Maximizing Reimbursement Through MIPS Compliance

The Merit-Based Incentive Payment System (MIPS) is designed to incentivize healthcare providers to deliver high-quality, cost-effective care to patients on Medicare. 

Still, compliance with MIPS is tricky, especially for specialists in independent practices. Here are a few reasons why: 

• Some reporting requirements can feel burdensome for practices and the payment system tied to MIPS. 

• Smaller practices have fewer resources to divert from patient care to comply with the ever-changing MIPS requirements. 

If you are an independent nephrologist or urologist practice seeking to avoid penalties or maximize reimbursement, understanding the system is vital.  

This article breaks down how MIPS works, its benefits, strategies for improving MIPS scores, and how achieving success in compliance is not just a regulatory task but a financial opportunity. 

Understanding MIPS Compliance 

Under MIPS, providers are rewarded for meeting or exceeding certain performance thresholds and are penalized if they do not, which encourages delivery of high-quality care. 

The MIPS program adjusts Medicare Part B payments based on the overall performance of healthcare providers over a specific period (the year from Jan. 1 to Dec. 31).  

MIPS compliance refers to meeting the specific reporting and performance standards set by the Centers for Medicare & Medicaid Services (CMS) under the Quality Payment Program (QPP). These measures focus on four performance categories: 

• Quality: Providers are assessed on the care they provide.    

• Promoting Interoperability (PI): Evaluates if electronic health record (EHR) technology is used to improve healthcare quality and patient safety.  

• Improvement Activities (IA): Providers are assessed on their initiatives to improve their practices.  

• Cost: Evaluates the cost effectiveness of the care provided.   

The Medicare Physician Fee Schedule (PFS) final ruling outlines the CMS policies for eligible providers and groups to participate in MIPS for the performance year.  

While the final ruling introduces changes, key aspects of the MIPS reporting requirements stay the same. You can learn more about the Medicare PFS Final Rule here. 

How MIPS Works 

Each category is assigned a weight contributing to the final MIPS score, determining whether providers receive a penalty, no adjustment, or an incentive payment.  

These scores directly impact reimbursement rates. Compliance requires accurate tracking, reporting, and improving performance within these categories. 

MIPS reporting holds particular importance for specialists like nephrologists and urologists, as requirements might differ based on specialty-specific measures. 

Why MIPS Compliance Matters 

Given the weight of value-based care, where patient satisfaction and clinical efficiency are the gold standard, excelling in MIPS can set your practice apart from the competition. 

Another reason it matters? MIPS compliance directly impacts revenue.  

Providers who do not comply risk facing hefty financial penalties, reducing their overall reimbursement rates. Penalties could amount to as much as 9% of Medicare reimbursements. 

Think about it—a nephrology practice not part of a larger health system probably has fewer resources to keep track of compliance. If this practice misses a reporting deadline or fails to meet the performance threshold, the slip could result in thousands of dollars in reduced payments. 

Getting it Right 

On the other hand, by staying compliant, providers can avoid MIPS penalties and protect their Medicare payments, positioning themselves for increased reimbursement. And remember, when you meet the performance standards, you also position yourself as a leader in delivering value-based care, strengthening your reputation! 

The Financial Benefits of MIPS Compliance 

Providers have substantial financial opportunities if they perform well, as in, score high, in the MIPS performance categories. Meaning, high scores translate into positive payment adjustments, directly boosting revenue streams. 

Higher Positive Payment Adjustments   

High-performing providers enjoy substantial bonuses, with incentives advancing up to double-digit percentage increases in payouts. Those who excel in reporting can receive upward adjustments of up to 9%, significantly impacting overall cash flow.   

Shrinking Penalties 

MIPS aims to discourage poor performance by applying penalties to lower-scoring providers. By actively participating and demonstrating strong performance, providers can avoid these penalties. 

Competitive Advantage   

Maintaining a strong compliance record and securing incentives enhances your practice’s reputation, making it more attractive to patients and stakeholders. 

Opportunities for Future Initiatives   

Stellar performance today sets the stage for continued success as CMS adjusts measures and thresholds in subsequent years. 

MIPS compliance is not just about avoiding financial loss; it’s about turning compliance into an instrument for thriving in a value-based care ecosystem. 

Strategies for Improving MIPS Performance Scores 

Achieving high MIPS scores requires a purposeful, well-planned strategy that addresses all four categories of performance. Here’s how: 

 1. Invest in Advanced EHR Systems

EHR systems streamline data collection and reporting, ensuring accurate submissions across all performance categories. The right EHR also allows seamless integration, a key component of the MIPS Promoting Interoperability performance category. 

For specialists, consider systems designed for your field. For example, the iSalus Urology EHR, UroChoice, is a fully integrated practice management, EHR, telehealth, and medical billing solution.  

This specialty-specific system promotes interoperability, ensuring that other providers and staff can access patient information across all departments.  

FROM ONE OF OUR PARTNERS: How EHR Integration Can Improve MIPS Reporting and Increase Incentives 

2. Prioritize High-impact Quality Measures

For the 2025 performance period, a minimum of 75 points is required to avoid negative payment adjustments. To meet these goals, focus on quality measures that contribute to your MIPS score and align with your specialty.  

For nephrologists, this could mean prioritizing quality measures related to dialysis patient care. Utilizing a specialized platform like iSalus’ Nephrology EHR, NephroChoice, can help this process.  

For example, the system helps identify patients who have met the 4-visit threshold for dialysis, which is critical—not only to the health of the patient, but to the health of the practice.  

3. Leverage MIPS Compliance Software Solutions

Specialized compliance software simplifies the reporting process by automating submissions, tracking performance, and flagging issues. These tools help you stay on top of MIPS submission deadlines and avoid late submission penalties. 

For example, iSalus software offers MIPS Reporting to help providers succeed with MIPS and the new Quality Payment Program. The MIPS Assist feature empowers providers with expert consultants and cutting-edge tools that help them avoid penalties and position their practice for bonus incentives. 

 4. Engage Staff in Improvement Activities

In the 2025 performance period, Improvement Activities will not be weighted. Meaning all activities will have the same value. Providers must perform one or two improvement activities, depending on their reporting requirements.  

With this in mind, it’s essential to train your staff, integrate team-based care approaches, and assign clear roles to meet these requirements. Here are a few ways staff can document improvement activities: 

• Define the objectives, outcomes, or metrics for each activity 

• List any technology tools or software used; taking screenshots can help 

• Describe the process being improved and its benefits 

• Document compliance with improvement activities

5. Optimize Cost Performance by Tracking Data

Understanding and managing costs is vital for MIPS success. Using financial dashboards and data analytics, you can monitor costs while maintaining exceptional clinical outcomes. 

MIPS compliance allows healthcare providers to align with value-based care while maximizing reimbursement. By implementing the strategies outlined above, independent nephrology and urology practices can avoid the pitfalls of non-compliance and turn MIPS participation into a competitive advantage. 

Looking for expert guidance or solutions to simplify your practice’s compliance process? 

Explore iSalus’ specialty-specific EHR solutions today to streamline reporting, stay compliant, and focus on what truly matters—patient care.