Avoiding a MIPS penalty using claims reporting for Quality is getting increasingly difficult. While transitioning to electronic reporting is the safest way forward, it isn't an instantaneous process. That's why we have prepared a 2022 MIPS Ophthalmology Claims Reporting Guide that outlines what you need to do and ophthalmology-specific measure changes

Avoiding a MIPS penalty can have a huge impact on your bottom line. Penalties for failing 2022 MIPS range up to 9% levied on your 2024 Part B professional service reimbursements.

Penalty avoidance strategies can be split based on whether or not  you will be picked up in the Cost performance category.

Let’s look at this further. Once you determine which category you fall into, use this handy ophthalmology claims reporting guide to review your requirements.  

Will I Get Scored in 2022 MIPS Cost?

In 2022, ophthalmology-only practices that don't perform cataract or do eyelid melanoma excisions or repairs will likely be excluded from Cost unless they are eligible for one of the general cost measures.If you meet the criteria to be scored on any of the Cost measures, Cost will comprise 30% of your MIPS Final Score.

Two measures are general measures:

• Total per Capita Cost (TPCC): this measures the overall cost of care delivered to a patient with a focus on the primary care they receive from their provider(s). The measure is a payment-standardized, risk-adjusted, and specialty-adjusted measure.
  • Ophthalmologists and optometrists are excluded from this measure.
  • If you are group reporting and have PAs, NPs, CRNAs, or other clinicians eligible for TPCC, your group will be scored on this measure.
• Medicare-Spending per Beneficiary (MSPB): this is measures cost related to inpatient care. Ophthalmologists generally should not be picked up on this measure.

The remaining 23 measures are episode-based Cost measures that measure costs related to specific episodes of care. One of these is the Cataract episode-based cost measure. This is the only ophthalmology-specific cost measure.

How Can I Report Quality If I Do Not Have an EHR?

You can report quality measures via claims or through a registry. Claims-based measures are harder to do well on in general and offer very little variety. A more well-rounded option is to report through a registry. Check with your specialty society to find out more about the 2022 manual MIPS reporting options available to you and what steps you can take to make manual Quality reporting easier.

Next Steps

• Share this information with your practice colleagues.
• Contact your Client Success Manager if you have any questions. 
• If you’re not a MarsdenAdvisors client and you want hands-on, personalized assistance, contact us and we will have your back.

If you have any questions on this, let us know!