What Is MIPS (Merit-Based Incentive Payment System) in Health Care?


What is MIPS?

The Merit-based Incentive Payment System, also known as MIPS, streamlines three previous pay-for-performance programs and adds a fourth component to promote the ongoing improvement and innovation to clinical activities.

The four MIPS performance categories are as follows:

Unlike the past one-size-fits-all payment programs, MIPS gives clinicians the flexibility to report on the activities and measures that most accurately demonstrate the performance of their practice.

CMS estimates that about 90 percent of eligible clinicians will be in the MIPS reporting camp for 2017, including both individual providers and provider groups.

MIPS Eligible Clinicians

For 2017, the following Medicare Part B eligible clinicians are deemed eligible for the MIPS:

  1. A provider must be a physician, physician assistant, nurse practitioner, clinical nurse specialist, certified registered nurse, or anesthetist.
  2. A provider must not be in the FIRST year of Medicare Part B participation.
  3. A provider’s Medicare billing charges must be more than $10,000 and s/he must provide care for more than 100 Medicare patients in one year.
  4. A provider cannot be a hospital or facility.
  5. A provider is in a non-advanced APM.
  6. A provider can be in an Advanced APM but must not have enough payments or patients through the Advanced APM to be a Qualified Provider.

Beginning year three, provider eligibility is scheduled to expand to include physical or occupational therapists, speech-language pathologists, audiologists, nurse midwives, clinical social workers, clinical psychologists, or dietitians/nutritional professionals.

MIPS is a very dynamic path with both increased risk over time and shifting scoring weights. Under the MIPS, eligible clinicians will be measured and assigned a single MIPS composite performance score (CPS). The CPS will be based on the clinician’s performance in the following four, weighted performance categories. For year one, the scores are weighted on a 0-100-point scale. For more detailed information, click on the CMS link here: https://qpp.cms.gov/measures/performance

Learn more about MACRA, MIPS, and value-based care:

Use our MIPS Calculator to determine the financial impact of MIPS on your organization.

View the nThrive Analytics MIPS Performance Solution page.

Download the nThrive Analytics MACRA Readiness Checklist to find out if your health organization is ready.

View our MACRA Management Solutions page.

Contact us to schedule a free MACRA Readiness Assessment.