Medicare Part B clinicians billing more than $90,000 a year OR providing care for more than 200 Medicare patients a year OR provide more than 200 covered professional services under the Physician Fee Schedule.
Starting 2019, clinicians or groups can opt-in to MIPS, if they meet or exceed at least one of the low-volume threshold criteria.
For individual eligible clinicians and groups to make an election to opt-in or voluntarily report to MIPS, they would make an election via the Quality Payment Program portal by logging into their account and simply selecting either the option to opt-in (positive, neutral, or negative MIPS adjustment) or to remain excluded and voluntarily report (no MIPS adjustment). Once the clinician or group elects to opt-in to MIPS, the decision is irrevocable and cannot be changed for the applicable performance period. Clinicians who do not decide to opt-in to MIPS would remain excluded and may choose to voluntarily report. Such clinicians would not receive a MIPS payment adjustment factor.
MIPS determination period includes two, 12-month segments for the 2019 performance period. The first 12-month segment is from October 1, 2017 to September 30, 2018 including a 30-day claims run out. The second 12-month segment is from October 1, 2018 to September 30, 2019, doesn’t include a 30-day claims run out.
Quality measures should be reported for 12-month calendar year performance period. Cost category should be reported for 12-month calendar year performance period. Promoting Interoperability and Improvement activities measures should be reported for 90 days minimum performance period.
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.
|CATEGORY||PREVIOUSLY CALLED AS|
|Promoting Interoperability (PI)||Replaces Meaningful use (Medicare EHR Incentive Program)|
|Improvement Activities (IA)||-|
|Cost||Replaces Value-Based Modifier|
Based on their performance in these four categories, physicians and eligible providers will receive a payment adjustment. The payment adjustment for the performance year 2019 will be capped at +/- 7 percent in 2021.
Final Score = (Quality Score*Quality Weight) + (PI Score*PI Weight) + (IA Score*IA Weight) + (Cost Score*Cost Weight)*100
|FINAL SCORE||PAYMENT ADJUSTMENT|
|75 or more points||Positive Adjustment and Eligible for Performance Bonus|
|31-75 points||Positive Adjustment and NOT Eligible for Performance Bonus|
|30 points||Neutral Payment Adjustment|
|0 points||Negative Payment Adjustment of -7%|
An individual is defined as a single clinician, identified by their individual National Provider Identifier (NPI) tied to a single Taxpayer Identification Number (TIN). If you report only as an individual, you'll report measures and activities for the practice(s)/TIN(s) under which you are MIPS-eligible and be assessed across all 4 performance categories at the individual level. Your payment adjustment will be based on your Final Score derived from the 4 MIPS performance categories.
A group is defined as a single TIN with 2 or more clinicians (at least one clinician within the group must be MIPS eligible) as identified by their NPI, who have reassigned their Medicare billing rights to a single TIN.
If you report only as a group, you must meet the definition of a group at all times during the performance period and aggregate the group’s performance data across the 4 MIPS performance categories for a single TIN. Each MIPS-eligible clinician in the group will receive the same payment adjustment based on the group's performance across all 4 MIPS performance categories.
MIPS-eligible clinicians can report data as an individual and as part of a group under the same TIN. In this instance, the clinician will be evaluated across all 4 MIPS performance categories on their individual performance and on the group’s performance, with a final score calculated for each evaluation. The clinician will receive a payment adjustment based on the higher of the two scores.