Merit-Based Incentive Programs (MIPS)

If you decide to participate in traditional Medicare, you may earn a performance-based payment adjustment through MIPS. You earn a payment adjustment based on practice specific quality data. Starting in 2017, you will see a positive, neutral or negative adjustment ranging from -4% for no participation to +4% for full participation. The size of your payment adjustment will depend both on how much data you submit and your performance results.

Clinicians participating in MIPS must meet the low volume threshold of:

• Provides care to more than 200 Medicare Patients
• Exceeds $90,000 in Allowed Medicare Part B charges

An eligible clinician must report data in four categories:

• Quality
  Pick six measures that best fit your practice and specialty
  Report for a full year in starting in 2018
• Promoting Interoperability
  Base measures are required
  Performance measures and Bonus points are optional, but can be used to earn additional points
  Report 90 days or a full year
• Improvement Activities
  Submit up to 40 points
  Select from an inventory of over 100 activities to show how you improve care for your patients, enhance patient engagement and increase access to care among others
  Report 90 days or a full year
• Cost
  Cost measures assess the total cost of care during the year or during a hospital stay
  Medicare calculates your score on Cost based on Medicare claims submitted

Eligible clinicians must submit their MIPS data via their selected submission method by March 31 of the following calendar year. Some submission methods are:

• Claims
• EHR 
• Registry
• CMS Web Interface
• Manual Attestation