Merit-Based Incentive Payment System (MIPS)

Quality & Practice

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The Merit-Based Incentive Payment System (MIPS) is the program that will determine Medicare payment adjustments. Using a composite performance score, eligible clinicians (ECs) may receive a payment bonus, a payment penalty or no payment adjustment.

How it Works:

You report the measures and activities you collect during the performance period. CMS collects and calculates cost measures for you. The 4 performance categories are scored and make up your final MIPS score. Your final score determines the payment adjustment applied to your Medicare Part B claims. These categories are:

1: Quality

2: Improvement Activities

3: Promoting Interoperability

4: Cost

What are the exclusions from MIPS?

There are three exclusions of providers from MIPS eligibility:

  1. Providers participating in an APM, as defined by MACRA, are not subject to MIPS.
  2. Low Volume Threshold: Clinicians who bill less than $90,000 in Medicare beneficiaries in a designated period OR provide care for less than 200 Medicare patients a year are exempt from MIPS. CMS will conduct low-volume status determinations prior to and during the performance period using claims data. 
  3. New Medicare-enrolled Eligible Clinicians: Providers who enroll in Medicare for the first time during a performance year are exempt from MIPS until the next subsequent performance year.