One Compelling Reason

The Merit-based Incentive Payment System (MIPS) presents a significant opportunity to turn regulatory risk into true financial reward.

MIPS 101: What is it, exactly?


On October 14, 2016, CMS released the final rule for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA repeals the Medicare Part B Sustainable Growth Rate (SGR) reimbursement formula and replaces it with a new value-based reimbursement system called the Quality Payment Program (QPP). The QPP consists of two major tracks:

  1. The Merit-based Incentive Payment System (MIPS)
  2. Advanced Alternative Payment Models (Advanced APMs)

MIPS combines the Physician Quality Reporting System, Value Modifier Program and Electronic Health Record Incentive Program into a single reporting program.

Do I Qualify?


CMS estimates approximately 500,000 clinicians are eligible to participate in MIPS in 2017, the first year of the program. You are eligible to participate in the MIPS track if:


You bill more than $30,000 per year in Medicare Part B allowed charges,


Provide care to more than 100 Part B enrolled Medicare patients per year


You are a physician, physician assistant, nurse practitioner, clinical nurse specialist or certified registered nurse anesthetist.

The types of Medicare Part B eligible clinicians affected by MIPS will expand in the future.

How does it work?


If you decide to participate in MIPS, you will earn a performance-based payment adjustment to your Medicare payment. MIPS scoring considers four weighted performance categories:

The cost category is calculated from adjudicated claims; no data submission is required for 2017, but it will be weighted in 2018 and beyond.



tip one

2017 Performance Period


The MIPS performance period for 2017 began Jan. 1, 2017 and closes Dec. 31, 2017.

tip two

90 days


During this first year of MIPS, eligible clinicians must submit at least 90 days’ worth of data to avoid a downward payment adjustment.*

*CMS has indicated they will require a full year of data in future years; you can submit more than the minimum 90 days in any route but that does not impact your score.

tip three

Reminder: Oct. 2, 2017


Oct. 2, 2017 is the last possible performance period start.

tip four

Clinician Reports


All clinicians reporting for 2017 will have until the end of March 2018 to deliver performance data in order to avoid the downward adjustment.

tip five

Clinician Reports


Clinicians will be able to submit as individuals or as part of a group.

This resource is based on the final policies for the MIPS 2017 reporting/2019 payment period. For information on the proposed changes for the MIPS 2018 reporting/2020 payment period please see the Premier Advisor Live Reviewing the CY2018 Quality Payment Program (QPP) Proposed Rule webinar.

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