What is MIPS? Who must report under MIPS? Adapted from http://www.insight-txcin.org/post/what-is-merit-based-incentive-payment-system

1. WHAT
IS
MIPS?
BY TXCIN

2. The Medicare Access and CHIP
Reauthorization Act (MACRA) of 2015 began a
reformation of modern healthcare from fee-
for-service (FFS) to value-based care. Among
other policies, MACRA legislation repealed the
Medicare Part B Sustainable Growth Rate
(SGR) reimbursement methodology, and it
initialized a phasing out of the Medicare
Physician Fee Schedule (PFS). In addition,
MACRA legislation introduced the Quality
Payment Program (QPP), a new, more
streamlined performance-based payment
system consisting of two scoring and
reimbursement frameworks:
The Merit-based Incentive Payment
System (MIPS) [and]
The Advanced Alternative Payment Model
(AAPM) system.

3. what is
MIPS?
Both frameworks are regulatory
“environments” that establish
performance measurements
used to score clinicians to
determine payment
adjustments and bonuses. The
Merit-based Incentive Payment
System (MIPS) is the “default”
framework under the QPP.
Under MIPS, the three existing
reporting programs—the
Physician Quality Reporting
System (PQRS), the Value-based
Payment Modifier (VBPM), and
Meaningful Use of Certified EHR
Technology (MU)—are renamed
and combined with a new
Improvement Activities (IA)
category to score physician
performance.

4. WHO MUST
REPORT
UNDER MIPS?
Initially, most eligible clinicians will report
under the MIPS framework, and they will
receive varying payment adjustments
based on performance. For performance
years 2017 and 2018, MIPS Eligible
Clinicians (ECs) are defined as the
following:

5. I
M
P
Physicians (Doctor of medicine,
osteopathy, dental surgery, dental
medicine, pediatric medicine,
optometry, and chiropractic legally
authorized to practice by a State in
which he/she performs this function)
Physician Assistants
Nurse Practitioners
Clinical Nurse Specialists
Certified Registered Nurse
Anesthetists
S

6. The Health and Human Resources
(HHR) Secretary may broaden this list
of eligible clinicians to include other
providers in 2019+, including physical
and occupational therapists, speech-
language pathologists, audiologists,
nurse midwives, clinical social
workers, clinical psychologists, and
dietitians/nutritional professionals.
http://www.insight-txcin.org/post/what-is-merit-based-incentive-payment-system

7. There are three
exemptions for MIPS
eligible clinicians who
otherwise meet the
requirements listed
above. For performance
year 2018 they are the
following:

8. I
M
P
1. Clinicians in their first year of
Medicare Part B participation.
2. Clinicians billing $90,000 or less
in Medicare Part B charges, or who
provide care for 200 Part B patients
or less in one year (this was raised
from $30,000 and 100 patients in
performance 2017).
3. Clinicians who are participating
in Advanced APMs.
S

9. Eligible clinicians are incorporated
into the MIPS framework by
default. They can choose to report
as an individual, although most
clinicians will choose to
participate within a group, or
“virtual” group. Virtual groups are
multiple small practices of 10 or
fewer eligible clinicians who report
as one entity, regardless of
specialties or locations.

10. Want
More?
http://www.insight-
txcin.org/post/what-is-
merit-based-incentive-
payment-system

11. ABOUT
TXCIN
North Texas Clinically
Integrated Network, Inc. (dba
TXCIN) is a non-profit ACO
that began in late 2014. A
small group of independent
physicians aligned to initiate
clinical integration and value-
based contracting. Partnering
with RevelationMD and its
state-of-the art information
platform, TXCIN has become
the largest independent
network of physicians in North
Texas.