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Merit-based Incentive Payment System

Merit-based Incentive Payment System

MIPS Image

CMS is required by law to implement a quality payment incentive program, referred to as the Quality Payment Program (QPP), which rewards value and outcomes in one of two ways: Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).

Under MIPS, clinicians are included if they are an eligible clinician (EC) and meet the low volume threshold, which is based on allowed charges for covered professional services under the Medicare Physician Fee Schedule (PFS) and the number of Medicare Part B patients who are furnished covered professional services under the Medicare PFS.

Performance is measured through the data clinicians report in four performance categories:

  • Quality
  • Improvement Activities
  • Promoting Interoperability (formerly Advancing Care Information)
  • Cost

CMS updated and consolidated previous programs, including: Medicare Electronic Health Records (EHR) Incentive Program for Eligible Clinicians, Physician Quality Reporting System (PQRS), and the Value-Based Payment Modifier (VBM).

The MIPS Performance Year begins on January 1 and ends on December 31 each year. Program participants must report data collected during one calendar year by March 31 of the following calendar year. To check your participation status and verify which changes to the QPP might affect you and your practice, visit https://qpp.cms.gov/mips/overview

Exception Applications

The Quality Payment Program Exception Application for PY 2018 is open from August 6, 2018 - December 31, 2018. You may also contact the Quality Payment Program Service Center and work with a representative to verbally submit an application. Applications are subject to annual renewal and may change each Performance Year (PY) due to shifting requirements. For PY 2018, you can apply for either the Promoting Interoperability Hardship Exception or the Extreme and Uncontrollable Circumstances Exception. To read more on the application or to apply for an exception, visit: https://qpp.cms.gov/mips/exception-applications

To learn more about the Quality Payment Program, MIPS requirements, and more, visit https://qpp.cms.gov