​​MACRA University

Merit-based Incentive Payment System (MIPS) 

Overview:  

  • All Medicare eligible clinicians (ECs) will fall under the MIPS program, at least initially, in 2017.
  • MIPS will rely on data submitted by ECs and EC groups to determine a Composite Performance Score (CPS) in four categories:
    • Quality 
    • Cost (Resource Utilization) - Deferred until the 2018 performance year
    • Advancing Clinical Information (EHR utilization and interoperability)
    • Clinical Practice Improvement Activities


Each category will contribute points that will be used to compile a Composite Performance Score (CPS) for each individual EC or group.  


The CPS will be used to determine whether the EC or group receives a negative or positive adjustment in Medicare reimbursement in a future payment year, which will be one year after the end of the reporting year.  For example, MIPS-related information reported in 2017  will affect reimbursement in 2019.


The level of payment adjustment will initially range between +/- 4% in 2019, but will rise to +/- 9% by 2022 and in subsequent years.  During the 2017 performance year, CMS has provided four pathways that will allow for avoidance of MIPS penalties. 


The CPS (i..e., the "MIPS Score") will be published on a Medicare website and will be available to the public.  CMS has stated that they will not publically report scores unless they have a complete set of data regarding a clinician's or a group's performance. 


ECs that qualify for participation in an advanced Alternative Payment Model (APM) do not receive variable payment adjustments under MIPS, but instead receive a 5% bonus on all Medicare Payments from 2019-2024, depending on when they meet the requirements of being an APM qualified participant.


Medicare anticipates that as few as 15% of ECs will qualify for an advanced APM in 2017.   All ECs will fall under the MIPS, and if it is later determined that they become a qualified APM participant, they will then no longer be required to participate in the MIPS program.