MIPS Resource Center
Getting the Scoop on MIPS 2018
MIPS (Merit-based Incentive Program System) is a Medicare payment program that is intended to incentivize eligible clinicians (ECs) to focus on the quality of care rather than quantity of care. MIPS streamlines and combines such currently legacy Medicare programs as meaningful use and PQRS.
Clinicians are scored based on the following areas:
- Quality (formerly PQRS and CQMs)
- Advancing Care Information (formerly meaningful use)
- Clinical Practice Improvement (expanding hours, improving outreach, etc.)
- Cost (based on episode-specific costs reported on claims)
Clinicians will achieve half of these objectives in their EHR software.
Who's Required to Participate?
You're required to participate in MIPS if you or your group bills $90,000 or more in Medicare Part B allowed charges and sees 200 or more Part B beneficiaries. If you fall below either of these criteria, you're off the hook—you're not eligible to participate in MIPS in 2018.
CMS defines a group as two or more clinicians who reassign their billing rights to a single TIN (tax identification number).
To learn more about the participation criteria, refer to the QPP website.
What's at Stake?
Your MIPS performance in 2018 impacts your 2020 Medicare payments. Payment adjustments based on 2018 performance increase to +/- 5%—that's a potential 10-point swing in Medicare payments.
MIPS is designed to make ECs compete in quality performance. Since MIPS is mandated to be budget neutral, the program essentially takes money from lower performing ECs and pays it to higher performing ECs. There’s a lot of incentive for ECs to bring their A-game.
What are the Performance Categories?
Clinicians are scored based on the following performance categories:
• Quality (formerly PQRS and CQMs)
• Advancing Care Information (formerly meaningful use)
• Clinical Practice Improvement (expanding hours, improving outreach, etc.)
• Cost (based on episode-specific costs reported on claims)
Cost is a new category in 2018. This is a passive category and requires no action on your part.
What Do I Need to Report?
Report a total of six quality measures, one of which must be an outcome measure.
Advancing Care Information
Report all four base measures and choose five additional performance measures.
Report up to four improvement activities.
No action required on your part. CMS calculates cost based on Medicare Spending per Beneficiary and Total per Capita Cost.
Where Can I Learn More?
Click the buttons below to learn more about MIPS.