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Merit-Based Incentive Payment System (MIPS)

 

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Merit-Based Incentive Payment System (MIPS)

The Merit-based Incentive Payment System (MIPS), moves Medicare Part B fee-for-service providers to a framework for incentivized payments that includes a penalty for non-compliance or poor performance. MIPS uses the requirements from previous programs and places them into a single complex program that consists of 4 categories. Incentive performance under the program is measured by Quality, Improvement Activities (IA), Promoting Interoperability (PI), and Cost. The sum of these four weighted category scores will determine the final MIPS score and resulting payment adjustment.

Why MIPS is Important

Medicare Part-B providers who meet the definition of a “MIPS Eligible Clinician” are subject to performance-based payment adjustments, either positive, negative, or neutral. The intent of the MIPS program is to relate a meaningful portion of provider payments to quality by focusing on improved health outcomes and maximizing cost-effective care. High performing clinicians and practices are rewarded with higher Medicare reimbursements, paid for by penalties applied to non-performing clinicians and practices.

What you can expect

Participating practices who are positioned for success in the program could see a positive scaled adjustment, while under performing practices could see a substantial negative payment adjustment.