Background on MIPS

The goals of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program are to help providers focus on quality and improve the health of patients.

MACRA is the piece of legislation that gives providers new tools, models, and resources to help deliver the best possible care. Organizations/Providers can choose how they want to participate based on their practice size, specialty, location, or patient population:

  • The Merit-based Incentive Payment System (MIPS)
    • Most practitioners will be subject to MIPS, including Medicare Part B eligible clinicians
      (Physicians and Advanced Practice Nurses)
  • Advanced Alternative Payment Models (APMs)
    • Provider groups that can earn more for taking on some risk related to their patients' outcomes

You can learn more and determine your need to participate in MIPS by entering your NPI on the Quality Payment Program web site; exclusions for MIPS based on participation in APMs are also defined.


MIPS performance measures

MIPS is one of two tracks in the QPP, which aims to simplify quality reporting and change the way clinicians receive Medicare payments. Effective January 1, 2017, MIPS streamlined previous activities into one:

  • Quality – Previously Physician Quality Reporting System (PQRS)
  • Promoting Interoperability
  • Cost – Previously Value-Based Payment Modifier
  • Improvement Activities – New category which promotes engagement in clinical activities

Exemptions

For the 2018 performance year, there are three exemptions from MIPS for clinicians who otherwise meet the eligibility requirements above:

  • Low Medicare Part B volume threshold
    • Providers with ≤$90,000 in Part B allowed charges or ≤200 Part B beneficiaries will not be subject to MIPS, compared with a MIPS threshold of ≤$30,000 in charges or ≤100 beneficiaries in 2017
  • Small practices
    • Groups with ≤15 clinicians that submit data on at least one performance category are automatically awarded five bonus points
  • Extreme and uncontrollable circumstances
    • Hurricane impacted areas are not required to report

MIPS Timeline

2017

Performance

The first performance period opens January 1, 2017 and closes December 31 2017. During 2017 record quality data and how you used technology to support your practice. If an Advanced APM its your practice, then you can join and provide care during the year through that model.

March 31, 2018

Send in performance data:

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 in order to earn the 5% incentive paymeny by significantly participating in an Advanced APM, just send quality data through your Advanced APM.

2018

Feedback:

Medcare gives you feedback about your performance after you send your data.

January 1, 2019

Payment:

You may earn a positive MPS payment adjustment for 2019 if you submit 2017 data by March 31 2018. If you participate in an Advanced APM in 2017, then you may earn a 5% incentive payment in 2019.

To read more, access the CMS Quality Payment Program web site.


2018

Performance Year

  • Performance period opens January1, 2018.
  • Closes December 31, 2018.
  • Clinicians care for patients and record data during the year.

March 31, 2019

Data Submission

  • Deadline for submitting data is March 31, 2019.
  • Clinicians are encouraged to submit data early.

Feedback:

 

  • CMS provides performance feedback after the data is submitted.
  • Clinicians will receive feedback before the start of the payment year.

January 1, 2020

Payment Adjustment

  • MIPS payment adjustments are prospectively applied to each claim beginning January 1, 2020.

Financial Impact of MIPS

MIPS assigns each eligible physician a Composite Performance Score (CPS) based on the following four criteria, and adjusts payment based on performance:

  2017 2018 2019
Criteria Weighted Value Max Penalty/
Max Incentive
(Payment year
2019)
Weighted
Value
Max Penalty/
Max Incentive
(Payment year
2020)
Weighted
Value
Max Penalty/
Max Incentive
(Payment year
2021)
Quality (Formerly PQRS) 60% -4% to +4% 50% -5% to +5% 30% -7% to +7%
Promoting Interoperability
25% 25% 25%
Clinical Practice Improvement
Activities
15% 15% 15%
Resource Use 0% 10% 30%