What is Merit-Based Incentive Payment System

Here's your step-by-step guide about the Medicare Merit-Based Incentive Payment System (MIPS)

An Overview of MIPS

The Merit-Based Incentive Payment System (MIPS) is one of the two newly introduced medical reimbursement frameworks that replace the existing payment models in the medical industry. The CMS initiative aims at quality payment incentive program, known as the quality payment program. This rewards outcomes and values in either of the two ways, namely, Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).
Under MIPS, clinicians who belong to the eligible clinician type and meet the low-volume threshold are included. This track of the quality payment program shifts Medicare Part B providers from the existing system to a performance-based payment model.
MIPS streamlines the following three historical Medicare programs:
  • Physician Quality Reporting System (PQRS)
  • Value-based Payment Modifier (VBM)
  • Medicare Electronic Health Record (EHR) Incentive Program

Participation in MIPS: Group Vs Individual Reporting

A unique feature of MIPS is the fact that eligible clinicians may choose to participate as either individual or part of a group. Individual eligible clinicians need to report MIPS data to the CMS with reference to NPI number that is tied to a TIN.
A group of two or more clinicians having unique NPIs may participate as a group, if they have reassigned their billing rights to a common single TIN. Having chosen to participate as a group, eligible clinicians will be assessed as a group in all the four MIPS performance classifications.

Performance Categories in MIPS

For monitoring the provider performance, certain metrics have been set apart. In the place of quantity, emphasis will be on performance now, with regard to reimbursement. The MIPS offers clinicians the flexibility of choosing the measures and activities that prove to be meaningful to their practices. The following are the four performance categories:
Quality:This category replaces the earlier model of Physician Quality Reporting System (PQRS) and necessitates eligible clinicians to report their data to the CMS for quality measures that are associated with appropriate medical resource use, patient safety, patient outcomes, patient experience, efficiency, and care coordination.
Improvement activities:This is intended for facilitating eligible clinicians to participate in the activities which will enhance clinical practice in certain areas such as patient safety, shared decision making, increasing access, and coordinating care.
Advancing care information:It replaces the Medicare EHR Incentive Program (Meaningful Use). This category reflects how well the EHR technology is being used by the clinicians. Focus is on objectives associated with information exchange and interoperability.
Cost:The cost category (Resource Use, as it is referred to) replaces the CMS Value-based payment modifier program. It evaluates eligible clinicians on measures associated with resource utilization that may be calculated by using Medicare claims.

Payment Adjustments Under MIPS

This reflects eligible clinician's performance before two years. Payment adjustments for 2017 will be applied during 2019. Eligible clinician's or the group's Final score will determine the MIPS payment adjustment amount.