Merit-based Incentive Payment System

Miraca offers consulting services to help providers optimize their CMS reimbursements. The MIPS (Merit-based Incentive Payment System) program will begin with your data from 2017 to affect your reimbursements in 2019.

Participation is not optional! With the passing of MACRA, CMS has combined Meaningful Use, PQRS, and Value-Based Modifier into its MIPS program along with brand new Clinical Performance Improvement requirements. As a budget-neutral program, penalties from the low-performing providers will be used to fund payments to high-performing providers.

Miraca offers the MIPS Maximizer exclusive software tool along with expert consulting services to help providers and practices participate successfully in MIPS.

  • What We Do: We analyze the complex data (with complex terminology) from your QRUR report twice per year to identify actionable opportunities for your practice.
  • What We Deliver: We provide specific action items in a condensed report based on our analysis of your QRUR report, and we provide onsite assistance to implement new processes.
  • How We Help: Miraca helps practices by monitoring patient cost and quality data through workflow implementation in your office. We help you navigate these programs so that you can stay independent.
    • Maximize your reimbursement opportunity with CMS and commercial payors by showing high quality at optimal costs
    • Enhance your Physician and Practice ratings on CMS’s new Physician Compare website
    • Prepare for value-based payment systems from commercial payors. United Healthcare saved $38 billion in 2014 by engaging 20% of its network providers in value-based contracts. Experts project that 50%–70% of all payments will funnel through value-based contracts by 2020.

Detailed workflow and program know how is critical to optimizing performance AND maximizing reimbursement!

How MIPS is calculated by CMS

Each provider’s MIPS score will be used to calculate payment adjustments for each payment year. MIPS will evaluate Medicare Part B providers annually in four performance categories to assign a score from 0–100, offering providers the potential to earn or lose 4% to 27% in reimbursement as soon as 2022. Miraca is monitoring possible changes to these calculations.

The performance categories are as follows:

Performance Categories

MIPS penalties and bonuses through 2022

The three quality reporting programs (MU, PQRS, VBM) continue through 2018, then MIPS takes effect in 2019.

Weights by Performance Category

Performance Category 2019 MIPS Payment Year 2020 MIPS Payment Year 2021 MIPS Payment Year and Beyond
Quality 50% 45% 30%
Resource Use 10% 15% 30%
CPIA 15% 15% 15%
Advance Care Information* 25% 25% 25%

*The weight for advancing care information could decrease (not below 15 percent) if the Secretary estimates that the proportion of physicians who are meaningful EHR users is 75 percent or greater. The remaining weight would then be reallocated to one or more of the other performance categories.

Contact Miraca Life Sciences to learn how Miraca can assist your practice.
Call 1.855.347.7284 or email EHRPath@MiracaLS.com

The Point of Diagnosis Patient Advocacy (PDPA) program saves us time explaining to the patient the information Miraca now provides.
— Doug Wright, MD


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