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.
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.
- Understanding Quality Requirements
- Understanding Promoting Interoperability Requirements
- Documenting Clinical Practice Improvement Activities
- Tracking and Reporting MIPS Performance
- Claiming a Hardship Exception
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). Assesses the quality of care you deliver based on measures of performance.
- Promoting Interoperability (formerly meaningful use and advancing care information). Focuses on the electronic exchange of health information using certified electronic health record technology (CEHRT) to improve patient access to their health information, exchange of information between providers and pharmacies, and systematic collection, analysis, and interpretation of healthcare data.
- Clinical Practice Improvement (expanding hours, improving outreach, etc.). Assesses your participation in clinical activities that support the improvement and patient engagement, care coordination, and patient safety.
- Cost (based on episode-specific costs reported on claims). Assesses the cost of the care you provide based on your Medicare claims. Cost measures are also used to gauge the total cost of patient care during the year or a hospital stay.
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?
There are no changes to MIPS eligibility in 2021. 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 Provider 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.
If you or your group fall below all these criteria, you're off the hook—you're not eligible to participate in MIPS in 2021. 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).
The following video from CMS demonstrates how to opt in as a MIPS-eligible clinician.
What's at Stake?
Your MIPS performance in 2021 impacts your 2023 Medicare payments. Payment adjustments may be as high as +/- 9%—that's a potential 18-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:
- Promoting interoperability
- Clinical practice improvement activities
Each category is weighted within your MIPS score. In 2021, the Quality category drops from 45% to 40%, and the Cost category rises from 15% to 20%.
In 2022, the Quality and Cost categories will each be worth 30% of your total MIPS score.