Quality and Practice

Quality & Practice

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Merit-Based Incentive Payment System (MIPS)

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.


ALERT: 2020 MIPS Hardship and Uncontrollable Circumstances Exemption Applications Now Available

MIPS-eligible clinicians and groups can now apply for the 2020 Promoting Interoperability (PI) Hardship Exception or the MIPS Program Extreme and Uncontrollable Circumstances Exception.

Applications must be submitted to CMS by December 31, 2020. It's easy to apply and applications are being processed in a timely fashion. Exceptions will be available to those who meet certain criteria established by CMS.

Tip: The 2020 application requires clinicians to provide a justification for why they should be excepted. To ensure a speedy review, applicants should specifically reference that they have been impacted by the COVID-19 public health emergency.

View the 2020 Quality Payment Program Exception Applications Fact Sheet.

alert

Contact the Quality Payment Program at 1-866-288-8292, Monday through Friday, 8 am - 8 pm (EST) or by e-mail at QPP@cms.hhs.gov. Those who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.

Your Academy is advocating for changes to the 2020 Reporting year as well. We will keep you informed of that progress. Email healthpolicy@aapmr.org with any questions or concerns.

2020 MIPS Requirements

The Centers for Medicare and Medicaid Services (CMS) updates the Merit Based Incentive Payment System (MIPS) requirements annually. View this webinar, which goes over the changes to help prepare you for 2020 reporting. Also, check out this checklist for what to do throughout 2020. 

 

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.