MIPS Learning Center
The MIPS learning center was created to ensure you have all the information necessary to succeed with MIPS reporting in 2017. Whether you are just doing research, have questions about eligibility, or specific MIPS registry measures, you will find answers to all your MIPS questions below.
Step 1 : What is MIPS?
On January 1, 2017, CMS launched the Merit-based Incentive Payment System (MIPS). This new program merges measure reporting from previous CMS quality initiatives, while also strengthening financial incentives for participation. MIPS combines and streamlines familiar activities into one program:
- MIPS Quality - Previously Physician Quality Reporting System (PQRS)
- Advancing Care Information (ACI) - Previously the EHR Incentive Program (Meaningful Use)
- Improvement Activities - Previously quality improvement activities performed without reporting
- Cost - Previously Value-Based Payment Modifier
(starts in 2018)
Under MIPS reporting, a provider's MIPS Composite Performance Score (CPS) is rated on a scale from 0 to 100, and significantly influences Medicare payment adjustments for each payment year. MIPS scores are calculated based on each providers level of participation in the different categories and ultimately determine the CMS penalty or level of incentive earned for a reporting year.
Click to read: What is MIPS? FAQ
Why Start Now?
The 2019 payment adjustment schedule will be based on the 2017 performance metrics. In other words, provider performance in 2017 will be measured by the new MIPS scoring model and will have a direct impact on your 2019 reimbursements or penalties.
In addition to the payment adjustment, each eligible clinician’s MIPS CPS and individual performance category scores will be made publicly available on the Physician Compare website, including a comparison of the ranges of scores for eligible clinicians across the country. The sooner you can solidify a strong reporting strategy, the better prepared you’ll be for MIPS reporting success.
What will be posted when your provider performance score becomes public?
Over the next few years, CMS will make information about group practices, physicians, and other healthcare professionals enrolled in Medicare available to the public. This information will include MIPS performance data of each provider compared to his/her peers nationally.
Who does this impact?
Every eligible clinician with claims to Medicare. MIPS scores will result in either bonus or penalty payment adjustments. There is no score that will not affect reimbursement.
Check Step 2 to find out if you are eligible for MIPS reporting
Who does this NOT impact?
Neither hospital Medicare nor Medicaid Meaningful Use incentives will be impacted by MIPS.
Additionally, providers electing to participate in an advanced alternative payment model (APM), providers who enroll in Medicare for the first time, and providers who do not service a minimum number of medicare patients.
See Step 2 for additional information
What is the Bonus and Penalty Adjustment Schedule?
The MIPS score’s maximum impact on reimbursement increases from plus or minus 4% for the 2019 payment year to plus or minus 9% for the 2022 and subsequent payment years.
For full payment adjustment details see Step 4.
Step 2: Are you eligible?
During the 2017 performance year, the pool of eligible clinicians (formerly referred to as eligible providers) is shrinking significantly. However, any clinician that bills Medicare Part B is encouraged to report in 2017 and 2018. Check if you are eligible to report in 2017 below.
In 2019 the pool of eligible clinicians expands to include additional professions.
Check your eligibility
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 ≤ $30,000 or provide care for ≤ 100 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, 2017, would be exempt for the 2017 performance year (January 1, 2017- December 31, 2017).
Stay up to date with the latest news regarding MACRA and MIPS
Step 3 : MIPS Performance Categories
With launch of MIPS came the introduction of new performance categories. Each of the categories below is an updated version of a previous quality program that has been consolidated under MIPS.
The MIPS Quality Performance Category is closely related to its predecessor, the Physician Quality Reporting System (PQRS). Much Like PQRS, the Quality Performance Category can be reported individually or as a group, and requires submission of quality measure information to CMS. It is the most valuable performance category in 2017, worth 60% of the MIPS composite score.
Read more about MIPS Quality
Key Changes from PQRS:
- With MIPS reporting quality matters! High performing groups or clinicians can earn up to 22% in incentives
- Unlike PQRS, measure groups are no longer available, and 50% of ALL payers must be reported on
- Reporting through a registry like MIPSPRO requires only 6 measures or 1 specialty measure set to be reported
One must be an outcome based or high priority measure
- MIPS does not have NQS domain requirements
- Must select 6 measures, including 1 outcome or high-priority measure.
- Can select from individual measures or specialty measure set
- Population measures are automatically selected
Advancing Care Information:
The Advancing Care Information Performance Category is Meaningful Use updated to be more flexible, customizable, flexible and focused on patient engagement and interoperability.
Read more about Advancing Care Information
Advancing Care Information (ACI) Key Objectives:
- Protect patient health information
- Electronic prescribing
- Patient electronic access
- Coordination of care through patient engagement
- Health information exchange
- Public health and clinical data reporting
ACI, is responsible for 25% of the MIPS Composite Score and requires:
- That eligible clinicians report at least the 5 required measures
- Scoring is based on patient engagement and information exchange
- Flexible scoring is introduced for all measures in order to promote care coordination for better patient outcomes
ACI performance is calculated using 2 distinct scores:
- Base Score: To receive base score points, clinicians must provide either numerator/denominator or yes/no for each required measure. The base score accounts for 50% of the ACI category performance.
- Performance Score: Beyond the required 5 measures, physicians can select measures that best fit their practice. They will then be ranked on performance of these measures. The performance score accounts for 90% of the ACI category performance
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. The Improvement Activities Performance Category is worth 15% of the MIPS Composite Performance Score in 2017.
Read more about Improvement Activities
Summary of the Improvement Activities Category
- A minimum of one Improvement Activity out of the 92 available must be selected
- Activities are weighted as either High (20 points) or Medium (10 points)
- Eligible clinicians can use a combination of high and medium weight activities
- The maximum Improvement Activities score is 40 points, or 20 for small/rural practices
- The Improvement Activities category score is calculated by dividing the total activity points earned by the total available points for your practice
Improvement Activities Category Exemptions
- Non-Patient facing eligible clinicians and groups, practices of 15 or fewer professionals, practices located in rural areas and geographic health professional shortage areas can report two medium weight activities or one high weight activity to achieve the full 40 points
- Certified patient-centered medical homes, comparable specialty practices, or medical homes receive full credit in this category automatically
- APMs automatically receive 20 points for this category.
Step 4: Payment Adjustment and Pacing Options
Much like the Value-Based Payment Modifier Program (VM) of the past, 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 Score. This scores is calculated on a scale from 0 to 100 and is comprised of the 3 performance categories referenced in
Read more about the financial impact of MIPS
The performance in each MIPS category can have serious impact on revenue. For the performance year 2017 non-participating eligible clinicians will see an automatic -4% 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 22% in the 2017 performance year and up to 37% for performance year 2020.
To ease the burden of transitioning to MACRA/MIPS, CMS has introduced 3 pacing options for at least the performance year 2017. Each pacing option has different reporting specifications; however, all three options offer the safety of knowing the MIPS negative payment adjustment can be avoided.
Read more about available pacing options
Submit a full year:
Eligible clinicians who completely report all three performance categories will be eligible for a positive payment adjustment
Submit a partial year:
Eligible clinicians who submit "more than minimal" data for the three MIPS performance categories for at least 90 days will be eligible for a slight positive payment adjustment. Longer reporting periods are likely to result in higher incentives, as will reporting the full requirements for each performance category.
Submit a something:
Minimal reporting for MIPS is considered to be, at least a 90 day reporting period and:
- One Measure from the Quality Performance Category
- One Activity from the Improvement Activities Category
- Five measures from the Advancing Care Information Category
Step 5 : Get Started with MIPSPRO
Under MIPS, performance matters! It's no longer enough to just report quality data. In 2017, CMS penalties and incentives will reach 4% and although Medicare quality reporting is complicated, MIPSPRO makes the reporting process easy, while; our quality reporting team guides you through the MIPS reporting process, and to success!
MIPSPRO delivers key features to ensure your success
- Real-time Dashboards
- MIPS Quality, ACI & IA 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 $229 per provider/year, starting today is the key to MIPS reporting success in 2017.