Am I eligible to participate in MIPS?

Medicare Part B clinicians billing more than $30,000 a year AND providing care for more than 100 Medicare patients a year.

Exemptions from MIPS include:

  • Clinicians in their first year billing Medicare;
  • Clinicians with their volume of Medicare payments or patients falling below the low-volume threshold (100 Medicare patients OR $30,000 or less in Medicare Part B charges); and
  • Clinicians who qualify for a bonus payment under AAPMs.

The low-volume threshold is calculated at the participation level of the EC. If reporting as a group, the low-volume threshold would be calculated at the group level. If reporting as an individual, the lowvolume threshold would be calculated at the individual level.

CMS will calculate an EC’s low-volume threshold status using two sets of claims data. For the 2017 performance period, the first data set will include claims data from September 1, 2015, to August 31, 2016.

The second data set will include claims data from September 1, 2016, to August 31, 2017. CMS will not change the low-volume status of ECs who fall below the low-volume threshold during the first review period, but not the second.

Do I have participation options in 2017?

Our goal is to help physicians document all the diseases for Medicare Audit compliance, which will result in the appropriate RAF score for each patient. This will in turn improve your CMS 5 Star/HEDIS measures

  • Provide feedback to physicians with custom physician training
  • Capella-Wish software is, specially designed for HCC coding compliant and Wellness Center Support
  • Chart review by Certified Coders - AHIMA or AAPC
  • Review your patient charts Claims (electronic or paper), Lab and Prescription data and identify all of the RAF & Non-RAF related ICD-9-CM and/or ICD-10 codes and any 5 Star/HEDIS measures
  • Review the claims data and identify the gaps between the codes in the patient chart and claims data
  • Review charts for Documentation Standards, MEAT and CCI edits Identify documentation deficiencies for provider feedback /training
  • Create a specific library of patient charts for you to access and monitor electronically
  • Scan paper charts at the physician practice if needed. We can obtain charts directly from the physician office or work with those charts provided by the health plans
How does MIPS work?

The MIPS is based on the FFS model with a direct tie to quality performance. You earn a payment adjustment based on evidence-based and practice-specific quality data. You show you provided high quality, efficient care supported by technology by sending in information in the following categories.

MIPS consolidates 3 existing reporting systems—the Physician Quality Reporting System (PQRS), the Physician Value-based Payment Modifier (VBPM) and the Medicare Electronic Health Record Incentive Program (also known as "Meaningful Use")—into a single program for performance assessment. It also includes a new improvement activities category.

Quality Replaces PQRS
Advancing Care information (ACI) Replaces Meaningful use (Medicare EHR Incentive Program)
Improvement Activities (IA) -
Cost Replaces Value-Based Modifier

The cost category will be calculated in 2017, but will not be used to determine your payment adjustment. In 2018, cost category will be used to determine your payment adjustment. Based on their performance in these four categories, physicians and eligible providers will receive a payment adjustment. The payment adjustment will be capped at +/- 4 percent in 2019, rising to +/- 9 percent in 2022 and subsequent years.

Quality Requirements
  • 60% of Final Score
  • Select 6 Quality Measures
  • One must be an Outcome or High Priority Measure
  • Option to select Specialty-specific set of measures
Advancing Care Information Requirements
  • 25% of Final Score
  • Must use certified EHR technology to report measures
  • In 2017, 2 measure sets for reporting based on EHR edition
    • 2014 Edition – 11 Measures
    • 2015 Edition – 15 Measures
  • Select up to 9 Measures
Improvement Activities Requirements
  • 15% of Final Score
  • Participation in Activities that improve clinical practice
  • Select 4 Activities
Cost Requirements
  • 0% of Final Score in 2017
  • No Reporting Requirement
  • Assessment based on Medicare claims data
  • Select 4 Activities
Final Score

Final Score = (Quality Score*Quality Weight) + (ACI Score*ACI Weight) + (IA Score*IA Weight) + (Cost Score*Cost Weight)*100

70 or more points Positive Adjustment and Eligible for Performance Bonus
4-69 points Positive Adjustment and NOT Eligible for Performance Bonus
3 points Neutral Payment Adjustment
0 points Negative Payment Adjustment of -4%
What are the Reporting Methods?

Reporting as an individual

If you send MIPS data in as an individual, your payment adjustment will be based on your performance. An individual is defined as a single National Provider Identifier (NPI) tied to a single Tax Identification Number. The ACI and IA categories will include attestation options.

You’ll send your individual data for each of the MIPS categories through an electronic health record, registry, or a qualified clinical data registry. You may also send in quality data through your routine Medicare claims process.

Reporting as a group

If you send your MIPS data with a group, the group will get one payment adjustment based on the group’s performance. A group is defined as a set of clinicians (identified by their NPIs) sharing a common Tax Identification Number, no matter the specialty or practice site. Groups will also be able to attest for the ACI and IA performance categories.

Your group will send in group-level data for each of the MIPS categories through the CMS web interface or an electronic health record, registry, or a qualified clinical data registry. To submit data through our CMS web interface, you must register as a group by June 30, 2017.

How do I know if I'm ready to participate in MIPS for 2017?
  • Review your Financial as well as Reporting Structure and Get Personalized Assessment.
  • Do financial forecasting with MIPS Estimator.
  • Consider using a qualified clinical data registry or a registry to extract and submit your quality data. Acurus has registered with CMS to act as a Qualified Clinical Data Registry (QCDR).
  • Check that your electronic health record is certified by the Office of the National Coordinator for Health Information Technology. If it is, it should be ready to capture information for the MIPS advancing care information category and certain measures for the quality category.

Contact Information


E Mail :


Phone : 714-221-6300


Fax : 909-348-8194


160 South Old Springs Road,
Suite 280, Anaheim Hills,
CA 92808, USA

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