Merit-Based Incentive Payment System (MIPS)

Quality & Practice

Did you find what you're looking for?

If not, email us at healthpolicy@aapmr.org.

The Merit-Based Incentive Payment System (MIPS) is the 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.

How it Works:

You report the measures and activities you collect during the performance period. CMS collects and calculates cost measures for you. The 4 performance categories are scored and make up your final MIPS score. Your final score determines the payment adjustment applied to your Medicare Part B claims. These categories are:

1: Quality

2: Improvement Activities

3: Promoting Interoperability

4: Cost

What are the exclusions from MIPS?

There are three 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 $90,000 in Medicare beneficiaries in a designated period OR provide care for less than 200 Medicare patients a year 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. 

MIPS Value Pathways

Starting in 2023, MIPS eligible clinicians, group practices (i.e., Taxpayer Identification Number or TIN), subgroups of TINs, and APM Entities will have the option to participate in the Merit-Based Incentive Payment System (MIPS) under a new framework known as MIPS Value Pathways or MVPs.  MVPs are intended to streamline the MIPS participation experience by connecting activities and measures across the four MIPS performance categories that are relevant to a specific specialty, condition, or population.