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Merit-Based Incentive Payment System (MIPS)

This payment track builds on traditional fee-for-service payments by adjusting them up or down based on a physician’s performance in a new reporting system.

How MIPS works

This reporting system combines several existing Medicare reporting programs; the Physician Quality Reporting System (PQRS), the Medicare EHR Incentive Program (also known as Meaningful Use), and the Value-Based Payment Modifier Program—and also adds in a new component, Improvement Activities.

In Year 2 (2020 payments based on 2018 performance) physicians participating in MIPS will receive a composite score based on four weighted categories:

  • Quality = 50%
  • Advancing Care Information = 25%
  • Improvement Activities= 15%
  • Cost = 10%

These categories will be combined into one number called the MIPS Composite Performance Score.

MIPS scoring

What's new in 2018

  • No more “pick your pace” option
  • Must earn 15 points to receive a neutral adjustment
  • Must earn 70 points to be eligible for “exceptional performance” bonus
  • Quality – full year of data required
  • Cost – full year of data will be assessed (no reporting required)
  • Improvement Activities & Advancing Care Information – 90-day performance period
  • Extreme and Uncontrollable Circumstances –exceptions for areas impacted by hurricanes and other natural disasters
    • Applications will be available for 2018 as needed
  • More options for small practices (ACP ASKED FOR THESE!)
    • Increased low volume threshold to 200 patients or $90,000 in Medicare Part B allowed charges
    • 5 bonus points for small practices (≤15 eligible clinicians)
    • Virtual group option
    • Extra points if not able to meet data completeness requirements
  • MIPS Bonus for Complex Patients (ACP ASKED FOR THIS TOO!)

2018 low volume threshold

Excluded individuals or groups must have ≤ $90,000 Part B allowed charges OR ≤ 200 Part B patients.

Look up your (or your group's) eligibility on the CMS site

How are payments determined?

MIPS payments will be the Medicare base rate in addition to a physician’s composite performance score adjusting his or her payments up or down.

  • In 2019, the first year of the program, payments can go up or down by 4%.
  • In 2020, physician payments can go up or down by 5%.
  • In 2021, physician payments can go up or down by 7%.
  • In 2022 and beyond, physician payments can go up or down by 9%.
MIPS payments

Payments can never be reduced by more than the level set in the law. However, in order to make the adjustments budget neutral, the upward adjustments may have a scaling factor applied to make the total upward and downward adjustments equal to each other.

Additionally, physicians who are determined to be an exceptional performer will be eligible to receive an additional positive payment adjustment of up to 10%. This exceptional performance payment adjustment is not budget neutral but will come from a separate designated fund.

Performance categories