Merit-Based Incentive Payment System (MIPS)

As if there weren’t enough acronyms in your life, there’s a few more you need to know as we transition into a value-based healthcare system. While this could potentially be a great band name, MACRA and MIPS are the latest initiatives aiming to increase the quality of patient care for the lowest cost possible.

The Medicare Access and CHIP Reauthorization Act (MACRA) is a bill passed by Congress in 2015. Under the previous system, The Physician Quality Reporting System (PQRS) is being transitioned into the Quality Payment Program (QPP).

Furthermore, QPP combines the previous PQRS with Meaningful Use (MU), and the Value-Based Modifier (VBM), to get the new Merit-Based Incentive Payment System (MIPS), which incentives quality initiatives by enabling participants to earn up to a 5% performance-based payment adjustment following the performance year.

What you need to know

Through MIPS, data is reported in four categories: Quality (50%), Advancing Care Information (25%), Clinical Practice Improvement Activities (CPIA, 15%), and Resource Use/Cost (10%).

The max score is 100. The higher the MIPS score, the better the payment adjustment following the performance year (up to 5%). Meanwhile, not participating in MIPS could mean a -4% negative payment adjustment.

As part of the initiative, MIPS participants need to select six different measures in the Quality Performance category to report to CMS. Of these six measures, one must be an outcome measure and one must be considered high-priority. These can be measures for appropriate use, patient experience, patient safety, efficiency or care coordination.

Click here to see the 22 MIPS measures CODE has submitted to CMS.

This year is a trial run, with the first performance period beginning January 1, 2017, and runs through December 31, 2017. The data submission deadline is March 31, 2018, and the payment adjustment period will begin in January of 2019.


Eligible Clinicians (EC) for MIPS includes Physicians (MD/DO and DMD/DDS), Physicians Assistants, Nurse Practitioners, Clinical Nurse Specialists, and Certified Registered Nurse Anesthetists, and those who participate in Medicare Part B. Note, MIPS does not apply to hospitals.

Those in their first year of Medicare Part B participation, those who charge Medicare less than $30,000 and provide care for fewer than 100 Medicare patients in one year, and certain participants in Advanced Alternative Payment Models, are exempt.