MIPS Reporting for Practice Perfect EMR Users
Why Patient360 vs. “Those Other Guys”?
Patient360 is the preferred MIPS reporting partner for your EHR.
Patient360 was carefully chosen after an exhaustive comparison of leading MIPS reporting vendors. Unlike other non-preferred alternatives, Patient360 has a performance comparison dashboard.
*NOTE: Some physical medicine options are exclusively designed for MD/DO providers. Patient360 is willing to inquire with any measure steward/author about expanding HCPCS (e.g., CPT) to include physical therapy providers but cannot guarantee their willingness to modify the measure as it is written.
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 program premiered in 2017 and is now entering its 3rd year in 2019.
New in 2019
Physical and Occupational Therapists are newly included Eligible Providers and must report if they meet eligibility thresholds.
Am I required to report?
Probably.
Now, for the first time, PT/OT therapists are included in the MIPS program for 2019. That means that if you meet ALL the eligibility thresholds found below, you must report MIPS or face a penalty. You can 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).
2019 MIPS Participation Options for Physical Therapists
Should I report?
The CMS lookup tool is active and you can find your status and 2019 reporting options available to you by typing in your NPI.
- With a 7% penalty applied to eligible therapists who do not report, it is in your best interest to at a minimum, avoid that penalty.
- 30 points meets the minimum to allow your practice to be neutral. IMPORTANT: Being Neutral is still avoiding giving up 7% of your billing!
- 31–74 points is a small upward adjustment. 75+ points is exceptional performance bonus territory.
- You can still report even if you are not required to either Voluntarily (no payment adjustment) or through Opt In (payment adjustment applied).
Impact on the Bottom Line
Practice 1
15 Providers
$2,672,866 in Part B Claims in 2019
MIPS Impact = +/- $187,100.62
Practice 2
8 Providers
$623,150 in Part B Claims in 2019
MIPS Impact = +/- $43,620.50
Practice 3
3 Providers
$481,746 in Part B Claims in 2019
MIPS Impact = +/- $33,722.22
These figures are based on a +/- 7% adjustment. Non-participation in 2019 will automatically result in a -7% adjustment in 2021.
