Medicare's MIPS: Let's Break it Down

MIPS is short for Merit-Based Incentive Payment System. It is one of the two payment systems under Medicare’s MACRA for Medicare Part B providers. MACRA stands for Medicare Access & CHIP Reauthorization Act. In our recent blog post about MACRA, we provide a good, high-level overview of the program, and we mention MIPS. We’ll highlight key details about MIPS here.

MIPS and APM (Alternative Payment Model) are the two payment mechanisms set in place by MACRA in 2019. MIPS is unique because reimbursement is based on individual performance, hence the name “Merit-Based Incentive Program.” Here’s how it works.

Performance for reimbursement is measured in four categories:

  • Quality

  • Cost

  • Clinical Practice Improvement Activities

  • Advancing Care Information (EHR Use)

Each of these four categories are scored and each provider is given a composite score based off their results. The composite scores are then compared to a performance threshold that is an average of all MIPS eligible providers in a given time period. The good news is composite scores start fresh every year, and there are also incentives in place for practitioners who show improvement/achieve certain scores.

Incentives and Penalties:

When a practitioner’s composite score increases, they receive positive payment adjustments. These adjustments can be up to 4% in 2019 and practitioners have the potential to grow to up to 9% in 2020. Composite scores that remain the same do not receive MIPS payment adjustments, and scores that fall receive negative payment adjustments. Let’s repeat that…scores that fall receive negative payment adjustments. That’s right, a penalty. The negative payment adjustments also start at 4% and are capped off at 9%.

One common concern about MIPS is how to prepare for it. Having the right technology in place now can benefit you, so you’re prepared when MIPS rolls out in 2017. It also matters how you use technology, EMR and reports. Good technology and processes lead to better population health management and performance measurement. MIPS streamlines Meaningful Use (MU), Physician Quality Reporting System (PQRS), and Value Based Modifier (VBM) reports into one program, so it is vital for your organization to have the resources necessary to take advantage of the rewards.

MIPS is quickly approaching, and we want you to be ready to maximize your payment rates.



Sources: FACS, SA-Ignite