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?


You are eligible to participate in the MIPS track if:


You bill more than $90,000 per year in Medicare Part B allowed charges,


Provide care to more than 200 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.



tip one

2018 Performance Period


The MIPS performance period for 2018 began Jan. 1, 2018 and closes Dec. 31, 2018.

tip two

90 days


The performance period for the Promoting Interoperability (PI) and Improvement Activities (IA) is any consecutive 90 days. The window to begin tracking the data for these categories is between January 1 and October 2, 2018.

*Please note that the performance period of the Quality and Cost categories is 365 days, from January 1 to December 31, 2018.

tip three



Eligible clinicians may receive up to five bonus points for complex patients. Practices of 15 or fewer clinicians will receive an automatic five-point bonus to their MIPS composite score.

tip four

Clinician Reports


All clinicians reporting for 2018 will have until the end of March 2019 to deliver performance data in order to avoid the downward adjustment.

tip five

Group Reporting


Clinicians will be able to submit as individuals or as part of a group. Virtual groups have been added as a reporting option in 2018.

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