Merit-Based Incentive Payment System (MIPS)
The Quality Payment Program (QPP) has 2 tracks you can choose from: Alternate Payment Models (APMs) or Merit-Based Incentive Payment System (MIPS).
Medicare Part B clinicians billing more than $30,000 a year AND proving care for more than 100 Medicare Part B patients a year will be subject to MIPS.
**NEW** CMS has published a Lookup Tool for Clinicians to Determine Participation in MIPS:
To determine on-line if a provider is eligible for MIPS in 2017:
- Visit the QPP website at https://qpp.cms.gov/
- Click the green CHECK NOW button on the main page
- Enter the Provider’s NPI and click the green Check Now button
Participation year begins 2017 and the MIPS performance score is determined using 4 weighted performance categories that will determine your composite performance score (CPS) on a 0-100 point scale. CMS will then apply a positive, negative, or neutral payment adjustment in 2019 to each MIPS eligible clinician based on the composite performance score (CPS) for 2017.
The 4 performance categories are: (subject to CMS’s final reporting implementation)
- Quality (modified PQRS)
- Advancing Care Information (modified MU)
- Clinical Practice Improvement Activities (CPIA) (NEW)
- Resource Use (modified VM based on Medicare claims)
As required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), MPFS payment rates will remain at the 2019 level through 2025. Performance data will be collected in 2017 to determine payment adjustments for 2019. Starting in 2019, payments to eligible clinicians will be subject to adjustment through MIPS or Alternate Payment Models (APMs). Fee Schedule updates will cease beginning 2020.
For participation year 2017, CMS has provided flexibility for starting this new program. If you choose the MIPS path of the Quality Payment Program, you have three options:
- No Participation – If you don’t send in any 2017 data, then you receive a negative 4% payment adjustment.
- Test Participation – If you submit a minimum amount of 2017 data to Medicare (for example, one quality measure or one improvement activity for any point in 2017), you may earn a neutral or small payment adjustment.
- Partial Participation – If you submit 90 days of 2017 data to Medicare, you may earn a small positive payment adjustment.
- Full Participation – If you submit a full year of 2017 data to Medicare, you may earn a moderate positive payment adjustment.***
***The best way to get the maximum positive adjustment is to participate for the full year in 2017. This will also prepare you for the future of the program.
To potentially earn a positive payment adjustment under MIPS, send in data about the care you provided and how your practice used technology in 2017 to MIPS by the deadline, March 31, 2018.
Most clinicians will be subject to MIPS with the exception of:
- First Year Medicare Part B Participation – Clinicians who enroll in Medicare for the first time during the performance period are exempt from MIPS until the next year.
- Clinicians below low-volume threshold – Medicare Part B allowed charges less than or equal to $30,000 OR care for 100 or fewer Medicare Part B patients.
- Certain clinicians in ADVANCED Alternative Payment Models
Link to the Quality Payment Program (QPP) website – https://qpp.cms.gov/