Quality & Practice

Merit-Based Incentive Payment System (MIPS)

Please note: MIPS applies to 2017 reporting. For 2016 information, please visit our PQRS page.

To watch the video in full screen mode, click on "MIPS Overview" in the upper left corner.

Check out another helpful overview video for MACRA.

MIPS is a new program that streamlines 3 currently independent programs to work as one:

  1. Electronic Health Record Incentive Program/Meaningful Use (MU)
  2. Physician Quality Reporting System (PQRS)
  3. Value-Based Modifier (VBM) 

MIPS also adds a fourth component, Clinical Practice Improvement Activities (CPIA), to promote ongoing improvement and innovation. This new program will ease clinician burden and allow clinicians to choose the activities and measures that are most meaningful to their practice to demonstrate performance. 

What’s the timeline for reporting?

MIPS chart

For 2016, physicians will continue to report the MU, PQRS, and be subjected to the VBM as separate programs. There is a 2-year lag from performance year to payment year. For 2016 reporting, incentives and penalties will be realized in 2018. MACRA states that incentives and penalties for MIPS will begin in 2019. The first performance year for MIPS will begin in 2017, making 2019 the year any adjustments in payments will be made. CMS will define the performance years for MIPS in a final rule anticipated to be published at the end of 2016. 

Who is eligible for MIPS?

mips eligible

Exclusions from MIPS

There are 3 exclusions of providers from MIPS eligibility:

  1. Providers participating in an APM, as defined by MACRA, are not subject to MIPS.
  2. CMS will define a low-volume threshold that includes a combination of minimum Medicare patients, service volume, and/or billings below which a provider is excluded from MIPS.
  3. Providers who enroll in Medicare for the first time during a performance year are exempt from MIPS until the next subsequent performance year. 

Public Reporting of MIPS

Each MIPS-eligible professional’s MIPS score will be available on the Physician Compare website.  For the first time, consumers will be able to see their providers rated on a scale of 0-100 and how their providers compare to peers nationally.  This level of transparency goes well beyond the current information available on publicly about physicians. 

How MIPS Performance Categories are Weighted

mips weighted

MIPS continues to measure performance as specified by each of the three programs.  Total scoring for MIPS will range from 0-100. Eligible clinicans will receive scores under theMIPS categories:

  • Advancing Care Information (Formerly Meaningful Use) Category Score: An eligible clincian can earn a maximum of 100 points, accounting for 25% of the MIPS composite score for complying with Advancing Care Information requirements in the performance year.
  • Quality Category Score (formerly PQRS):  An eligible clinican can earn a maximum of 90 points accounting for 50% of the MIPS composite score for meeting mandatory quality reporting requirements.
  • Resource Use Category Score: The MIPS resource use category score ((10% of the MIPS composite score) will be calculated based on CMS claims data.

NEW Clinical Practice Improvement Performance Category Score (60 points, accounting for 15% of the MIPS composite score): The proposed rule  states that eligible clinicians can choose the activities best suited for their practice; the rule proposes over 90 activities from which to choose. Clinicians participating in medical homes earn “full credit”in this category, and those participating in Advanced APMs will earn at least half credit.


Last Updated: June 2016