What is MIPS?

What is MIPS?

The Medicare Access and CHIP Reauthorization Act (MACRA) brings changes to the Medicare payment system. The hope is that it will be an improvement over the Sustainable Growth Rate (SGR) formula. Under MACRA most doctors will be paid according to the Merit-Based Incentive Payment System (MIPS). Others will fall into the Alternative Payment Methods (APMs) system.

What Does MIPS Rate?

MIPS ratings fall into four categories: Quality, Advancing Care Information, Resource Usage and Clinical Practice Improvement Activities. Performance in these four categories begins to count on Jan 1, 2017. Payment adjustments will take place in 2019.

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The Quality program will account for up to 50% of a possible 100% score in the first year. It has six categories:

-Patient Outcomes
-Appropriate Use
-Patient Safety
-Patient Experience
-Care Coordination

Within these categories, more than two hundred activities are measured.

Advancing Care Information

Advancing Care Information replaces Meaningful Use. It will account for 25% in the first year. It looks at how you use Electronic Health Records in your day to day practice. There are six objectives in this category:

Protecting Patient Information
-Patient Electronic Access
-Coordination of Patient Care through Engagement
-Electronic Prescribing
-Health Information Exchange
-Public Health and Clinical Data Registry

Performance in all six categories results in a base score of 50 out of 100. Mastering the Protecting Patient Information category is required to receive any points from other objectives. While obtaining a score greater than 100 is possible, points toward your MIPS score are limited to 25.

Resource Usage

The claims you submit to Medicare are used to determine your score in the Resource Usage category. It counts towards 10% of the total score for year one. You must see at least twenty patients for this category to count. If you do not have enough volume, you will receive a score of 0. The other three categories will be reweighted to allow for a possible score of 100.

Clinical Practice Improvement

Clinical Practice Improvement will account for 15% of your score. It’s meant to reward good care coordination, beneficiary engagement, and patient safety. There will be over ninety options to achieve a maximum score of 60. Patient surveys and post-visit follow-ups count towards this category.


Although MACRA and MIPS aim to simplify things, there are some new things you need to know. For example, the term neutral budget and how it will apply to you. In a nutshell, it means that there will be winners and losers. For every doctor getting a positive payment adjustment, there will one doctor getting a negative payment adjustment.

Under this new system, not having any adjustment may be seen as a win–especially when facing a potential 9% payment reduction by 2022. Fortunately, for the first five years, there will be extra dollars kept exempt from the neutral budget requirements. These will go to the highest performers with a cap of 10% over the standard positive adjustment.

There is a lot to learn, and a lot to prepare. Remember, the payouts from the adjustments will begin in 2019 but reporting starts in 2017. The New Year is right around the corner. With such a material change looming there’s not much time to waste.

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