The Meat and Potatoes of MIPS

THIS HOLIDAY SEASON, we can expect two things: an abundance of hearty meals and the fast-approaching turn of a new year.

January is just around the corner, but many healthcare providers are still unaware of how the next year will play out for their payment adjustments under new MACRA programs.

So, we’ve laid out the meat and potatoes of MIPS, a payment system many health professionals will be reassigned to around the same time our post-holiday shopping bills arrive.


What acronyms do you need to know? 

CMS: Centers for Medicare & Medicaid Services
MACRA: Medicare Access and CHIP Reauthorization Act
CHIP: Children’s Health Insurance Program
QPP: Quality Payment Program
MIPS: Merit-Based Incentive Payment System
APM: Alternative Payment Model


Who will MIPS affect? 

CMS estimates between 592,000 and 642,000 clinicians will participate in MIPS in 2017. You will need to start recording MIPS data in 2017 if you bill Medicare more than $30,000 a year, provide care for more than 100 Medicare patients a year and are one of the following:

  • Physician
  • Physician assistant
  • Nurse practitioner
  • Clinical nurse specialist
  • Certified registered nurse anesthetist

Entities sufficiently participating in Advanced APMs or participating in Medicare for the first time in 2017 are exempt from MIPS.


When does MIPS go into effect? 

The first performance period under MACRA begins January 1, 2017 and performance data must be submitted by March 31, 2018. Payment adjustments based on this data will take effect in 2019.


Where do you need to make changes? 

MIPS replaces several programs, including Meaningful Use/Medicare EHR Incentive Program, Physician Quality Reporting System and Value-Based Payment Modifier Program. Your new MIPS score breaks down into four categories:

  1. Quality – replaces the Physician Quality Reporting System
  2. Improvement Activities – new category
  3. Advancing Care Information – replaces Meaningful Use
  4. Cost – replaces the Value-Based Payment Modifier

How can you prepare? 

First, determine whether you or your health system will be participating in MIPS in 2017. Then, review your system to confirm that it is equipped to follow MIPS measures and report these activities

And if this all too overwhelming, remember we have the rest of 2016 to eat, drink and be merry. Take care.

—Shelby