MIPS or merit based incentive payment system is among the tracks within the quality payment program that moves providers of Medicare Part B to a payment system that is based on performance. Three historic Medicare programs are streamlined by MIPS, namely Medicare Electronic Health Record Value Based Payment Modifier Program and Physician Quality Reporting System into one payment program.
All providers who fulfill the qualifications that pertain to being an eligible clinician for MIPS are expected to participate in MIPS accordingly to avoid being subjected to a negative payment adjustment of a specified percentage on reimbursements.
Group and Individual Reporting
One of the unique elements of MIPS is that qualified clinicians have a choice to participate as part of a group or as an individual. Individual eligible clinicians are required to report MIPS information to CMS under the NPI number linked to one TIN.
More than one clinician with a unique NPI with their billing rights reassigned to one TIN can participate as a group. When eligible clinicians opt to participate as a group, they are evaluated as a group across all the performance categories.
Participation Pace
2017 was designated as what is known as a transition year for the payment program in order to help providers move into the new payment methods that MACRA consist of. This means that a total of four options are available for participation among the eligible clinicians who have varied requirements as related to reporting the data to CMS. Online resources are available for more insight into the available participation options.
It is essential to note that there is a minimum amount of data that is required to fulfill Test Pace obligations for MIPS and prevent negative payment adjustments as defined by each of the performance categories. Eligible clinicians may be expected to report more data for every performance category to meet full and partial year participation requirements.
Performance Categories
What is MIPS? MIPS refers to a payment system that is based on performance and consist of four categories that give clinicians the ability to be flexible when choosing the measures and activities that are most important to their practice.
The performance of an eligible clinician in each performance category is combined for the purpose of creating a compound performance score that is also referred to as the final score. This is used to decide payment adjustments for future years. MIPS includes the following performance categories:
- Quality- This category is a substitute for the PQRS or Physician Quality Reporting System and needs eligible clinicians to provide data reports to CMS for the quality measures that are related to care coordination, patient experience, efficiency, patient safety, suitable use of medical resources and patient outcomes.
- Advancing Care- This is a replacement for Meaningful Use or Medicare EHR Incentive Program and focuses especially on objectives that are related to information exchange and interoperability.
- Improvement Activities- This category aims to encourage the eligible clinicians to get involved in activities that enhance clinical practice within areas such as increasing access, coordinating care, patient safety and shared decision making.
- Cost- This MIPS category assesses eligible clinicians in terms of the measures related to using resources, which are calculated through Medicare claims.
