MIPS Tips: An Introduction to MIPS & How It Applies to Your Practice

Participation in MIPS is going to affect how you run your practice in 2020—and each year that follows. Not sure what MIPS is? MIPS, or Merit-Based Incentive Payment System, is a value-based payment model that will link payments to quality and cost-efficient care1 —in other words, your patients’ perception of the care they receive will be vital to your practice’s wellbeing. 

Let’s dive into the details to ensure you are ready for the impact of MIPS.

Eligibility & Participation in MIPS

There are a variety of different clinicians who are eligible to report for MIPS, including physician assistants, nurse practitioners, clinical psychologists, registered dietitians, physical therapists, and more.2 Eligible clinicians can participate in MIPS as an individual or as part of a group. Additionally, eligibility in MIPS is dependent on your National Provider Identifier (NPT) and Associated Taxpayer Identification Numbers (TINs). 

 According to Quality Payment Program, “Clinicians and practices must exceed the low-volume threshold (LVT) during both review periods to be eligible for MIPS. The low-volume threshold includes 3 aspects of covered professional services: allowed charges, number of Medicare patients who receive services, and number of services provided.2

 In regard to participation in MIPS, there are three types that are determined by the eligibility guidelines above. Mandatory participation in MIPS is for those who exceed the LVT criteria, opt-in participation is for individuals and groups who exceed one or all LVT criteria, and voluntary participation is those who don’t meet the LVT criteria. 

How Will Performance Be Measured?

 By participating in MIPS, your performance as a health care professional will be measured in four areas: Quality, Improvement Activities, Cost, and Promoting Interoperability. Each performance indicator holds a different weight that will impact your final score, which is out of 100 points. 

 Quality is measured by the quality of care you deliver to patients. This particular measure is based on performance indicators developed by the Centers for Medicare & Medicaid (CMS), as well as other medical professionals. For the 2019 performance year, Quality is 45% of the MIPS final score. 

 Promoting Interoperability encourages patient engagement through the electronic exchange of health-related information, like test results or therapy plans. This information is intended to be used among a patient’s circle of health care providers so they can coordinate care. For the 2019 performance year, Promoting Interoperability is 25% of the MIPS final score. 

 Improvement Activities are organized to include an inventory of activities that measure how you are working to improve the care you provide to patients. There are a number of activities to choose from based on your patients and practice. For the 2019 performance year, Improvement Activities is 15% of the MIPS final score. 

 Cost of care will be calculated by CMS based on the Medicare claims you make. In order to determine the total cost of patient care in one calendar year, MIPS uses different cost measures. For the 2019 performance year, Cost is 15% of the MIPS final score. 

 The MIPS Payment Adjustment

 When your final MIPS score is compiled, your payment adjustment will be determined. A payment adjustment is based on points earned—and maps out whether or not you will receive a positive or negative payment adjustment. 

 The table below from Quality Payment Program maps out the 2020 MIPS Scoring Guide, which provides insight into the ranges of scores and the corresponding payment adjustment. It is important to note that the payment adjustment will increase to +9% or -9% based on your final score in the 2022 payment year.  

Final Score  Payment Adjustment 
75.00 – 100.00  points Positive MIPS payment adjustment. Eligible for additional adjustment for exceptional performance.
30.01 – 74.99 points  Positive MIPS payment adjustment. Not eligible for additional adjustment for exceptional performance. 
30.00 points  Neutral MIPS payment adjustment (0%).
7.51 –29.99 points  Negative MIPS payment adjustment greater than -7% and less than 0%.
0 – 7.50 points  Negative MIPS payment adjustment of -7%.

Are You Ready For MIPS?

 As of January 1, 2020, the MIPS Performance Year 2020 has commenced. If you were determined to be eligible for MIPS, you have until March 31, 2020 to submit all necessary data collected from January 1–December 31, 2019—the 2019 Performance Year. On July 1, 2020, you will be provided with feedback from CMS about the outlook for your payment adjustment. This is done midyear to provide you with information needed to improve your current practices before the close of 2020. Get ahead of the curve by ensuring your practice is ready and well informed about MIPS. 


Create an account with MeyerPT today or contact your personal account manager at 1.866.528.2144 for more information.

References

1“Merit-Based Incentive Payment System (MIPS) Overview.” QPP, qpp.cms.gov/mips/overview.

2“How MIPS Eligibility is Determined.” QPP, qpp.cms.gov/mips/how-eligibility-is-determined.