What You Need To Know About The Merit-Based Incentive Payments System (MIPS)

by Emily on August 24, 2018

in Articles

The Medicare Access and the CHIP Reauthorization Act of 2015 (MACRA) was established legally on April 16, 2015. This legislation serves to major purposes. First, this law annuls the sustainable growth rate (SGR) and secondly, it presents a new Quality reporting program referred to as the Merit-Based Incentive Payments System (MIPS). Over time, MIPS will take more importance as most of the program requirements start taking shape. Here are a few things that you should know about MIPS.

When

The MIPS Performance Year starts on 1st January and ends on 31st December of every year. Participants of this program must report the data collected during the one year calendar by the 31st of March of the following calendar year. For example, program participants who collected their data in 2018 need to report their data by March 31, 2019, for them to be eligible for an increase in payment and avoid a payment reduction in their 2020 payout.

Eligibility

CMS extended MIPS eligibility when compared to past value-based reimbursement programs such as the Value-based Modifier, Physician Quality Reporting System, and EHR Incentive Programs, to boost the reach of the Quality Payment Program. With MIPS, qualifying provides are known as eligible clinicians and this term encompasses both eligible professionals and eligible hospitals. For the first two years of the MIPS program, eligible clinicians include physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists and more. MIPs participation excludes newly enrolled Medicare providers and clinicians with a low-volume threshold. For a detailed mips overview check out www.mdinteractive.com/mips.

Individual or Group Reporting

The MIPS program is exceptional when compared to past payment systems because it allows eligible clinicians to participate either as individuals or as part of a group. Individual eligible clinicians can report MIPS data to the CMS under one NPI number that is tied to one TIN. Two or even more eligible clinicians that have distinct NPIs and have reassigned their billing rights to one TIN can participate in MIPS as a group. When eligible clinicians opt to participate in MIPS as a group, they can be accessed as one group across all the four MIPS performance categories.

How incentives are calculated

The financial impacts of the MIPS scoring system are quite significant. The composite score will determine whether the clinician receives a positive, negative, or a neutral payment adjustment.

  • Positive payment adjustments-Clinicians that have composite performance scores that are above the threshold receive positive payment adjustments.
  • Zero adjustments-Clinicians with composite performance scores are either above or below the set threshold do not receive any MIPS payment adjustment.
  • Negative adjustments-Clinicians whose performance scores falls between zero and ¼ of the threshold get a maximum possible payment adjustment for that year.
  • Exceptional Performance Bonus-This is a special additional incentive payment that is funded with $500 million every year and is applied to the topmost 75% of physicians with above the performance threshold. This ensures that even if all clinicians satisfy the MIPS threshold there will always be funds for positive updates.

MIPS is a performance-based payment system that is made up of four categories including   Promoting Interoperability (PI), Improvement Activities, cost, and quality. MIPS offers clinicians the flexibility of choosing the measures and activities that are meaningful to their medical practice. To generate the MIPS Final Score or MIPS Composite Performance Score is generated by combining the weighted performance of all the four categories to showcase the performance of qualified clinicians. The MIPS Final Score is what is used for determining the part B future payment adjustments. Professionals that want to thrive in the industry must consider the Merit-based Incentive Payment System and ensure compliance.

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{ 1 comment… read it below or add one }

Tarique Amir August 24, 2018 at 19:12

Hi Emily,

Nice post, you have shared in-depth information in this post. I am glad I landed on your post.

Thanks for sharing, have a good day. 🙂

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