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.

Navigating this Guide

This guide is indented to be your one-stop resource for understanding the traditional MIPS program and achieving MIPS measures and objectives using Eyefinity software. Click the links below to take a deep dive into specific categories and find step-by-step measure instructions.

Or, continue reading this page for general MIPS information.

Understanding 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. Assesses the quality of care you deliver based on measures of performance. You must collect Quality data for the entire year.
  • Promoting Interoperability. 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. You must complete 180 continuous days of promoting interoperability using a 2015-edition "Cures Update" certified EHR, like Eyefinity EHR 7.0 or later or ExamWRITER 15.3 or later.
  • Improvement Activities. Assesses your participation in clinical activities that support the improvement and patient engagement, care coordination, and patient safety.
  • Cost. Assesses the cost of the care you provide based on specific types of episodes reported on your Medicare claims. Cost measures are also used to gauge the total cost of patient care during the year or a hospital stay. Because the cost category is measured entirely outside of your use of our software, refer to the Quality Payment Program for information about how cost is measured.

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

Determining Your Participation Status

There are no changes to MIPS eligibility in 2024. 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.

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 2022. 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.

Check Your Eligibility

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

Keeping Your Eye on the Prize

Your MIPS performance in 2023 impacts your 2024 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.

Reporting on All Patient Encounters

Although your participation status is based on your Medicare cases, and your MIPS performance impacts your Medicare payments, your MIPS performance generally accounts for Medicare and non-Medicare patient encounters. Some MIPS performance categories may be limited to Medicare patients due to the limitations inherent to claims-based data collection, you should presume your MIPS performance is based on all billable patient encounters, regardless of payer.

Navigating the Performance Categories

Clinicians are scored based on the following performance categories:

  • Quality (30%)
  • Promoting interoperability (25%)
  • Improvement activities (15%)
  • Cost (30%)

Each category is weighted within your MIPS score, as noted above. The category weights are unchanged from the previous year.

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

Meeting the Payment Threshold

Your MIPS score is weighted according to the categories listed above, but how does your MIPS score translate into a Medicare payment incentive or penalty? The following table describes the MIPS score thresholds and how they may impact Medicare payment adjustments. The payment thresholds are unchanged from the previous year.

2024 MIPS Score Potential 2026 Medicare Adjustment Notes
0.00–18.75 -9% Negative 9% payment adjustment
18.76–74.99 -x% Negative payment adjustment between -9% and 0%, based on a linear sliding scale.
75.00 0% Neutral payment adjustment
75.01–100.00 +x%

Positive payment adjustment between 0% and 9% that depends on how well you score compared to other eligible clinicians

This payment adjustment pool is funded by the negative payment adjustments imposed on other clinicians