MIPS & QCDR - FAQs

If all of the following are true, you are likely required to report MIPS data to CMS or you will be penalized (barring unusual circumstances, such as COVID-19 exemptions):

• You’re an eligible clinician type
• You are NOT considered a Qualified Participant (QP) in an Advanced Alternative Payment Model
• You bill more than $90,000 for Medicare Part B covered professional services
• You see more than 200 Medicare Part B patients, and;
• You provide more than 200 covered professional services to Medicare Part B patients.

To check your individual and/or group eligibility, you may find CMS’s NPI Eligibility Lookup tool helpful.

Still have uncertainty about your obligation to report MIPS, please reach out to us on the “Contact Us” section so we can help.

Maximum penalties include a 9% reduction to your overall Medicare collections.  MIPS performance is scored on a 100-point scale. To avoid a penalty in 2023 you must achieve a score of at least 75 points (penalty threshold).  The closer you can get your score to the penalty threshold the lower your penalty.  If you achieve a score greater than the penalty threshold you will receive a positive payment adjustment.  The more points you earn, the greater the reward. In 2023, CMS estimates those with a perfect MIPS score of 100 points will earn around a 6% increase to the Medicare Physician Fee Schedule.  

MSN’s MIPS Calculator can give you an estimate of the dollars available/at-risk under MIPS: Download the MIPS Calculator

It’s important to note that Medicare Advantage plans or Commercial payers can also link their reimbursement structure to your participation and/or performance under MIPS; so, your success under the program might mean more to you than is initially apparent.  

Although it may be called something different in the future, the concept of MIPS (rewarding/penalizing providers for quality care) is here to stay.  CMS is proposing to replace traditional MIPS with MIPS Value Pathways (MVPs) in the future (2027 or later).  MVPs are a repackaging of MIPS where an eligible clinician/group reports on all of the same traditional MIPS categories, however, the quality measures, improvement activities, and cost measures they have to choose from are limited to an abbreviated list related by either the provider’s specialty or a patient condition treated by the provider.  For more information about MVPs, visit the CMS page on MVPs.  MSN’s QCDR supports reporting of MVPs, which are optional beginning in 2023.   Bottom-line, if you are not paying attention to MIPS, you can leave a lot of money on the table. 

Reporting through a QCDR expands the number of available quality measures for reporting.  Most National quality measures (available to everyone) are either topped-out or devalued which can really hamper your ability to achieve a high MIPS score.  Conversely, most QCDR measures are still worth up to 10 points; so, adding QCDR measures to your repertoire increases your ability to vastly improve your score. 

As a QCDR, MSN offers its clients access to over 20 QCDR Specialty Quality Measures in addition to all National quality measures. These measures are created through our Provider Workgroup and are tailored to meet the needs of our specialty providers.  

To find out more about the QCDR measures offered by MSN, download the measure specifications here.

MSN provides MIPS consulting services and operates a CMS-approved QCDR. Work with us and you will receive the knowledge and tools you need to participate in the MIPS program successfully! Examples of services offered to MSN clients are:

Measure Selection Assistance:

• Through our QCDR, clients have access to over 20 QCDR Specialty Quality Measures in addition to all national quality measures. To find out more about the QCDR measures we offer, download the measure specifications.
• We can narrow selection efforts for you by providing a tailored list of MIPS Quality Measures you are eligible to report – measures that will earn the most points with the least amount of workflow disruption. We also provide detailed documentation guidance for each quality measure you’ve selected to report.

Measure Performance:

• QCDR Members receive Monthly Quality Performance reports to help identify and target quality efforts in a timely manner. Our reports show you how your performance stacks up against the performance of other MSN QCDR Members and providers nationally.
• MSN’s secure online QCDR Portal will allow you to view your Quality results at the group, provider, location, and encounter level. This information is accessible from anywhere you have an internet connection!

Final Reporting:

• As a member of our QCDR, the MSN team will optimize your score, providing you with a list of the best (highest scoring) measures to report to CMS.
• Our QCDR reports your data directly to CMS at the end of each Reporting Year and provides you with confirmation from CMS once completed. We also provide additional support for Improvement Activity selection and reporting.

Data Validation and Audit (DVA) support:

• In the event that your group is selected by CMS for an audit, we will provide Support during the audit process.

And More…Please refer to “Our Services” for a full list of the services we provide. We offer a wide array of consulting services to assist you with value-based purchasing arrangements.

MSN leads productive measure development workgroups for the specialties we serve, most notably Radiology, Anesthesiology, Pathology, and Orthopedics. Our workgroups are comprised of highly skilled and experienced providers from around the country. These groups work diligently to introduce new quality measures, improvement activities to CMS each year. If you have an idea for a new quality measure, Improvement Activity, cost measure, or MVP for your specialty, please reach out to us through the “Contact Us” section of our website to share your ideas and contact information with us.