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Quality & Practice

Merit-Based Incentive Payment System (MIPS)


Within the Quality Payment Program, there are 2 paths providers can choose and use to report quality data:

 

The Merit-Based Incentive Payment System (MIPS) is the name of a new program that will determine Medicare payment adjustments. Using a composite performance score, eligible clinicians (ECs) may receive a payment bonus, a payment penalty, or no payment adjustment.

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

MIPS 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, Improvement Activities (IA), 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. 

The first performance year for MIPS will begin in 2017, making 2019 the year any adjustments in payments will be made. 2017 reporting closes on March 31, 2018. MIPS reporting can be submitted to CMS through the Spine Quality Outcomes Database.

Who is eligible for MIPS?

mips eligible

 

What are 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. Low Volume Threshold: Clinicians who bill less than or equal to $30,000 in Medicare beneficiaries in a designated period are exempt from MIPS. CMS will conduct low-volume status determinations prior to and during the performance period using claims data. 
  3. New Medicare-enrolled Eligible Clinicians: Providers who enroll in Medicare for the first time during a performance year are exempt from MIPS until the next subsequent performance year. 

 

What do you need to do for MIPS?


Category What do you need to do?  2017 Category Weight

Quality

Replaces the Physician Quality Reporting System (PQRS).

Most participants: Report up to 6 quality measures,
including an outcome measure, for a minimum of 90 days.

Groups using the web interface: Report 15 quality
measures for a full year.

Groups in APMs qualifying for special scoring under MIPS, such as Shared Savings Track 1 or the Oncology Care Model: Report quality measures through your APM. You do not need to do anything additional for MIPS quality.

Learn more about Quality.

 60%

Improvement Activities

New category.


Most participants: Attest that you completed up to 4 improvement activities for a minimum of 90 days.

Groups with fewer than 15 participants or if you are in a rural or health professional shortage area: Attest that you completed up to 2 activities for a minimum of 90 days.

Participants in certified patient-centered medical
homes, comparable specialty practices, or an APM
designated as a Medical Home Model:
You will
automatically earn full credit.

Groups in APMs qualifying for special scoring under MIPS, such as Shared Savings Program Track 1 or Oncology Care Model: You will automatically receive points based on the requirements of participating in the APM. For all current APMs under the APM scoring standard, this assigned score will be full credit. For all future APMs under the APM scoring standard, the assigned score will be at least half credit.

Participants in any other APM: You will automatically
earn half credit and may report additional activities to
increase your score.

Learn more about Improvement Activities.

 15%

Advancing Care Information

Replaces the Medicare EHR Incentive Program, also known as Meaningful Use.

Fulfill the required measures for a minimum of 90 days:

  • Security Risk Analysis
  • e-Prescribing
  • Provide Patient Access
  • Send Summary of Care
  • Request/Accept Summary of Care

Choose to submit up to 9 measures for a minimum of
90 days for additional credit.

OR

You may not need to submit Advancing Care Information if these measures do not apply to you.

Learn more about Advancing Care Information.

 25%

Cost

Replaces Value-Based Modifier.

No data submission required. Calculated from
adjudicated claims.
Counted starting in 2018.