Clinicians can participate in the Merit-based Incentive Payment System (MIPS) or in Advanced Alternative Payment Models (APMs) in order to avoid downward payment adjustments and potentially receive upward adjustments. The performance period for MIPS begins January 1, 2017 and the first payment adjustments will be applied in 2019.
Use this resource to develop your 2017 MIPS participation plan. Select Quality measures, Improvement Activities and Advancing Care Information measures to determine how your practice can successfully meet MIPS participation requirements.
Affected clinicians are called "MIPS-eligible clinicians" and will participate in MIPS. The types of Medicare Part B eligible clinicians affected by MIPS may expand in future years.
During the first two performance years, MIPS will apply to physicians, PAs, NPs, clinical nurse specialists and certified registered nurse anesthetists. In the third year and onward the list of eligible clinicians will expand to include additional practitioners.
First year of Medicare Part B participation
Below low patient volume threshold
Certain participants in Advanced Alternative Payment Models
Medicare billing charges less than or equal to $30,000 or provides care for 100 or fewer Medicare patients in one year.
Groups and individuals will be determined to be "patient-facing" if they bill 100 or more face-to-face codes during the performance period. These codes will be released by CMS in the near future.
Quality: 6 measures, 1 outcome
Advancing Care Information: Fulfill the required measures for a minimum of 90 days:
Note: you may not need to submit Advancing Care Information if these measures do not apply to you.
Improvement Activities: 4 medium-weighted or 2 high-weighted activities (some exceptions for small and rural practices)
If you send your MIPS data with a group, the group will get one payment adjustment based on the group’s performance. A group is defined as a set of clinicians (identified by their NPIs) sharing a common Taxpayer Identification Number, no matter the specialty or practice site. Importantly, all performance data must be assessed as a group for all MIPS categories.
Data Submission: Your group will send in group-level data for each of the MIPS categories through the CMS web interface or an electronic health record, registry, or a qualified clinical data registry. Groups practices will not have to register with CMS in advance for this reporting option.
Individual clinician or group that bills 100 or fewer patient-facing encounters during a performance period.
Improvement Activities: 2 medium-weighted or 1 high-weighted activity
If you send MIPS data in as an individual, your payment adjustment will be based on your performance. An individual is defined as a single National Provider Identifier (NPI) tied to a single Taxpayer Identification Number.
Data Submission: You’ll send your individual data for each of the MIPS categories through an electronic health record, registry, or a qualified clinical data registry. You may also send in quality data through your routine Medicare claims process.