decisionhealth Newsletters, Part B News - 2018 Issue 6 (June)
Conduct a mid-year MIPS check-up of your clinicians’ quality efforts
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Article Overview
This article covers a mid-year review process for clinicians participating in the Quality Payment Program’s MIPS quality category, with a focus on claims-based reporting. It explains the general structure of claims measures, the role of encounter and diagnosis codes, how to verify whether clinicians are on track, and why mid-year monitoring matters for practices using CMS participation resources and measure files. The piece is aimed at coding, billing, and practice staff responsible for MIPS tracking and claims review.
Why This Topic Matters
Mid-year monitoring can help practices identify reporting gaps early enough to improve performance before year-end. For teams managing claims-based MIPS submissions, understanding the review process can reduce the risk of incomplete reporting and related payment consequences.
Article Sections
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Quality Payment Program
Introduces the MIPS quality reporting context and why a mid-year review is useful for claims-based participation. It also frames the general reporting expectations for eligible clinicians.
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Review measures first, then claims
Describes the process of identifying which measures a clinician reports and checking claims for appropriate reporting elements. The section discusses the general components that appear in claims-based measures and how practices can audit performance at a high level.
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Be ready to act on findings
Outlines the types of follow-up a practice may consider after reviewing mid-year reporting status. It emphasizes monitoring progress and using the remaining months of the reporting year to stay on track.
What You Will Learn
- How mid-year MIPS quality review fits into claims-based reporting workflows
- What general elements claims-based quality measures may include
- Why practices should verify clinician reporting status during the year
- How CMS participation and measure resources support tracking efforts
- What kinds of follow-up monitoring teams may perform after a review
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Quality reporting staff
- Compliance staff
- Clinicians participating in MIPS
Codes Discussed
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