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Now in its seventh year, the Merit-Based Incentive Payment System (MIPS) continues to create confusion, especially for specialists. The program can have a big impact on Medicare Part B reimbursements, using the MIPS composite performance score to determine if providers will receive a payment bonus, a payment penalty, or no payment adjustment at all. Adjustments are based on performance in four categories: quality, cost, promoting interoperability, and improvement activities.
The biggest challenge for providers is to report data for at least six quality measures for a minimum number of cases for each calendar year. This poses an additional challenge for specialty providers as most of the measures were designed around the most common point-of-service where Medicare participants receive treatment – primary care. Specialty providers often find themselves force-fitting measures to fit the specialized care they provide. In addition, the benchmarks used to score performance keep raising the bar each year, making it increasingly difficult to earn a high score.