Merit-Based Incentive Payment System (MIPS)


The Merit-Based Incentive Payment System (MIPS) combines parts of the Physician Quality Reporting System (PQRS), the Value-based Payment Modifier (VM), and the Meaningful Use Program (MU) into one single program.

2018 MIPS Program Requirements

Medicare Part B clinicians billing more than $90,000 a year in Medicare Part B allowed charges AND proving care for more than 200 Medicare patients a year will be subject to MIPS participation.

CMS offers a lookup tool for Clinicians to determine participation in MIPS:

To determine if a provider is eligible for MIPS:

  • Visit the QPP website at https://qpp.cms.gov/
  • Enter the Provider’s NPI and click the ‘Check NPI’ button

The MIPS performance score is determined using 4 weighted performance categories that will determine your composite performance score on a 0-100 point scale. CMS will then apply a positive, negative, or neutral payment adjustment to each MIPS eligible clinician based on the composite performance score for the performance year.

The 4 performance categories are listed below. Click on each category to drill down for more information:

Quality

Advancing Care Information

Improvement Activities

Cost

pqrs modified meaningful use new value modifier
50% 25% 15% 10%

 

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 each year to determine payment adjustments for the payment year. 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.

 

 

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 $90,000 OR care for 200 or fewer Medicare Part B patients.
  • Certain clinicians who are significantly participating in Advanced Alternative Payment Models (APMs) – Receive 25% of their Medicare payments or see 20% of their Medicare patients through an Advanced APM.