Complying with MIPs (Merit Based Incentive Payments System)

A key part of MACRA, the Merit-Based Incentive Payment System (MIPS) has changed the way many providers qualify for Medicare reimbursements. Here is what you should know about complying with these regulations.

Who Does it Affect?

According to the Centers for Medicare and Medicaid Services, approximately 600,000 providers fall under the requirements of MIPS. That said, a few providers are exempt from having to submit data to MIPS. These include:

  • Clinicians enrolling in Medicare for the very first time in 2017
  • Clinicians who bill Medicare for no more than $90,000 in one year
  • Clinicians who serve no more than 100 Medicare patients in one year
  • Clinicians participating in an Advanced APM
  • Clinicians outside an MIPS-eligible specialty
  • Clinicians who are a Partial QP or Qualifying APM Participant (QP)

MACRA’s advanced alternative payment model (APM) is used for those who meet the above standards. On the other hand, if you do not meet these standards, your practice is subject to MIPS requirements.

How Does MIPS Impact Medicare Reimbursement?

Part of an industry movement toward performance-based billing, MIPS adjusts Medicare reimbursements based on four categories:

  • Quality, which will account for 50 percent of a provider’s score in 2018 and 30 percent in 2019
  • Resource use, which will account for 10 percent of a provider’s score in 2018 and 30 percent in 2019
  • Advancing care information, which will account for 25 percent of a provider’s score in both 2018 and 2019
  • Clinical practice improvement activities, which will account for 15 percent of a provider’s score in both 2018 and 2019

Performance in each category is used to calculate a final score that falls between zero and one hundred. Adjustments are then made based on a sliding scale, with higher performers getting higher rewards. According to CMS, exceptional performers that meet the appropriate performance threshold can receive an additional positive payment adjustment of up to 10 percent.

Complying with MIPS

Now that the merit-based incentive payment system has become standard, providers must effectively gather and report key metrics that clearly demonstrate their compliance. For most, this means increasing the use of EHR, regardless of whether they fall into MIP and APM. To ensure eligibility for positive payment adjustments and reduce the risk of negative payment adjustments, practices must also identify gaps in their existing tracking and reporting capabilities. They should also deploy and integrate EHR platforms that can efficiently capture and share patient information that leads to positive patient outcomes, which promote higher payment adjustments.

Providers should also carefully review MACRA guidelines to better determine which measures will result in better outcomes, depending on their individual practices and patients. By investing in high-performing EHR software, physicians can eliminate guesswork and wasted time that comes with collecting and reporting data. They can also unchain themselves and their staff from time-consuming operational duties, so they can dedicate the majority of their efforts on improving patient care.



2 responses to "Complying with MIPs (Merit Based Incentive Payments System)"
  • February 20, 2018

    Resource use, which will account for 10 percent of a provider’s score in 2018 and 30 percent in 2019 – it seems really optimistic, but…yeah – we should improve our standards and believe that every change may be crucial for the future.

  • March 29, 2021
    Gargi Heda

    Its really interesting to know about MIPS. Thank you for sharing this informative article with us.

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