Quality Payment Program

Merit-based Incentive Payment System (MIPS)

For more information please visit: https://qpp.cms.gov/mips/overview

Report as an Individual

An and individual is defined as a single clinician, identified by thear 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.

Report 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 t o 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 all4 MIPS performance categories.

Four Phases of Participation

Quality

This performance category replaces PQRS. This category covers the quality of the care you deliver, based on performance measures created by CMS, as well as medical professional and stakeholder groups. You pick the six measures of performance that best fit your practice.

Promoting Interoperability (PI)

This performance category replaced the Medicare EHR Incentive Program for EPs, commonly known as Meaningful Use. This is done by proactively sharing information with other clinicians or the patient in a comprehensive manner. This may include: sharing test results, visit summaries, and therapeutic plans with the patient and other facilities to coordinate care.

Improvement Activities

This is a new performance category that includes an inventory of activities that assess how you improve your care processes, enhance patient engagement in care, and increase access to care. The inventory allows you to choose the activities appropriate to your practice from categories such as, enhancing care coordination, patient and clinician shared decision-making, and expansion of practice access.

Cost

This performance category replaces the VBM. The cost of the care you provide will be calculated by CMS based on your Medicare claims. MIPS uses cost measures to gauge the total cost of care during the year or during a hospital stay. This performance category will count towards your MIPS final score.

Additional Details

Performance Year

The MIPS Performance Year begins on January 1 and ends on December 31 each year. Program participants must report data collected during one calendar year by March 31 of the following calendar year.

Exemptions

- Bill less than $90,000 for Part B covered professional services (including Railroad Retirement Board and Medicare Secondary Payer), and
- See less than 200 Part B patients, and;
- Provide less than 200 covered professional services to Part B patients.

Exceptions

If you find it difficult to meet the requirements you can apply for an exception: https://qpp.cms.gov/mips/exception-applications

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