The new CMS MIPS site: A breath of fresh air

May 8th, 2019 / By Allison Morgan, MS, CPC

While the intent of MIPS is important with its end goal of improved quality and patient care, the program’s content can be challenging for coders, billers and providers. The data is considerable in its volume, caveats and updates. When looking up a particular MIPS measure or element, you may quickly realize the need to get up to speed on a number of related components like documentation, reporting, guidelines, rules, etc. It’s all interconnected and can feel like a never-ending maze of data.

I was able to experience this firsthand during discussions I had with one of my peers as she prepared for a national conference presentation on MIPS radiology documentation best practices. During our talks, there were many times I felt as if elements or measures of the program were a complete enigma, yet our conversations ultimately led to a few “A-ha” moments.  

NAVIGATION  

A pleasant surprise was when I learned about the revamped CMS Quality Payment Program (QPP) website . In the past, I had to brace myself when needing to research program information on the site. The dry, technical context in which the data was presented, combined with the dreaded wait for the zip files to download before I could start digging through the data made the process feel relentless.

On the new site, CMS includes much more user-friendly navigation, along with better differentiation of the tracks that help users follow the breadcrumbs to where they need to go for reporting.  This improved navigation is made possible through infographics, which use visual icons or images in an easy to read format to help explain concepts or information that may otherwise be difficult to follow. I think the combination of the new infographics and the MIPS content is a match made in heaven!

CLAIMS-BASED VS. CQM REPORTING

The measures tool remains on the website. The tool allows users to filter their view by specialty and reporting type. Something for users to remember, not only when using the tool but also when reporting and reviewing measures: The reporting guidelines and codes can vary if the measure is Part B claims-based vs. Clinical Quality Measure (CQM) based. You may also know CQM as registry-based. This is something that can easily be lost in the weeds and can impact the use of codes. Coders need to be clear as to whether their practice reports claims-based or CQM and be sure they are educated on the measure specific to that reporting approach. Be aware that there are certain codes reported on certain measures that are applicable to the claims-based version of the measure but not the CQM version. Measures #405 or #406 are perfect examples. 

UPDATES

Still a bit of a challenge on the site is finding updates to measures. Updates can wreak havoc on practices for a reporting year if they are not discovered sooner rather than later. Measure #364 (Optimizing Patient Exposure to Ionizing Radiation: Appropriateness: Follow-up CT Imaging for Incidentally Detected Pulmonary Nodules According to Recommended Guidelines) highlights this challenge as coders must be aware of the addition of new denominator guidelines and codes when reporting in 2019. The removal of certain measures also illustrates the impact of updates. Measure #359 (Optimizing Patient Exposure to Ionizing Radiation Utilization of a Standardized Nomenclature for Computed Tomography (CT) Imaging) and #363 (Optimizing Patient Exposure to Ionizing Radiation: Search for Prior CT Studies through a Secure Authorized, Media Free Shared Archive) were both eliminated in 2019. 

While the challenges associated with MIPS won’t go away anytime soon, CMS is taking steps to help make the transition process and exposure to the content more user-friendly. As the program continues to grow, the changes made to the QPP/MIPS site show that CMS is working to try to understand and provide the information their audience needs. It’s nice to see a program focused on improving quality for the patient also improve the quality of program content and information available for their users.

Allison Morgan is a clinical development analyst at 3M Health Information Systems.