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MACRA knowledge hub

Learn about the MACRA proposed rule, MIPS, and alternative payment models. Discover how you can be rewarded for providing better, lower-cost, patient-centered care while avoiding program penalties.

Understanding MIPS (merit-based incentive payment system)

While MACRA offers two tracks—MIPS and APM—almost all Eligible Clinicians must participate in the Quality Payment Program through MIPS in 2017 unless they are new to Medicare or bill very low Medicare volume. CMS determines which clinicians qualify for APM status.  

MIPS is the next evolution of Meaningful Use (MU), the Physician Quality Reporting System (PQRS), and the Value-based Payment Modifier (VM) programs. 

MIPS Performance Measures
MIPS focuses on four threads of work, assigning providers a composite score based on performance across all four threads that serve as a modifier on their Medicare Part B reimbursements.

  1. Quality (formerly PQRS)
  2. Advancing care information (formerly MU)
  3. Improvement Activities (a new measure of care coordination, patient engagement and safety)
  4. Cost

Each category is given a different weight, and relative weighting changes over time. In 2017, quality measures are weighted at 60 %, advancing care information (replacing MU) at 20 percent, improvement activities at 15%, and cost will be 0%. These weighting are expected to change in future MIPS years. 

Eligible Clinicians
Under MIPS, Eligible Professional is updated to “Eligible Clinician” (EC), expanding the population of individuals covered by MIPS. Merit-based incentive payment system (MIPS) Eligible Clinicians include:
  • Physicians
  • PAs
  • NPs
  • Clinical nurse specialists
  • CRNs
  • Anesthetists
  • Groups that include such clinicians
Providers exempt from MIPS in 2017 include Eligible Clinicians who bill less than $30,000 in Medicare Part B fees, OR who care for fewer than 100 Medicare patients (both per year). Clinicians can check their MIPS eligibility on cms.qpp.gov

 

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Learn about the benefits of Meaningful Use that extend far beyond incentive payments.
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