Quality and Practice

Quality & Practice

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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 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.

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.  

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 $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. 

 

Resources

  • MIPS Exemptions and Special Status Resource GuideThis Resource Guide identifies Exemption and Special Status categories under the MIPS program, and includes updated information on their identification and treatment under 2019 final rules.
  • QPP Advanced APM Track Resource Guide. This Resource Guide is intended to serve as a quick reference for key aspects of participation under the Advanced APM Track of the QPP (e.g. Advanced APM criteria, QP thresholds, and more).  It has also been updated to incorporate policies finalized in the 2019 final rule. 
  • Resource Guide on Switching Practices under MIPS. This Resource Guide provides information on the treatment of clinicians who switch practices while participating in MIPS, including general rules that apply and specific illustrative scenarios.