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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.

Major 2019 Changes

  • In Year 3 (2021 payments based on 2010 performance) physicians participating in MIPS will receive a composite score based on four weighted categories:
    • Quality = 45%
    • Advancing Care Information = 25%
    • Improvement Activities= 15%
    • Cost = 15%
  • Must earn 30 points to receive a neutral adjustment
  • Must earn 75 points to be eligible for “exceptional performance” bonus
  • 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!)

2019 Low Volume Threshold

  • Excluded individuals or groups must have ≤ $90,000 Part B allowed charges OR ≤ 200 Part B patients OR ≤ 200 covered professional Part B services.  
  • Clinicians, groups, or APMs may “opt-in” to MIPS if they meet 1-2 criteria 

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

Small and Rural Hospitals

CMS recognizes the additional challenges faces by small and rural practices. Free technical assistance is available for practices with 15 or fewer clinicians, or practices that are located in a rural or health professional shortage area.  Click here to find help.

MIPS - Scoring

The MIPS scoring is a composite score of the 4 performance categories:

  • Quality – worth 45% of the total. Must report on 6 measures worth up to 10 points each and scored against benchmarks based on collection type (previously known as reporting method).  Bonus points for reporting an additional outcome or high-priority measure. 
  • Promoting Interoperability – worth 25% of the total.  2015 CEHRT required, must report 6 measures or a complete specialty set (or claim exemption). Bonus points for 2 optional opioid measures.
  • Improvement Activities – worth 15% of the total MIPS score.  Clinicians or groups must earn a total of 40 points. High weighted activities are worth 20 points and medium weighted activities are worth 10 points.  Small, rural, or HPSA clinicians or groups earn double points. PCMH/PCSP get full credit. Only 1 clinician in the group has to perform the activity.
  • Cost – worth 15% of the total score. Based on average of TCC or MSPB, as applicable.  * episode-based measures added. No reporting necessary as this category is calculated by CMS.

MIPS Resources

ACP Resources:

CMS Resources: