MIPS 2023; Acceptance Criteria for Improvement Activities

The Improvement Activity category of MIPS 2023 has 15 percent shares in the final scores. It seems that it covers a relatively small part of the MIPS final score and could be neglected. But it’s not true. MIPS 2023 has a rigid framework with no exception bonus at all. Likewise, CMS has set 75 points as the performance threshold for PY 2023 reporting. Thus, a provider cannot miss a chance to score any point.

The Improvement Activity Category of QPP MIPS is a directional approach empowering the CMS's original motive. Every year by implementing MIPS reporting, the US Congress wants to achieve higher healthcare standards. Improvement Activity category ample the participants with a set of measures/activities. The provider then makes sure that they implement them all, nullifying every risk factor.

Let’s have a look at the Improvement Activity Category briefly! And see what are its protocols in MIPS reporting for PY 2023.

The Significance of Improvement Activities

This category assures that the practice is planning to upgrade its level of care. That’s why they make considerable moves throughout the performance year. And the Improvement Activities category of MIPS 2023 gives the attestation to their participation for advance clinical practice.

8 Subcategories of Improvement Activities

There are several ways for the providers in MIPS 2023 framework for choosing their IAs. CMS has provided an extensive list of different IAs for MIPS reporting. However, QPP MIPS has a guide and listing available in its QPP Resource Library.

Nonetheless, clinicians have more than 100 activities for making a selection. These all fall under these 8 subcategories mentioned below:

1. Health Equity Promotion
2. Beneficiary Participation
3. Care Coordination
4. Emergency Reaction and Preparation
5. Patient safety and practice evaluation
6. Management of the Population
7. Enhanced Practice Access
8. Mental and Behavioral Health

CMS Annual Call for Improvement Activities Selection

All stakeholders must have to pick their improvement activities beforehand. Therefore, they must wait for the ‘Annual Call’ by CMS. At that time, stakeholders enter a commenting period for a short duration. They may ask for updates on their present activities in the improvement activities inventory during this phase. MIPS 2023 openly invites all MIPS-eligible clinicians, organizations, relevant stakeholders, and beneficiaries to submit their requests. CMS also examines all agency off-cycle contributions from the Department of Health and Human Services as well.

CMS has restricted the stakeholders for IAs submission. They must do so between February 1 to July 1, 2023. The CMS will then consider them for inclusion for the coming CY 2025 as its Performance year. However, if the stakeholders become trapped in any Public Health Emergency (PHE), then CMS has guided them on what to do. CMS will generally accept the nomination after the due date only if their selected measures have relevance to that PHE.

Moreover, CMS asks the stakeholders to make a modification submission in certain conditions. For instance, when an update is necessary for the improvement activity they provided or one that refers to a program or policy they run, etc.

The Required Acceptance Criteria for MIPS 2023 IAs Selection

The stakeholders cannot make IAs selections mindlessly. They must obey the MIPS framework and rules for doing so. Thus, we have 8 of the following essential acceptance criteria for improvement activities. All of them must be met for IAs to be considered for selection:

1. First of all, the newly selected measures/activities must have relevance with any existing IAs subcategory of MIPS. Moreover, they have permission to submit a proposal for a new subcategory as well.
2. The stakeholders must check the significance of that activity. It must have a positive influence on the achievement of advanced beneficiary health outcomes.
3. One must analyze the necessity of minimizing the burden, thereby one must consider the feasibility of implementation. Health Resources and Services Administration (HRSA) has identified several areas as geographic Health Professional Shortage Areas (HPSAs). Alongside, we have different small practices and practices in rural areas as well. Therefore, stakeholders must check out the extent of the possibility of implementation before selecting their IAs.
4. You must have evidence that supports the high probability of contributions to improved beneficiary health outcomes.
5. The selected IAs can be tied to current and relevant MIPS quality, promoting interoperability, and cost measures where suitable and viable
6. Make sure that CMS can validate the action.
7. The stakeholders must avoid duplication of additional improvement actions in the Inventory for MIPS 2023.
8. Last but not least, your IAs selection must inspire advancements that go beyond the standard healthcare protocols

Optional Acceptance Criteria

It is not mandatory for providers to strictly follow the criterion provided below. So, it is optional for them to consider one or more of these specifications. However, those who consider this criterion have one benefit i.e., their submission’s chances of being added to inventory boost up.

●     Compliance with patient-centered medical homes

●     Assistance for the patient's family or other personal caretakers

●     Responds to a PHE as decided by the Secretary

●     Focuses on modifying procedures to lessen gaps in access to healthcare

●     Emphasize behaviors that will benefit the person and their family

●     Evocative of activities that various individual MIPS-qualified doctors or groups might carry out (e.g., primary care, specialty care, etc.)

Conclusion

That’s all about the MIPS 2023 acceptance criteria for the Improvement Activity Category. For more queries, P3Care offers its MIPS consulting services to all stakeholders. You can also place your queries in the comment section below. Our customer support team will actively respond to you and help you connect with our team members. 

Read our article https://www.p3care.com/blog/here-are-5-reasons-for-chiropractic-billing-services-denied-claims/

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