MIPS (Merit-Based Incentive Payment System)

MIPS (Merit-Based Incentive Payment System) was established as part of MACRA and streamlines quality and value programs for Medicare physicians by combining the follow three programs into one: Physician Quality Reporting Program (PQRS), Value-Based Modifier Payment, and the Medicare EHR Incentive Program.

Under MIPS, physicians and practitioners will be given a composite performance score based on how well they perform in the following categories: quality of care (worth 60% of overall score), advancing care information (ACI, renamed from Meaningful Use) (25%), clinical practice improvement activities (15%), and cost (0%). The weighting of these categories changes from year to year. Beginning in 2019, physicians will receive payment adjustments based on their MIPS performance score from two years prior (i.e. your payment adjustment for 2019 is based on your MIPS performance score from the 2017 reporting year). The payment adjustments are broken down as follows: +/- 4% in 2019, +/- 5% in 2020, +/- 7% in 2021, and +/- 9% in 2022.

There are three groups of physicians and practitioners who are not subject to MIPS, those who: are in their first year of Medicare participation, are below the low volume threshold, or participate in eligible Alternative Payment Models and qualify for the bonus payment.