Patient360 has a longstanding history as a CMS qualified Registry, reporting and optimizing quality data for our clients.
As a preferred MIPS reporting partner for Fusion Enterprise (Formerly A2C Medical), Patient360 works with clients and your EMR to reduce the burden of MIPS reporting, while helping you achieve your best MIPS score.
What is MIPS Reporting?
You may have heard about the acronym, MIPS, as being a new requirement for your practice, whether you are a part of a larger group, or just a solo therapist. But what is it, really? And do you need to worry about it? “MIPS” stands for the Merit-based Incentive Payment System and replaces PQRS, Value Based Modifier (VBM) and the Meaningful Use (MU) legacy programs of the past. The MIPS program premiered in 2017.
Added in 2019 as Eligible Providers, Physical and Occupational Therapists must report MIPS if they meet eligibility thresholds (see thresholds below).
Am I required to report?
If your practice or clinic meets ALL the eligibility thresholds found below, you must report MIPS or face a penalty. If you are not required to submit, based on the eligibility thresholds, you may have the opportunity to choose to report as an opt-in or voluntary participant if you would like the practice or chance at a bonus payment.
Refer to the table below to identify if your practice meets the Required Participation criteria or Opt-In/Voluntary Participation criteria.
Also LookUp Here (although please understand participation may change throughout the year based on Determination Period, described below).
Should I report?
Remember, successful reporting is not just about getting a bonus. There are penalties each year that you must try to avoid. In addition, reporting MIPS, even through Opt-In is one of the only ways to offset the scheduled Physician Fee Schedule cuts for PT/OTs. There are penalties each year that you must try to avoid and Performance Thresholds that have increased each year since the beginning of MIPS.
What are my options for MIPS this year?
A great way to see what MIPS Reporting options are available to your NPI and/or TIN is to use the CMS lookup tool. This tool will show your Participation and Eligibility status (as explained above in the chart) for MIPS during each year of the program. Participation may be as an individual, as a group, via Opt-in, or through Voluntary Reporting. You can use this tool with certainty, but reach out to us if you are having trouble interpreting your status.
With a MIPS penalty applied automatically to practices and providers who fail to meet the minimum Performance Threshold, it is in your best interest to review your MIPS data early and often! You can use Patient360 analytics to do exactly that. Remember, being neutral is still avoiding giving up a percentage of your billing (currently 9%) to CMS for non-compliance with MIPS.
What is changing this year?
Now is the time to get your practice started for MIPS reporting! This year maintains a 9% penalty applied to eligible therapists who do not report—avoid that penalty.
- 75 points meets the minimum to allow your practice to be neutral.
- 75–89 points is a small upward adjustment.
- 89+ points is Exceptional Performance Bonus territory applied to the upward payment adjustment.
- Voluntarily Reporting (no payment adjustment) and Opt-In Reporting (payment adjustment applied) are still available to those who do not meet all three LVTs.
Why use Registry and not Claims?
|Group Reporting Available||Yes||No|
|Available end-to-end electronic bonus||Yes||No|
|Real Time Performance Dashboard & Analytic Tools||Yes||No|
|Flexible start date for MIPS Reporting||Yes||MUST report through the year|
|Electronic Reporting||Yes||No (paper claim codes required)|
How Much Does It Cost?
Fusion Enterprise has negotiated a highly-discounted rate for their customers: