The Medicare MIPS Program is unnecessarily complex and unwieldy for hospital-based physiatrists, who often have minimal support staff. Failure to report MIPS in 2024 can result in a 10% Medicare PENALTY in 2026. However, successfully reporting MIPS in 2024 can result in a 10% BONUS in 2026! The 10% penalty or bonus has a tremendous impact on hospital-based physiatry practices, because 60% to 70% of patients have Medicare as their primary insurance. There are many resources available – from the CMS MIPS Help Desk to private registry companies. However, in my experience, they lack understanding of hospital-based practices, and are focused primarily on outpatient practices. This article will outline the steps I recommend for hospital-based physiatrists to achieve success in meeting the requirements of Medicare’s MIPS program, and thereby earn a lucrative bonus.
Reporting for Past Years
First, establish a chronology of how your practice has dealt with MIPS reporting in past years.
– Based on reporting for 2022, are you receiving a Medicare penalty or bonus in 2024? Ask your billing personnel for a current Medicare Remittance Advice, and you will know instantly.
– Based on reporting for 2023, will you receive a penalty or bonus in 2025? You should check a Remittance Advice for the upcoming 2025 year.
Current Year Reporting (2024)
Reporting MIPS in 2024, which will result in a penalty or bonus in 2026, involves the following 4 categories:
- Quality (30%) – This category is the most important, and the one you can easily control. I recommend reporting a Specialty set via a Registry.
- Improvement Activities (15%) – There is a comprehensive list of available Improvement Activities to report. Since you are probably already performing these activities, all you need to do is select 2 of them.
- Promoting Interoperability – aka EHR- (25%) – You are probably classified as a “small practice” by Medicare, which means that you do not need to report this category and the 25% will be redistributed to the other 3 categories.
- Cost (30%) – Cost is calculated by Medicare so there is nothing for you to report.
The summary above is a general outline and provides an overview of the MIPS program. With some effort, hospital-based physiatrists can not only meet the requirements of the MIPS program, but also earn a lucrative bonus!
This article was contributed by Mr. Bruno Stillo, Physiatry Billing Specialists, 800-835-4482, http://physiatrymedicalbilling.com/
They specialize in Inpatient Physiatry Medical Billing for 20 years. All of their clients are on staff at acute care rehabilitation facilities. If you are starting a new practice, they can set up everything for you. If you have an existing practice, and want to improve your billing system, they can clean up your old receivables, and ensure that new billings are done professionally.