Merit-Based Incentive Programs (MIPS)
Updated: 10/21/2019
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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 three low volume threshold criteria: |
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In 2019, an eligible clinician must report data in four categories: |
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Eligible clinicians must submit their MIPS data via their selected submission method by March 31 of the following calendar year. Some submission methods are: |
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- Quality Measures
- Anti-depressant Medication Management
- Appropriate Testing for Children with Pharyngitis
- Appropriate Treatment for Children with Upper Respiratory Infection (URI)
- Breast Cancer Screening
- Childhood Immunization Status
- Children Who Have Dental Decay or Cavities
- Chlamydia Screening for Women
- Closing the Referral Loop: Receipt of Specialist Report
- Colorectal Cancer Screening
- Controlling High Blood Pressure
- Diabetes: Eye Exam
- Diabetes: Hemoglobin A1c (HbA1c) Poor Control (9.0%)
- Documentation of Current Medications in the Medical Record
- Heart Failure: Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic
- Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
- Pneumonia Vaccination Status for Older Adults
- Preventive Care & Screening: Influenza Immunization
- Preventive Care & Screening: Screening for Clinical Depression and Follow-up Plan
- Preventive Care & Screening: Tobacco Use: Screening and Cessation Intervention
- Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-up Plan
- Use of High-Risk Medications in the Elderly
- Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents