Merit-Based Incentive Programs (MIPS)

Eligibility

To participate in MIPS, clinicians must meet the three low volume threshold criteria:

1. Bill Medicare over $90,000 in Part B allowed charges a year, and
2. Provide covered professional services for more than 200 Part B-enrolled individuals, and
3. Provide 200 or more covered professional services to Part B-enrolled individuals

Additionally, providers must be one of the clinician types listed:

• Physicians (including doctors of medicine, osteopathy, dental surgery, dental medicine, podiatric medicine, and optometry)
• Osteopathic practitioners
• Chiropractors
• Physician assistants
• Nurse practitioners
• Clinical nurse specialists
• Certified registered nurse anesthetists
• Physical therapists
• Occupational therapists
• Clinical psychologists
• Qualified speech-language pathologists
• Qualified audiologists
• Registered dietitians or nutrition professionals
• Clinical social workers
• Certified nurse midwives

Eligible clinicians (ECs) must report data in four categories unless otherwise specified by your MIPS eligibility:

1. Quality
   • Pick six measures that best fit your practice and specialty
   • Include one Outcome measure or one High-Priority measure
   • Report for a full year
   • Submit via QRDA submission, Claim Submission or via Registry
2. Promoting Interoperability
   • Clinicians will be scored based on performance in four objectives
   • Completing both the Security Risk Assessment and the SAFER Review is mandatory
   • Base on bonus points have been removed
   • Report 180 days or up to a full year
   • Submit via the QPP attestation website or via a registry
3. Improvement Activities
   • Submit up to 40 points
   • Select from an inventory of over 100 activities to show how you improve care for your patients, enhance patient engagement and increase access to care among others
   • Report 90 days or up to a full year based on the activity requirements
   • Submit via the QPP attestation website or via a registry
4. Cost
   • Cost measures assess the total cost of care during the year or during a hospital stay
   • Medicare calculates your score on Cost based on Medicare claims submitted
   • Data submission is not required. Medicare will automatically evaluate Part B claims submitted for the full year

Eligible clinicians must submit their MIPS data via their selected submission method by March 31 of the following calendar year. Some submission methods are:

• QRDA
• Claims
• Registry
• Manual Attestation