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Medical Claim Software Prevents Denials to Boost Revenue

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Integrated Content and Rules Engine for Healthcare Software Developers

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CMS-Approved Qualified MIPS Vendor for CEHRT and Registry Submissions

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Comprehensive Clinical Coding Platform with Real-Time Coding Updates

 

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Simplified Medical Necessity Verification for Advance Beneficiary Notice (ABN)

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Risk-Free Revenue Recovery

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E&M Coding Solution for Medical Practices and Hospitals

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Automated Reporting to Improve Primary Care

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“I love all the webinars, I appreciate all the topics that are usually brought up. The panelists are always very knowledgeable and the information is well presented.”  

- Beverly Durham, CPC, Commonwealth Community Care

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“Alpha II has been responsive. They’ve worked with us through problems when we need to troubleshoot. They’ve been there, really building a great relationship for all of our clients.” 

- Todd Frischknecht, President and CEO, PCIS Gold

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Your Guide to 2024 MIPS Reporting

Participation Options

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  • Individual
  • Group
  • Virtual Group
  • Subgroup
  • APM Entity

Individual

A clinician submits their own individual performance data. Can report:
Traditional MIPS 
  • APM Performance Pathway (APP) (must be a MIPS APM Participant) 
  • MIPS Value Pathway (MVP) 

Group

A practice submits performance data on behalf of all clinicians billing under the tax identification number (TIN). Can report:
Traditional MIPS 
  • APM Performance Pathway (APP) (must be a MIPS APM Participant) 
  • MIPS Value Pathway (MVP)

Virtual Group

A CMS-approved virtual group is a number of providers not under any given TIN, but come together “virtually” to form a group for reporting purposes only.  Can report:
  • Traditional MIPS

Subgroup

A subgroup is a subset of clinicians in a group (at least 2 clinicians) which contains at least one individually eligible MIPS eligible clinician. Can report:
  • MIPS Value Pathway (MVP)  (requires advance registration)

APM Entity

MIPS eligible providers that are MIPS APM participants. Can report:
Traditional MIPS 
  • APM Performance Pathway (APP) (must be a MIPS APM Participant) 
  • MIPS Value Pathway (MVP)

Eligible Clinician Types

Physicians (including doctors of medicine, osteopathy, dental surgery, dental medicine, podiatric medicine, and optometry) • Osteopathic practitioners • Chiropractors • Physician assistants • Nurse practitioners • Clinical nurse specialists • Certified registered nurse anesthetists • Physical therapists • Occupational therapists • Clinical psychologists • Qualified speech-language pathologists • Qualified audiologists • Registered dietitians or nutrition professionals • Clinical social workers • Certified nurse midwives

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Low Volume Threshold (LVT)

Eligible clinician types must participate in MIPS if they meet all three of the following criteria:
$90,000 Bill more than $90,000 for Medicare Part B covered professional services
and
200 See more than 200 Medicare Part B patients
and
200 Provide more than 200 covered professional services to Medicare Part B patients

Eligible clinicians and groups may opt-in if they meet at least one of the LVT criteria

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TOUCH
Be considered a MIPS eligible clinician and be required to report data to MIPS
Be considered a MIPS eligible clinician and be required to report data to MIPS

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TOUCH
Receive performance feedback
Receive performance feedback
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TOUCH
Receive a MIPS payment adjustment (positive, negative, or neutral)
Receive a MIPS payment adjustment (positive, negative, or neutral)
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TOUCH
Be eligible to have your data publicly reported on the Doctors and Clinicians section of Care Compare (formerly “Physician Compare”)
Be eligible to have your data publicly reported on the Doctors and Clinicians section of Care Compare (formerly “Physician Compare”)
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TOUCH
Be assessed in the same way as MIPS eligible clinicians who are required to participate in MIPS
Be assessed in the same way as MIPS eligible clinicians who are required to participate in MIPS
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Special Status

QPP automatically assigns special statuses to MIPS eligible clinicians, practices, virtual groups, and APM Entities who meet certain criteria. Special status may affect reporting requirements.
Ambulatory Surgical Center (ASC) – based
  • Automatic reweighting of the Promoting Interoperability performance category to 0%
Hospital – based
  • Automatic reweighting of the Promoting Interoperability performance category to 0%
Non-patient facing
  • Automatic reweighting of the Promoting Interoperability performance category to 0% and earn 2x points for Improvement Activities under traditional MIPS
Small practices
  • Automatic reweighting of the Promoting Interoperability performance category to 0% and earn 2x points for Improvement Activities under traditional MIPS
Rural
  • Earn 2x points for Improvement Activities under traditional MIPS
HPSA (Health Professional Shortage Area)
  • Earn 2x points for Improvement Activities under traditional MIPS

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Reminder: More than 75% of the clinicians in a group with a special status must be MIPS-eligible clinicians

Performance Category Weighting

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100 Possible Points for Final Score

Performance Thresholds

75 POINTS
to avoid a negative adjustment of -9%
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Data Completeness

 
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mips-university-alphaii-number1-whiteGreater than 75% for maximum scoring

mips-university-alphaii-number2-whiteLess that 75% renders no scoring for large practices, 3 point floor for small practices

Available Bonus Points

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mips-university-alphaii-number1-white6 – Small practice (must submit at least one measure)

mips-university-alphaii-number2-whiteUp to 10 – based on your improvement in the quality performance category from the previous year

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