What is MIPS?
MIPS is a performance-based payment system that is one of the participation tracks under the Quality Payment Program. For 2017, MIPS is composed of three performance categories: Quality, Improvement Activities, and Advancing Care Information. These performance categories provide clinicians with the flexibility to choose the activities and measures that are most meaningful to their practice.
MIPS streamlines three historical Medicare programs — the Physician Quality Reporting System (PQRS), the Value-Based Payment Modifier Program and the Medicare EHR Incentive Program (Meaningful Use) — into a single payment program.
An eligible clinician’s scored performance in 2017 in each of the three weighted performance categories is combined to create the MIPS Composite Performance Score, also known as the MIPS Final Score, which is used to determine any potential Medicare Part B payment adjustment in a future year. For example, your participation in 2017 determines your potential payment adjustment in 2019.
What are the MIPS performance categories?
The three performance categories included in MIPS in 2017 are:
- Quality. The Quality category requires eligible clinicians to report data to CMS for quality measures related to patient outcomes, appropriate use of medical resources, patient safety, efficiency, patient experience and care coordination. For 2017, the Quality category will make up 60% of an eligible clinician’s or group’s MIPS Final Score.
- Advancing Care Information. The Advancing Care Information (ACI) category reflects how well clinicians use ONC certified EHR technology, with a special focus on objectives related to interoperability and information exchange. For 2017, the ACI category will make up 25% of an eligible clinician or group’s MIPS Final Score. This is the replacement for the Medicare Meaningful Use program.
- Improvement Activities. The Improvement Activities category encourages eligible clinicians to participate in activities that improve clinical practice in areas such as shared decision making, patient safety, coordinating care, and increasing access. In 2017, the Improvement Activities category will make up 15% of an eligible clinician or group’s MIPS Final Score.
Does MIPS apply to me?
MIPS applies to any provider that meets the definition of a MIPS eligible clinician. A MIPS eligible clinician is defined as the following licensed providers and any group that includes such professionals:
- Doctors of Medicine (MD)
- Doctors of Osteopathy (DO)
- Doctors of Dental Surgery/Dental Medicine (DMD/DDS)
- Doctors of Podiatry
- Doctors of Optometry
- Physician Assistants (PA)
- Nurse Practitioners (NP)
- Clinical Nurse Specialists
- Certified Registered Nurse Anesthetists.
The Centers for Medicare and Medicaid Services (CMS) has released an online tool to help providers determine their eligibility for MIPS this year. Check your eligibility »
There are some exemptions to MIPS that may mean the program requirements do not apply to you. The following bullets outline the exemptions to MIPS for 2017:
- Clinicians in their first year of Medicare Part B participation. In order to be classified as a newly enrolled Medicare eligible clinician, the clinician cannot have previously submitted claims in the previous calendar year either as an individual, an entity or as part of a group, regardless if they billed under a different tax number.
- Clinicians who have less than or equal to $30,000 in allowed Medicare Part B charges or less than or equal to 100 Medicare patients.
- Clinicians who are significantly participating in an Advanced APM, as defined by CMS.
- Clinicians who bill 25 or fewer patient-facing encounters during 2017. CMS considers a patient-facing encounter as an instance in which the MIPS eligible clinician or group billed for services such as general office visits, outpatient visits, and surgical procedure codes under the Medicare Physician Fee Schedule. Patient facing encounters do not have to be face-to-face; CMS has included telemedicine under this definition of patient-facing.
How do I get started right now?
You can get started with MIPS participation by following the items listed below:
- Get started in less than five minutes with an ONC certified EHR.
- Determine your eligibility for MIPS and understand the requirements.
- Choose the measures or activities for each performance category that you want to track this year. CMS’s website can help you select measures, and be sure to review your current billing codes and Quality Resource Use Report (QRUR) to help you identify those measures that best suit your practice.
- Meet measures as you care for your patients and use your EHR to track your progress under those measures throughout 2017.
Look for new tools to help you navigate MIPS requirements like a new MIPS dashboard that we plan to add to the Practice Fusion EHR later this year. This MIPS dashboard will include tools that will help make quality measures easier for you to understand and track. Throughout 2017, Practice Fusion will continue to offer additional resources to support your participation in MIPS, such as providing an educational overview about how to report data for MIPS when the MIPS reporting window opens in 2018.