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MIPS: What you need to know now!

The Medicare Access and CHIP Reauthorization Act (MACRA) Quality Payment Program’s Goal is paying for value and better care. The QPP has 2 paths: Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs).

We will focus on the Merit-Based Incentive Payment System (MIPS) path.

Please Note: A final rule is expected from CMS by November 2016.

Starting in 2017, all of the current programs (PQRS, Meaningful Use, Value Modifier) will be combined into ONE program, MIPS.

MIPS: What you need to know!

  1. MIPS combines parts of PQRS, Value Modifier and the Meaningful Use EHR incentive program into one single program in which Eligible Professionals (EPs) will be measured on:
    • Quality – 50% (equivalent to current PQRS) Key changes:
      • Reduced from 9 measures to 6 measures with no domain requirements
      • Emphasis on Outcome measurements (if available)
    • Resource Care – 10% (equivalent to current Value Modifier) Key changes:
      • Adding 40+ episode specific measures to address specialty concerns
    • Clinical practice improvement – 15% (NEW category!)
      • Minimum selection of one CPIA activity (from 90+ proposed activities) with additional credit for more activities
      • Full credit for patient-centered medical home
      • Minimum of half credit for APM participation
    • Advancing Care Information – 25% (equivalent to current Meaningful Use) Key changes:
      • Dropped “all or nothing” threshold for measurement
      • Removed redundant measures to alleviate reporting burden
      • Eliminated CPOE and CDS objectives
  2. 1ST MIPS Performance Period: January 2017 – December 2017
  3. 1ST MIPS Payment Adjustment Period: January 2019
  4. Most clinicians will be subject to MIPS with the exception of:
    • First Year Medicare Part B Participation
    • Below patient volume threshold – Medicare billing charges less than or equal to $10,000 and providers care for 100 or fewer Medicare patients in one year
    • Certain participants in ADVANCED Alternative Payment Models
    • Does not apply to hospitals or facilities
  5. The MIPS performance score is determined using 4 weighted performance categories (see #1) on a 0-100 point scale.
  6. Your Composite Performance Score will be compared to the national MIPS Performance Threshold. The result will be a +/- or neutral payment adjustment up to the percentages below for each year.






The information provided in this post was current at the time it was created.

All information from Medicare changes frequently and to make sure you are reading the most current information please refer to the CMS website for up-to-date information.

The information offered in this post is meant as a summary reference of existing rules/regulations as we know them to be at the time of creation.