How to Report MIPS in 2019
Step 1 : Are you a MIPS-eligible clinician or group?
During the 2017 and 2018 performance years, the pool of eligible clinicians excluded some specialties that were previously included in Medicare quality reporting initiatives like PQRS and MU.
In 2019 the pool of eligible clinicians expands to include some of the previously excluded professions, including Physical / Occupational Therapists, Speech-Language Pathologists, Audiologists, Clinical Psychologists, and Dietitians/Nutritional Professionals in MIPS reporting for the first time. Read More About Eligibility >
Participation in an Advanced Alternative Payment Model (APM)
Eligible clinicians part of an Advanced APM, are exempt from MIPS reporting. Current examples of APMs are certain Accountable Care Organizations (ACO) and bundled payment models.
MACRA Quality Payment Program Low-Volume Threshold
Eligible clinicians or groups will be exempt from MIPS reporting if they bill ≤ $90,000 or provide care for ≤ 200 Medicare Part B patients.
Newly Enrolled in Medicare
If a clinician enrolls in Medicare in the middle of a performance year, they do not have to participate in MIPS reporting that year. For example, if a clinician was to enroll in Medicare on February 6, 2018, would be exempt for the 2018 performance year (January 1, 2018- December 31, 2018).
Step 2: Why Report?
The MIPS Payment Adjustment
Much like the sunset Value-Based Payment Modifier Program (VM), MIPS determines each eligible clinicians’ payment adjustment based on how they rank versus their peers. The score that is used to determine the performance threshold for MIPS is called the MIPS Composite Performance Score, or the MIPS final score. This score is calculated on a scale from 0 to 100 and is comprised of the aggregated performance from the four MIPS performance categories.
Unlike past quality initiatives, a clinician's MIPS payment adjustment will now follow them even after they depart from the TIN they reported under.
Read more about the financial impact of MIPS
The performance in each MIPS category can have serious impact on revenue. For the performance year 2018 non-participating eligible clinicians will see an automatic -5% adjustment on their Medicare reimbursements. The cost of not participating in MIPS increases each year and reaches a maximum of -/+ 9% for performance year 2020.
Additionally, the top performing professionals are eligible for bonus reimbursements of 25% in the 2018 performance year and up to 37% for performance year 2020.
In addition to impacting eligible clinicians financially, MIPS performance has the potential to effect the reputation of eligible clinicians and groups. Scores will be publicly posted to Physician Compare as soon as the informal review period closes following the performance year.
Step 3 : Pick Your Pace
To ease the burden of transitioning to MACRA, CMS is providing pacing options for transition year performance. The options for 2018 are slightly more intensive compared to the options available for the 2017 transition year.
MIPS Final Score between
0% - 29%
MIPS Final Score between
30% - 74%
MIPS Final Score between
75% - 100%
Read more about MIPS Pacing Options in 2019
Navigating MIPS in 2019
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Step 4: MIPS Performance Categories
The MIPS Quality Performance Category is closely related to its predecessor, the Physician Quality Reporting System (PQRS). To successfully report Quality, participants must report 6 measures (one of which is an outcome measure) over a full calendar year for at least 60% of the applicable patient visits.
The Promoting Interoperability Performance Category is Meaningful Use updated to be more flexible, customizable, and focused on patient engagement and interoperability. Beginning in 2019, clinicians will submit a single set of PI Measures to align with 2015 edition CEHRT. This single measure set includes existing and new PI measures. Measures are no longer classified as base score or performance score measures.
The Improvement Activities Performance Category is a new concept introduced by MIPS reporting and rewards eligible clinicians for participating in activities related to their patient population. Clinicians and groups can choose to participate in activities most relevant to both their practice and patient population.
2019 is the second performance year that Cost will be a weighted category for a participant's MIPS final score. The Cost category score will be the average performance score for the Medicare Spending Per Beneficiary (MSPB) measure, the Total per Capita Cost measure, and eight episode based measures (when applicable). All Cost measures are automatically captured through administrative claims.
Step 5 : Get Started with MIPSPRO
Under MIPS, performance matters! It's no longer enough to just report quality data. In 2019, CMS penalties and incentives will reach 7% and although Medicare quality reporting is complicated, MIPSPRO makes the reporting process easy with an intuitive system and a quality reporting team to guide you through the MIPS reporting process and to success!
MIPSPRO delivers key features to ensure your success:
- Real-time Dashboards
- MIPS Quality, ACI, IA, & Cost for all specialties and all measures
- MIPSPRO adapts to your practice
- Choose your pace of reporting
- Integrated data
- Data Validation & Support
With prices starting as low as $289 per provider/year, starting today is the key to MIPS reporting success in 2018.