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:
2: Improvement Activities
3: Promoting Interoperability
What are the exclusions from MIPS?
There are three exclusions of providers from MIPS eligibility:
- Providers participating in an APM, as defined by MACRA, are not subject to MIPS.
- 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.
- 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.