MIPS Scoring and Payments

Understand how scores are earned to proactively improve

At the heart of MIPS is rewarding high-value, patient-centered care through higher payments for those providers meeting the program goals. Providers who do not reach those goals, or who choose not to participate, will receive downward payment adjustments.

The first performance period opens January 1, 2017 and closes December 31, 2017. You must start participation by October 2, 2017.

The three components being measured in 2017 and the accompanying percentage of your total score include:

  • Quality category – 60%
  • ACI category – 25%
  • Improvement activities category – 15%

In 2018, the categories will be weighted as follows:

  • Quality category – 50%
  • ACI category – 25%
  • Improvement activities category – 15%
  • Cost category: 10%

The Financial Impact of Participation

Here’s how 2017 participation will affect your payments for 2019:

  • Non-participation – negative 4% payment adjustment
  • Submit something – avoid a downward payment adjustment
  • Submit 90 days – may earn a neutral or small positive payment adjustment
  • Submit a full year – may earn a positive payment adjustment

n 2018, the stakes will get higher. Organizations will need to submit 90-days of data for ACI and IA and full-year data for the Quality and Cost categories. 

Currently, the data submission deadline is March 31 and each year CMS will provide feedback about your performance approximately six months after you submit your data, which means that without a method to internally monitor performance, any performance issues cannot be addressed until almost the end of the following year.

With IgniteMIPS, you can project how your performance will impact your reimbursement and identify ways to proactively improve performance – and therefore, payments.