Participating in MIPS

Under MACRA (Medicare Access and CHIP Reauthorization Act of 2015), the Merit-based Incentive Payment System (MIPS) is a Medicare payment program focused on quality of care, rather than quantity of care. MIPS streamlines and combines meaningful use and PQRS.

Due to the disruption caused by the novel coronavirus (COVID-19), CMS has extended the 2019 MIPS reporting deadline to April 30, 2020. Clinicians who do not report their 2019 MIPS performance by April 30 will not be penalized. CMS will apply a neutral payment adjustment to the clinician's 2021 Medicare payments. For more information, visit the Quality Payment Program website.

Clinicians participating in the Medicaid promoting interoperability program should check with their state's Medicaid agency for deadline and hardship information.

What's in this Guide?

This guide is indented to be your one-stop resource for understanding MIPS and achieving MIPS measures and objectives using Eyefinity software.

What's MIPS?

MIPS is a Medicare payment program that is intended to incentivize eligible clinicians (ECs) to focus on the quality of care rather than quantity of care. Clinicians are scored based on the following areas:

  • Quality (formerly PQRS and CQMs)
  • Promoting Interoperability (formerly meaningful use and advancing care information)
  • Clinical Practice Improvement (expanding hours, improving outreach, etc.)
  • Cost (based on episode-specific costs reported on claims)

Clinicians will achieve half of these objectives (quality and promoting interoperability) within their EHR software.

Clinicians must complete 90 days of promoting interoperability using a 2015-edition certified EHR, like Eyefinity EHR 5.10 or later or ExamWRITER 15 or later.

Who's Required to Participate?

You're required to participate in MIPS if you or your group meet all of the following criteria:

  • You bill more than $90,000 in Medicare Part B allowed charges in Physical Fee Schedule (PFS) services per year
  • You provide covered professional services to more than 200 Medicare beneficiaries per year
  • You provide more than 200 covered professional services under PFS per year

If you're required to participate, you may qualify for an incentive or be subject to a penalty.

If you or your group meet one or two criteria, you may opt in to MIPS. Log into your QPP Portal to opt in. If you opt in, you cannot opt out again. You may qualify for an incentive or be subject to a penalty.

Providers who meet all three criteria are required to participate in MIPS. Providers who meet one criterion, may opt in.

If you or your group fall below all these criteria, you're off the hook—you're not eligible to participate in MIPS in 2019. You may report MIPS performance voluntarily, but you will not qualify for an incentive nor will you be subject to a penalty.

CMS defines a group as two or more clinicians who reassign their billing rights to a single TIN (tax identification number).

To learn more about the participation criteria, refer to the QPP website. or check your eligibility.

The following video from CMS demonstrates how to opt in as a MIPS-eligible clinician.

What's at Stake?

Your MIPS performance in 2019 impacts your 2021 Medicare payments. Payment adjustments based on 2019 performance increase to +/- 7%—that's a potential 14-point swing in Medicare payments.

MIPS is designed to make ECs compete in quality performance. Since MIPS is mandated to be budget neutral, the program essentially takes money from lower performing ECs and pays it to higher performing ECs. There’s a lot of incentive for you to bring your A-game.

What are the Performance Categories?

Clinicians are scored based on the following performance categories:

  • Quality
  • Promoting interoperability
  • Clinical practice improvement activities
  • Cost

Each category is weighted within your MIPS score.

Quality 45%. Promoting Interoperability 25%. Improvement Activities 15%. Cost 15%.