Merit-based Incentive Payment System (MIPS)

Your MIPS scores determines your Medicare payment… and your public reputation

The Department of Health and Human Services has set a goal of tying 85 percent of all Medicare fee-for-service to quality or value by 2016 and 90 percent by 2018. To achieve this goal, they have revamped their programs and payment structure, including introducing the Merit-based Incentive Payment System (MIPS). 

The Merit-based Incentive Payment System (MIPS) is a competitive program that merges Meaningful Use and PQRS to streamline multiple value-based programs. With MIPS, healthcare providers receive a single annual score determined by the following four categories:

  • Advancing Care Information (ACI, formerly MU)
  • Quality (formerly PQRS/VBM)
  • Improvement Activities
  • Cost (beginning in 2018)

Each of the categories has its own measures, scoring, and weighting to make up the category score, which then are aggregated to determine a MIPS final score.

The Bottom Line

It’s important to note that MIPS ranks clinicians against each other to determine who qualifies for incentives. Your final score will determine positive, neutral, or negative adjustments to your annual Medicare reimbursement.

The first MIPS performance year begins on January 1, 2017, and the results will affect clinicians’ 2019 Medicare reimbursement. In subsequent years, penalties and incentives continue to increase and eligibility requirements change.

In addition, MIPS scores will be publicly reported by the government via the Physician Compare website and made freely available to third-party sites like Consumer Reports, Amino, Yelp, and Angie’s List. That means that your score may not only affect your reimbursement, but also your reputation.

With so much on the line, it is critical to have a partner you can trust to help you optimize your score, revenue, and reputation.