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MIPS 101
Clinicians receive Medicare reimbursement under the guidance of the Physician Fee Schedule, but can receive an additional positive incentive or negative penalty based on “performance” data.
• MIPS is a 100-point system that consists of four weighted reporting categories: Quality (30%), Promoting Interoperability (25%), Improvement Activities (15%), and Cost (30%).
• The Quality Payment Program (QPP) under CMS, determines how clinicians report performance data each year. Clinicians can submit data through an Alternative Care Organization (ACO) or via a clinical data registry to CMS.
• NextGen HQM allows clinicians and practices to submit data files for MIPS and ACO reporting. The Quality Programs (QP) Team at NextGen provides guidance and assistance to help your practice achieve an optimum MIPS score and maximize Medicare reimbursement.
• More information about how NextGen supports the various methods of MIPS reporting is provided below.
Explore QPP
• MIPS is a 100-point system that consists of four weighted reporting categories: Quality (30%), Promoting Interoperability (25%), Improvement Activities (15%), and Cost (30%).
• The Quality Payment Program (QPP) under CMS, determines how clinicians report performance data each year. Clinicians can submit data through an Alternative Care Organization (ACO) or via a clinical data registry to CMS.
• NextGen HQM allows clinicians and practices to submit data files for MIPS and ACO reporting. The Quality Programs (QP) Team at NextGen provides guidance and assistance to help your practice achieve an optimum MIPS score and maximize Medicare reimbursement.
• More information about how NextGen supports the various methods of MIPS reporting is provided below.
Quality Measures
The quality category requires 12 months of data and is weighted at 30% of the overall MIPS score. The quality measures accommodate for differences in specialties and practices. Each quality measure has a supporting specification document called a “whitepaper”.
• Eligible Clinicians are scored on the top six measures that they choose to submit.
• Each quality measure can earn a decile score from 1 to 10 points. Deciles are calculated from national benchmarking data each year.
• If a clinician or practice performs better than the national benchmark on a measure, then they will earn a higher score.
• Please utilize resources in our Quality Resources page to help support your practice.
Quality Measures
• Eligible Clinicians are scored on the top six measures that they choose to submit.
• Each quality measure can earn a decile score from 1 to 10 points. Deciles are calculated from national benchmarking data each year.
• If a clinician or practice performs better than the national benchmark on a measure, then they will earn a higher score.
• Please utilize resources in our Quality Resources page to help support your practice.
Promoting Interoperability
The Promoting Interoperability (PI) Category requires 6-months (180 days) of data and is weighted at 25% of the overall MIPS score. The goal of the PI category is to enhance patient engagement and electronic exchange of health information. NextGen's certified EHR technology (CEHRT) allows your practice to be at the forefront of innovation and maintain regulatory compliance year after year. Please utilize resources in the PI Toolbox to help support your practice.
PI Toolbox
Improvement Activities
Clinicians receive Medicare reimbursement under the guidance of the Physician Fee Schedule, but can receive an additional positive incentive or negative penalty based on “performance” data.
• The Quality Payment Program (QPP) under CMS, determines how clinicians report performance data each year. Clinicians can submit data through an Alternative Care Organization (ACO) or via a clinical data registry to CMS.
• MIPS is a 100-point system that consists of four weighted reporting categories: Quality (30%), Promoting Interoperability (25%), Improvement Activities (15%), and Cost (30%).
• NextGen HQM allows clinicians and practices to submit data files for MIPS and ACO reporting. The Quality Programs (QP) Team at NextGen provides guidance and assistance to help your practice achieve an optimum MIPS score and maximize Medicare reimbursement.
• More information about how NextGen supports the various methods of MIPS reporting is provided below.
IA Inventory
• The Quality Payment Program (QPP) under CMS, determines how clinicians report performance data each year. Clinicians can submit data through an Alternative Care Organization (ACO) or via a clinical data registry to CMS.
• MIPS is a 100-point system that consists of four weighted reporting categories: Quality (30%), Promoting Interoperability (25%), Improvement Activities (15%), and Cost (30%).
• NextGen HQM allows clinicians and practices to submit data files for MIPS and ACO reporting. The Quality Programs (QP) Team at NextGen provides guidance and assistance to help your practice achieve an optimum MIPS score and maximize Medicare reimbursement.
• More information about how NextGen supports the various methods of MIPS reporting is provided below.
MIPS Value Pathways
MIPS Value Pathways (MVPs) are an alternative reporting option to traditional MIPS and APM Performance Pathway (APP) that practices can use to meet MIPS reporting requirements. Each MVP includes a subset of measures and activities that are related to a given specialty or medical condition. Please review the latest MVP fact sheet from the QP team, for a high-level overview MVP reporting.
Fact Sheet
Common Questions
FAQ’s Quality Programs
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As part of our commitment to providing top-ranked service to our family of clients, NextGen Healthcare offers Quality Programs (QP) Support and Services! The Quality Programs (QP) team provides tailored 1:1 services to help your practice integrate the most efficient solutions for regulatory reporting and achieving measurable success. We are a group of dedicated specialists with backgrounds in public policy, public health, health administration, and more. QP has analyzed over 22,000 pages (and counting!) of federal policy legislation and have used this knowledge base to create support and resources exclusively available to QP Services subscribers.
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- Reporting MIPS using your NextGen EHR requires access to the Health Quality Measures (HQM) module. The HQM module is an online web application that requires a username/password.
- Quick tip sheet: HQM How to Run Treatment Opportunity Reports for your Practice Document attached – there is not a link for this one yet.
- For more information, the webinar below provides an overview of the NextGen HQM reporting module, how to run common reports, and some helpful tips and tricks!
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Check CMS QPP Lookup Tool https://qpp.cms.gov/participation-lookup?npi= to see if your practice or clinician qualifies for any special status, is part of an APM, or is eligible for MIPS reporting. CMS updates the lookup tool throughout the year with the latest update in occurring in December.Training Request Form
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Document, document, document! We highly encourage practices to keep a MIPS file or binder every year with documentation of all required measures and attestations. CMS may conduct an audit up to 6 years after the performance year! If your practice is selected for an audit, you will most likely receive an email notification from Guide house, which is a 3rd party auditing company. We are always here to help – please open a case for audit assistance (action button to Success Community) or Contact the QP Team.Provider Import Template
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Provide a 2-3 sentence description of this resource. MIPS Value Pathways (MVPs) are an alternative reporting option to traditional MIPS and APM Performance Pathway (APP) that practices can use to meet MIPS reporting requirements. Each MVP includes a subset of measures and activities that are related to a given specialty or medical condition. Please review the latest MVP fact sheet from the QP team, for a high-level overview MVP reporting.
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