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MIPS Program

What is the Merit-Based Incentive Payment System (MIPS)?

MIPSThe 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 pay-for-performance 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, which will be applied to all covered professional services (based on the Physician Fee Schedule) during the payment adjustment year.

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. Ultimately, penalties are designed to motivate non-performers (or low performers) to engage in better “value-based” patient care.

What you can expect

The MIPS score (Composite Performance Score, or CPS) can range from 0-100. Depending on a clinician’s final MIPS score for a performance year (calendar year), the clinician either earns a positive payment adjustment, has a negative payment adjustment or remains neutral with no change to their payment amounts. Participating practices who are positioned for success in the program could see a positive scaled adjustment, while underperforming practices could see a substantial negative payment adjustment.

How ReportingMD can help MIPS-eligible clinicians excel

The criteria which determine MIPS eligibility are multi-faceted and complex. ReportingMD understands these criteria’s and works with client organizations to optimize incentive performance in the MIPS program (and other value-based care programs.)

With the proven experience of our client services team and Total Outcomes Management (TOM™) a powerful measure calculation engine, ReportingMD can help you navigate the complexities of the MIPS program.

We were invited by CMS to help develop the MIPS program, which provides our team with unique expertise and a depth of experience that’s unmatched.

Using TOM™, practices can gain operational visibility to the quality performance of their physicians and avoid CMS penalties for non-compliance. TOM™ aggregates data from multiple sources to identify and manage patient care gaps.

Learn why mid to large sized organizations turn to ReportingMD for powerful tools that help improve patient care, improve quality outcomes, and maximize reimbursements.