Step 1 : Are you a MIPS-eligible clinician or group?
During the 2017 and 2018 performance years, the pool of eligible clinicians excluded some specialties that were previously included in Medicare quality reporting initiatives like PQRS and MU.
In 2019 the pool of eligible clinicians expands to include some of the previously excluded professions, including Physical / Occupational Therapists, Speech-Language Pathologists, Audiologists, Nurse Midwives, Clinical Psychologists, and Dietitians/Nutritional Professionals in MIPS reporting for the first time. Read More About Eligibility >
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 2019 non-participating eligible clinicians will see an automatic -7% 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 can be eligible for bonus reimbursements of up to 37% for performance year 2021.
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 provided pacing options for transition year performance. The options for 2019 are slightly more intensive compared to the options available for the 2018 transition year.
MIPS Final Score between
0% - 29%
MIPS Final Score between
30% - 74%
MIPS Final Score between
75% - 100%
Read more about MIPS Pacing Options in 2019
< 30 points: up to -7% Penalty in 2021
Not participating in the Quality Payment Program or a low MIPS final score in 2019 will result in up to a -7% penalty. This is slightly more intensive than in 2018, with the performance threshold raising from 15% to 30%.
30 - 74 points: Positive Payment Adjustment in 2021
Achieving a moderate MIPS final score in 2019 will provide penalty avoidance and up to a 5% incentive.
75 - 100 points: Positive Payment Adjustment in 2021 with Possible Exceptional Performance Bonus
High performance will award up to 7% 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. Beginning in 2019, clinicians will submit a single set of PI Measures to align with 2015 edition CEHRT. This single measure set includes existing and new PI measures. Measures are no longer classified as base score or performance score measures.
The Improvement Activities Performance Category rewards eligible clinicians for participating in predetermined activities aimed at improving quality of care. Clinicians and groups can choose to participate in activities most relevant to both their practice and patient population.
2019 is the second performance year that Cost will be a weighted category for a participant's MIPS final score. The Cost category score will be the average performance score for the Medicare Spending Per Beneficiary (MSPB) measure, the Total per Capita Cost measure, and eight episode based measures (when applicable). All 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 2019, CMS penalties and incentives will reach 7%. Medicare quality reporting is complicated, but MIPSPRO makes the reporting process easy. Our intuitive system and quality reporting team will guide you through the MIPS reporting process and to success!
MIPSPRO delivers key features to ensure your success:
- Real-time Dashboards
- MIPS Quality, PI, IA, and 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 2019.