MIPS

MIPS - Merit Based Incentive Payment System

MACRA repealed the Sustainable Growth Rate formula and created the Quality Payment Program. The Quality Payment Program changes the way Medicare pays clinicians and streamlines multiple quality programs. There are two options to choose from based on practice size, specialty, location or patient population. These are MIPS and APM (Advanced Alternative Payment Models). Most clinicians will be subject to MIPS unless they are in their 1st year of Part B participation, become QPs through participation in Advanced APMs, or have low volume of patients.

Who Does MIPS Affect? Medicare Eligible Clinicians

• Physicians
• Physician Assistants
• Nurse Practioners
• Clinical Nurse Specialists
• Certified Nurse Anesthetists
• Group that include such clinicians

CMS has provided a tool to see if you qualify for MIPS. Go to: https://www.cms.gov/Medicare/Quality-Payment-Program/Lookup-Tools/Lookup-tools.html

EXCLUSIONS

• < 30k Part B
• < = Medicare Patients

MIPS has 4 Performance Categories

• Quality (PQRS) – formerly Physician Quality Reporting System (30%)
• Cost (VM) – formerly Value-Based Modifiers (30%)
• ACI(MU) – formerly MU (25%)
• Process Improvements (15%)

MIPS Reporting Periods - 2017

	PATH 1	PATH 2	PATH 3
Requirements	Report on 1+ quality measures	IA: 90 days	IA: 90 days
	Report on 1+ IA measure	ACI: 90+ days, less than 1 year	ACI Full year
	Report on All Base ACI measures	Quality: 90+ days, less than 1 year	Quality: Full year
Outcomes	No penalty	No penalty	No penalty