MIPS Overview

December 1st, 2016

It's time for more changes in how providers navigate Medicare payments, welcome to MACRA and MIPS. MIPS consolidates and changes the MU, PQRS, and VBM programs. Here are the more tedious program names from these acronyms: Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) -- Notice the clever nested acronym: Children's Health Insurance Program (CHIP) --, Merit-based Incentive Payment System (MIPS), Meaningful Use (MU), Physician Quality Reporting System (PQRS), and Value-Based Payment Modifier (VBM). The stated intent of these revised government programs is to achieve the "Triple Aim" of higher quality, lower spending, and better patient outcomes.

We will continue to add content as these programs develop and our products evolve to meet the new requirements. MACRA is 2,171 pages, so some of this information may change. Let's take a sip from the MIPS firehose now:

  • Each provider will receive a MIPS Score from 0 to 100
  • MIPS scores will be public and recalculated each year
  • Scores determine providers' yearly Bonus or Penalty

Four MIPS Performance Categories, for 2017 (percentages shift in 2018 and beyond)
Quality - 60%
Advancing Care Information - 25%
Clinical Practice Improvement Activities - 15%
Resource Use - 0%, but will be weighted and used for 2018 and beyond

Four MIPS Participation Options, for 2017
    No participation: Organizations not exempt from MIPS that do not send in any 2017 data will receive a negative 4% payment adjustment.
    Report one measure for a minimum 90-day period: One Quality, ACI, or CPIA measure will earn enough MIPS points (3 points, yes three, is the no-penalty threshold) to avoid a penalty and possibly earn a small incentive.
    Report more than one measure for a minimum 90-day period: More than one measure in any or all of the Quality, ACI, or CPIA categories avoids a penalty, maximizes the MIPS score, and potentially earns the highest possible incentive.
    Participate in an Advanced Alternative Payment Models (APM): Organizations that sufficiently participate through an Advanced APM earn a 5% Part B bonus and are exempt from MIPS.

Who is Eligible for MIPS
Physician assistant
Nurse practitioner
Clinical nurse specialist
Certified registered nurse anesthetist

In 2019 and beyond, these providers are added for MIPS:

Physical and Occupational Therapists
Speech-language Pathologists
Nurse Midwives
Clinical Social Workers
Clinical Psychologists
Dietitians/Nutritional Professionals

Who is Exempt from MIPS
First-year Medicare providers
Providers with a low volume of Medicare patients (less than $30,000 Medicare Part B or less than 100 Medicare patients)
Qualifying participants in eligible APM.Possibly exempt: Rural health clinics or Federally Qualified Health Clinics (FQHCs)

How do I know if I'm ready to participate in MIPS?

  1. Check that your electronic health record is certified by the Office of the National Coordinator for Health Information Technology. If it is, it should be ready to capture information for the MIPS Advancing Care Information category and certain measures for the Quality category.
  2. Consider using a qualified clinical data registry or a registry to extract and submit your quality data.
  3. Use the websites below to explore the MIPS data your practice can choose to send in. Check to see which measures and activities best fit your practice.

Where to learn more








Posted by Jim Sherrill | Topic: News  | Category: News
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