How Does MIPS Affect your Dental Practice?


Practicing medicine is no easy task in today’s environment with growing patient volume, increased regulation and pressure on profit margins. However, there are many incentive programs that can help dental clinics. The meaningful use program offered incentives and penalties for physicians to help offset the cost of adopting new technology like EHR systems. Just as dentists are getting comfortable with the requirements of meaningful use, along comes MIPS.

What is MIPS?

The Medicare Access CHIP Reauthorization Act (MACRA) was passed in 2015 to repeal the old incentive scheme under Medicare Part B (SGR). The new program consists of two parts, one of which is the Merit-Based Incentive Payment System also called MIPS. Like most federal programs these days, MIPS includes both bonuses and penalties for meeting certain performance criteria.

MIPS applies to a variety of health providers including dentists, doctors and nurses in the first stage (2017-2018). In the second phase, the coverage will expand to include other professionals like dieticians, physical therapists and even nurse midwives by 2019.

Should You Care about MIPS?

First of all, you should check if your group or you as an individual provider are eligible to participate in MIPS for 2017. Providers have to meet certain criteria and most dentists should have received their eligibility letters by now. Some individuals or groups may also get exemption status for this year.

Before you rejoice in your exempt status, keep in mind that MIPS is actually mandatory. CMS is allowing some providers to take it easy for this year alone. Even if you don’t participate this year, you will have to do so in 2018 anyway. Getting started now will give you time to understand the program and its reporting requirements.

Another reason to care about MIPS is the loss of potential reimbursements. Under MIPS, your practice can get bonuses that can significantly improve your bottom line. These bonuses are not fixed but are calculated as a percentage (4% to 9% over the next few years). If you don’t comply with MIPS, you can even lose a lot of revenue since penalties are also calculated as a percentage. These penalties are cumulative and the numbers get worse each year. By 2020, you could lose up to 9% of your reimbursements for non compliance.

How Does MIPS Work?

The basic goal of any federal program is to improve patient care and access to medical information for citizens. The meaningful use program focussed on the transition to digital health records to help improve patient outcomes. MIPS turns its attention to patient satisfaction and standards of care.

MIPS has a scoring system whereby providers are ranked after comparing their results for the year with each other. Based on your provider score, you will get a bonus or penalty on your reimbursements for the year. Payments under MIPS will be made after 2 years from the reporting period. So your group will get the bonuses for 2017 in 2019.

The MIPS score contains 4 components:

  • Quality
  • Advanced care information
  • Clinical improvement activities
  • Resource use

Each of these components has a different weight i.e some are more important than others. For instance, quality has a bigger impact on your provider score than clinical improvement activities.

Are You Ready for MIPS?

Participating in MIPS is not optional, so it’s better if you start preparing from today even if you are exempt for 2017. Some clinics already have a plan for reporting while others aren’t quite ready. If you have easy access to your clinical data, half the battle is won. At the very least you should be trying to avoid penalties when MIPS becomes mandatory from next year.

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