'Merit-based Incentive Payment System (MIPS)
Merit-based Incentive Payment System (MIPS) is a program developed for the U.S. Centers for Medicare and Medicaid Services (CMS) for the purpose of incentivizing its authorized clinicians toward high-value, high-quality patient outcomes.
MIPS' regulations were set in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and its creation of the Medicare Quality Payment Program (QPP).
MIPS produces a 0-100 score based on four categories: Quality (40%), Promoting Interoperability (25%), Improvement Activities (15%) and Cost (20%).[1]
CMS uses scores to penalize clinicians, reward them, or make no payment adjustment. Currently, to avoid penalties, providers must have a score of at least 60 in all four categories.
MIPS' four categories:
- Quality (40%). This category measures health care processes, outcomes, and patient experiences of their care.[2] It contains 209 individual Quality Measures.[3] Clinicians must choose six categories to report. There is no mandate as to which to report, but a clinician must be eligible to choose specific measures.
- Promoting Interoperability (25%). This category's aim is to promote patient engagement and electronic exchange of information using certified electronic health record technology (CEHRT).[4] There are 10 Promoting Interoperability measures.
- Improvement Activities (15%). This category measures participation in activities that improve clinical practice.[5]
- Cost (20%). Medicare payments for care provided to patients are measured in this category. This is the only category for which there is no need for active reporting, as the data is automatically collected from claims.
External links
- "Calculate your projected MIPS payment adjustment in less than 2 minutes". ablehealth.com. Retrieved Dec 13, 2021.
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- ↑ "MIPS Explore Measures - QPP". qpp.cms.gov.
- ↑ "Quality Measures Requirements - QPP". qpp.cms.gov.
- ↑ https://qpp-cm-prod-content.s3.amazonaws.com/uploads/1246/2021%20MIPS%20Quality%20Measures%20List.xlsx
- ↑ "Promoting Interoperability Requirements - QPP". qpp.cms.gov.
- ↑ "APP Improvement Activities Requirements - QPP". qpp.cms.gov.
