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Merit-Based Incentive Programs (MIPS)

Updated: 06/10/2023|Views: 9806

If you decide to participate in traditional Medicare, you may earn a performance-based payment adjustment through MIPS. Starting in 2021, you will see a positive, neutral or negative adjustment ranging from -9% for no participation to +9 for full participation for the performance year. The size of your payment adjustment will depend both on how much data you submit and your performance results.

Clinicians participating in MIPS 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

Eligible clinicians 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 a Security Risk Assessment is mandatory
    • Base on bonus points have been removed
    • Report 90 days or up to a full year
    • Submit via registry or manually via the attestation website
  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
    • Submit via registry or manually via the attestation website
  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
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