The Merit-based Incentive Payment System (MIPS) is one way to participate in the Quality Payment Program (QPP). The program describes how CMS reimburses MIPS eligible providers (EPs) for Part B covered professional services and rewards them for improving the quality of patient care and outcomes. Under MIPS, CMS evaluates your performance across multiple performance categories that lead to improved quality and value in our healthcare system.
Key points:
-
Payment Adjustment: Each Eligible Provider (EP) - defined as any unique NPI + TIN combination - will ultimately be given a Payment Adjustment on Medicare claims ranging from a max penalty of -9% to a theoretical max bonus of +9% (but much more likely max is lower). The final payment adjustment is a function of the NPI's Composite Performance Score (CPS).
-
Composite Performance Score: The EP's Composite Performance Score ranges from 0 to 100 with 0 resulting in the max penalty and a CPS of 100 resulting in the max bonus. The CPS is determined by a complex formula consisting of weighted averages from Four Performance Categories.
-
Four Performance Categories: Specific weighted averages of the following four performance categories produce your final Composite Performance Score (0-100): Quality, Promoting Interoperability, Improvement Activities, and Cost.
CMS designed MIPS to update and consolidate previous programs, including: Medicare Electronic Health Records (EHR) Incentive Program for Eligible Clinicians, Physician Quality Reporting System (PQRS), and the Value-Based Payment Modifier (VBM).
MIPS was designed to tie payments to quality and cost efficient care, drive improvement in care processes and health outcomes, increase the use of healthcare information, and reduce the cost of care.
The MIPS Performance Year begins on January 1 and ends on December 31 each year. Program participants must report quality data on 100% of cases during one calendar year by March 31 of the following calendar year. For example, program participants who collect data in 2024 will ultimately have their data sent to CMS by March 31, 2025 to be eligible for a payment increase and to avoid a payment reduction for claims filed in 2026.
If you would like more information on the Quality Payment Program please visit the QPP website:
Quality Payment Program
Or feel free to review the 2024 QCDR Qualified Registry guide below:
2024 QCDR Qualified Registry