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

By nThrive | Posted: 04/13/2017

What is MIPS?

In health care, MIPS stands for the Merit-based Incentive Payment System. It is a system for value-based reimbursement under the Quality Payment Program (QPP) with the goal of promoting the ongoing improvement and innovation to clinical activities.

MIPS streamlines three previous pay-for-performance programs – Value-Based Modifier (VBM), Physician Quality Reporting System (PQRS) and Medicare Meaningful Use (MU) – and adds an additional fourth component. It also defines four performance categories for eligible clinicians. Each of these performance categories contributes to an annual MIPS final score*.

The MIPS measures are:

  • Quality
  • Improvement Activities
  • Advancing Care Information
  • Cost

MIPS Reporting

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.

Learn more about MIPS reporting and data submission methods.

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:

View nThrive's  Qualified MIPS Registry 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.

*For help in calculating your score and the impact of MIPS on your organiation or physician practice, see our MIPS calculator.