Step 1 : Are you a MIPS-eligible clinician or group?
During the 2017 and 2018 performance years, the pool of eligible clinicians excludes some specialties that were previously included in Medicare quality reporting initiatives like PQRS and MU. However, any clinician that bills Medicare Part B is encouraged to report. Check if you are eligible to report in 2018 below.
In 2019 the pool of eligible clinicians expands to include additional professions. Read More >
Click to see exemptions for MIPS Eligible Clinicians
MACRA Quality Payment Program Low-Volume Threshold
Eligible clinicians or groups will be exempt from MIPS reporting if they bill ≤ $90,000 or provide care for ≤ 200 Medicare Part B patients.
Newly Enrolled in Medicare
If a clinician enrolls in Medicare in the middle of a performance year, they do not have to participate in MIPS reporting that year. For example, if a clinician was to enroll in Medicare on February 6, 2018, would be exempt for the 2018 performance year (January 1, 2018- December 31, 2018).
Step 2: Why Report?
The MIPS Payment Adjustment
Much like the sunset Value-Based Payment Modifier Program (VM), MIPS determines each eligible clinicians’ payment adjustment based on how they rank versus their peers. The score that is used to determine the performance threshold for MIPS is called the MIPS Composite Performance Score, or the MIPS final score. This score is calculated on a scale from 0 to 100 and is comprised of the aggregated performance from the four MIPS performance categories.
Unlike past quality initiatives, a clinician's MIPS payment adjustment will now follow them even after they depart from the TIN they reported under.
Read more about the financial impact of MIPS
The performance in each MIPS category can have serious impact on revenue. For the performance year 2018 non-participating eligible clinicians will see an automatic -5% adjustment on their Medicare reimbursements. The cost of not participating in MIPS increases each year and reaches a maximum of -/+ 9% for performance year 2020.
Additionally, the top performing professionals are eligible for bonus reimbursements of 25% in the 2018 performance year and up to 37% for performance year 2020.
In addition to impacting eligible clinicians financially, MIPS performance has the potential to effect the reputation of eligible clinicians and groups. Scores will be publicly posted to Physician Compare as soon as the informal review period closes following the performance year.
Step 3 : Pick Your Pace
To ease the burden of transitioning to MACRA, CMS is providing pacing options for transition year performance. The options for 2018 are slightly more intensive compared to the options available for the 2017 transition year.
MIPS Final Score between
0% - 14%
MIPS Final Score between
15% - 69%
MIPS Final Score between
70% - 100%
Read more about MIPS Pacing Options in 2018
0% - 14%: -5% Penalty in 2020
Not participating in the Quality Payment Program or a low MIPS final score in 2018 will result in a -5% penalty. This is slightly more intensive than in 2017, with the performance threshold raising from 3% to 15%.
15% - 69%: Positive Payment Adjustment in 2020
Achieving a moderate MIPS final score in 2018 will provide penalty avoidance and maybe a slight incentive.
70% - 100%: Positive Payment Adjustment in 2020 with Possible Exceptional Performance Bonus
High performance will award the 5% incentive and potentially an exceptional performance bonus.
Step 4: MIPS Performance Categories
The MIPS Quality Performance Category is closely related to its predecessor, the Physician Quality Reporting System (PQRS). To successfully report Quality, participants must report 6 measures (one of which is an outcome measure) over a full calendar year for at least 60% of the applicable patient visits.
Promoting Interoperability (Formerly Advancing Care Information):
The Promoting Interoperability Performance Category is Meaningful Use updated to be more flexible, customizable, and focused on patient engagement and interoperability. To receive credit in PI, participants must attest to all base score PI measures. Full credit will only be awarded to participants who also report performance score measures in addition to base score measures.
The Improvement Activities Performance Category is a new concept introduced by MIPS reporting and rewards eligible clinicians for participating in activities related to their patient population. Clinicians and groups can choose to participate in activities most relevant to both their practice and patient population.
2018 is the first performance year that Cost will be a weighted category for participant's MIPS final score. The Cost category score will be the average performance score for the Medicare Spending Per Beneficiary (MSPB) measure and the Total per Capita Cost measure. Both Cost measures are automatically captured through administrative claims.
Step 5 : Get Started with MIPSPRO
Under MIPS, performance matters! It's no longer enough to just report quality data. In 2018, CMS penalties and incentives will reach 5% and although Medicare quality reporting is complicated, MIPSPRO makes the reporting process easy with an intuitive system and a quality reporting team to guide you through the MIPS reporting process and to success!
MIPSPRO delivers key features to ensure your success:
- Real-time Dashboards
- MIPS Quality, PI (formerly ACI), IA, & Cost for all specialties and all measures
- MIPSPRO adapts to your practice
- Choose your pace of reporting
- Integrated data
- Data Validation & Support
With prices starting as low as $289 per provider/year, starting today is the key to MIPS reporting success in 2018.