Value-Based Care & MIPS/MACRA Reporting

The Medicare Access and CHIP Reauthorization Act (MACRA) created the Quality Payment Program. Most clinicians take part through the Merit-based Incentive Payment System (MIPS) or through an advanced alternative payment model. MIPS scores clinicians in several categories, and the score can lead to a payment adjustment.

MIPS reporting services help you choose measures, collect data, and submit it on time. Value-based care support goes further and tracks quality and cost under payer contracts. Westmont Revenue Partners connects you with vetted billing experts who do this work. Program rules change each year, so check current CMS guidance.

Who this is for

• Clinicians and groups billing Medicare Part B who may be eligible for MIPS
• Practices that want to avoid a negative payment adjustment
• Groups in accountable care organizations or other value-based contracts
• Small practices without a quality reporting lead
• Specialty groups unsure which measures fit their work
• Practices that changed EHRs and need to rebuild reporting

What's included

• Checking MIPS eligibility for each clinician and group
• Choosing the reporting method, such as individual or group
• Selecting quality measures that fit your specialty and data
• Reviewing improvement activities and choosing those you can document
• Supporting the promoting interoperability category, including security risk analysis records
• Running data extracts from your EHR or registry
• Tracking performance during the year and flagging gaps
• Submitting data through the chosen method before the deadline
• Reviewing final feedback and scores
• Handling targeted review requests when a score looks wrong
• Tracking value-based contract measures for payers beyond Medicare
• Preparing reports for leadership

How it works

1. The billing expert checks who is eligible and how your group reports.
2. You agree on measures and activities that fit your patients and systems.
3. They set up data collection and test it against your records.
4. They monitor results during the year and tell your team where care gaps remain.
5. They submit the data and keep proof of what was sent.
6. After results post, they review the feedback and discuss next year's plan.

Common challenges

• Annual rule changes. Measures, weights, and thresholds shift from year to year. Experienced teams read each year's final rule updates before planning.
• Measure fit. A measure that looks easy may not match your workflow. Billers test data pulls before committing.
• Poor data capture. If your EHR stores results in free text, the measure may show as unmet. Fixing templates early helps.
• Late-year surprises. Waiting until after the year ends leaves no time to close gaps. Mid-year reviews keep teams on track.
• Group versus individual reporting. The right choice depends on your size and data quality. A biller compares the options before the deadline.
• Exceptions and exclusions. Some patients or clinicians qualify for exceptions. A careful team documents them correctly.
• Interoperability documentation. This category needs records such as a security risk analysis. Billers help gather and store them.
• Payer contract differences. Each value-based contract defines its own measures. A single dashboard helps teams avoid mixing them up.

Metrics worth tracking

• Measure performance rates, which show how often care was delivered as defined
• Data completeness, which shows whether eligible patients are captured
• Care gap closure rate, which shows follow-through on open items
• Estimated final score during the year, which gives early warning
• Payment adjustment results by clinician or group, which show program impact
• Value-based contract performance, which shows progress against payer targets

Specialties that use this service

• Family Medicine
• Internal Medicine
• Cardiology
• Orthopedic Surgery
• Ophthalmology
• Physical Therapy
• Ambulatory Billing

How Westmont can help

• We match you with vetted billing experts experienced in MIPS and value-based reporting
• We look for fit with your specialty, EHR, and reporting method
• We help you describe your goals so providers can propose a clear scope
• We do not predict scores or payments, and we do not give compliance advice

Frequently asked questions

What is MIPS?

MIPS is a Medicare program that scores eligible clinicians on categories such as quality, cost, improvement activities, and promoting interoperability. The score can affect Medicare Part B payment in a later year. Categories, weights, and eligibility rules change, so check the current Quality Payment Program site.

Is every practice required to report to MIPS?

No. Eligibility depends on factors such as clinician type, Medicare billing, and participation in certain models. Some clinicians are exempt or may opt in. Check current eligibility rules on the Quality Payment Program site or ask a billing expert.

What is the difference between MIPS and MACRA?

MACRA is the law. The Quality Payment Program is the program it created. Within that program, clinicians take part through MIPS or through advanced alternative payment models. People often use the terms loosely, so confirm which one a vendor means.

Can an outside company submit our MIPS data?

Many billing and reporting providers can submit data for you, with your authorization. Ask what method they use, who reviews the data, and how they keep proof of submission. You remain responsible for the accuracy of what is reported.

When should we start working on MIPS?

Early in the performance year. Measures depend on how care is documented all year, so late fixes are limited. A mid-year review lets you close gaps while there is still time to act.

Related services

• Risk Adjustment / HCC Coding
• Practice Analytics & Reporting
• Compliance Audits & HIPAA Support
• Medical Coding & Coding Audits
• Medical Management Services
• Medical Revenue Cycle Management (RCM)