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 |
|---|---|
| Quality | Replaces PQRS |
| 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.
- 45% of Final Score
- Select 6 Quality Measures
- One must be an Outcome or High Priority Measure
- Option to select Specialty-specific set of measures
- 25% of Final Score
- Must use 2015 Edition CEHRT in 2019
- Performance based scoring at individual measure-level
- Select up to 9 Measures
- 15% of Final Score
- Participation in Activities that improve clinical practice
- Select 4 Activities
- No Bonus in 2019
- 15% of Final Score
- No Reporting Requirement
- Assessment based on Medicare claims data
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% |
Reporting as an individual
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.
Reporting as a group
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.
Reporting as both an individual and group
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.
- 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 Promoting Interoperability category and certain measures for the quality category
