2023 MIPS: Avoid a Penalty Guide

October 2, 2023

There’s Still Time to Avoid a 2023 MIPS Penalty

Tuesday October 3 will mark 90 days left in 2023. With the last 90 days of the year upon us, can you still report MIPS? Yes, but it will take some work. In this blog we’ll lay out how to pull everything together so you can still manage 2023 MIPS reporting.

Avoiding a MIPS penalty can have a huge impact on your bottom line. Penalties for failing 2023 MIPS range up to 9% levied on your 2025 Part B professional service reimbursements. Penalty avoidance strategies can be split based on whether or not you are going to report the Promoting Interoperability (PI) category and whether or not you will be picked up in the Cost performance category.

Once you determine which category you fall into, use this handy guide to review your requirements for achieving a 2023 MIPS score of at least 75 points to avoid a penalty.

PI: To Report or Not to Report?

If you are a small practice (15 or fewer clinicians) you will get an automatic PI hardship. But, if you report any PI data, you will be scored on the PI category.

If you are in a larger practice, you can apply for a PI hardship if extenuating circumstances created an inability to perform the PI measures. For more information, visit CMS’ hardship information page.

If you report PI, you must perform the PI measures for 90 consecutive days. You must be using an EHR with the Cures Update functionality by the first day of your 90-day PI performance period in 2023. Your EHR must also be certified to the 2015 Edition Cures Update by the last day of the performance period (December 31, 2023).

Will I Get Scored in 2023 MIPS Cost?

It depends. In order to be scored on Cost, you must be eligible for at least one of the 25 Cost measures. Two measures are general measures:

  • Total per Capita Cost (TPCC): this measures the overall cost of care delivered to a patient with a focus on the primary care they receive from their provider(s). The measure is a payment-standardized, risk-adjusted, and specialty-adjusted measure.
    • 56 specialties and subspecialties are excluded from this measure, including ophthalmology, dermatology, and orthopedic surgery. For a full list, see the CMS TPCC codes spreadsheet, Eligible_Clinicians tab.
    • If you are group reporting and have PAs, NPs, CRNAs, or other clinicians eligible for TPCC, your group will be scored on this measure.
  • Medicare-Spending per Beneficiary (MSPB): this measures cost related to inpatient care. If neither you nor anyone else in your group (if group reporting) provides inpatient care, you should not be scored on this measure.

The remaining 23 measures are episode-based Cost measures that measure costs related to specific episodes of care. For example:

  • Diabetes: This measure was widely attributed to specialists who reported MIPS at the group level in 2022, including those who only treated the complications of diabetes (e.g., diabetic retinopathy and diabetic dermatitis). In a letter, CMS has indicated that they plan to modify group-level attribution to require at least one clinician in the group to have prescribed at least two condition-related medications to two patients, paralleling the clinician-level attribution and functionally excluding clinician groups that only treat non-cardiac diabetes complications.
  • Routine Cataract Removal with IOL Implantation: This is the only ophthalmology-specific cost measure. In 2023, ophthalmology-only practices that don’t perform cataract will be likely be excluded from Cost if CMS modifies the Diabetes measure group-level attribution as indicated above.
  • Melanoma Resection: This is the only dermatology-specific cost measure. Outpatient dermatology-only practices that do not do melanoma resections other than Mohs and do not have NPs or PAs who bill under the practice TIN will be excluded from Cost if CMS modifies the Diabetes measure group-level attribution as indicated above. If you meet the criteria to be scored on any of the 25 Cost measures, Cost will comprise 30% of your MIPS Final Score.

If you are not eligible for any of the Cost measures, your Cost category weight will be redistributed to Quality and PI.

How Can I Report Quality?

If I Have an EHR?

You can report electronic clinical quality measures using EHR data either through your EHR or through a registry. To report through your EHR, contact your EHR to find out more.

If I Do Not Have an EHR?

If you have not already registered for a clinical data registry, the deadline to register for your specialty-specific registry may have already passed. Check with your specialty society to find out if you can still register and what steps you can take to make manual Quality reporting easier.

What About the Improvement Activities Category?

This category is very doable. All you need is 90 consecutive days of improvement activity (IA) performance. If you are group reporting, at least half of the clinicians in your practice need to perform the IA. There are many IAs to choose from; one that we recommend is IA_BE_25: Drug Cost Transparency (Use of a Real Time Benefit Tool). If you are providing patients real-time formulary and benefits information and counseling patients on assistance programs, you can use this activity. As far as documentation, you should be tracking which patients were counseled or, if you use a patient assistance platform like PXTechnology, they have reports that provide this information.

Next Steps

  • Share this information with your practice colleagues.
  • Subscribe to our blog to get alerts on this and other important issues. You can subscribe using the field in our website footer below.
  • If you are an Anatomy IT client
    • Contact your Client Success Manager if you have any questions.
  • If you are not an Anatomy IT client
    • Contact us to learn more about our MIPS Success Plan and to reap the rewards of our combined decades of experience.
    • Since we are in the last quarter of the year, we have limited availability for 2023 MIPS Success Plans. We will discuss options with you; these may include a limited engagement for 2023 or a combination of support for 2023 and 2024.

If you have any questions on this, let us know!

Posted in blog, MIPS