available to you, you will also be able to apply funds to growing your practice in the areas that matter most and improving the overall patient care you are able to offer.


Penalties Against Insurance Billing

When your office accepts medicare and medicaid billing and fails to meet compliance guidelines under MACRA you can end up being penalized on a yearly rolling basis against your insurance billing. We work at a very low monthly cost so you get the healthcare compliance consulting that you need, without all the extras you don’t. No practice is the same, while some of our clients use each and every portion of what we offer here, others benefit from one specific section that they need the most.

In 2017 there will be many more changes to the healthcare compliance industry as we know it. With a full team of over 30 healthcare consultants here we do the same research once that benefits thousands of medical offices in the United States we are able to streamline and offset the cost of your office doing it on your own. There’s no time like the present to get started, give us a call at (888) 893-4495 and your first consultation with us is free.