MIPS
The Merit-based Incentive Payment System (MIPS) is one of the two payment tracks created under MACRA; the other is the Advanced Alternative Payment Model (AAPM) track. MIPS adjusts payment based on performance in four performance categories:
- Quality (45%) – based on the Physician Quality Reporting System (PQRS)
- Cost (15%) – based on the Value-based Payment Modifier (VBPM)
- Promoting Interoperability (PI – 25%) – based on the Medicare EHR Incentive Program (Meaningful Use)
- Improvement Activities (15%) – a new category
Performance in each category is weighted and used to calculate a final score (0-100). Each EC or group’s final score is compared to a performance threshold to determine payment adjustments. The performance threshold for the 2019 performance period is 30 points.
- Final scores above the threshold will receive a positive payment adjustment.
- Final scores below the threshold will receive a negative payment adjustment.
- ECs in the lowest quartile will receive the maximum payment adjustment for a performance period.
- Final scores equal to the threshold will receive a neutral payment adjustment.
Physicians can participate as either individuals or groups. When reporting as a group, all ECs reporting within the tax identification number (TIN) must be included in the group’s reporting. The MIPS final score will be applied to each national provider identifier (NPI) within the TIN. Additionally, a TIN cannot be split into multiple groups.
Eligible clinicians excluded from MIPS include:
- Eligible clinicians who provide care to less than or equal to 200 Medicare Part B patients OR have less than or equal to $90,000 in Medicare Part B allowed charges OR provide less than or equal to 200 Medicare Part B covered services.
- Eligible clinicians in their first year of participation in Medicare.
- Qualifying and partial qualifying Advanced Alternative Payment Model (AAPM) participants who qualify for the AAPM bonus. Partial QPs may elect to report to MIPS.
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