The Merit-based Incentive Payment System, or MIPS, is a quality payment program designed by CMS for eligible clinicians who meet or exceed low volume thresholds. To be 2019 MIPS eligible, a clinician must:

  • Identify on Medicare Part B claims as a MIPS eligible clinician type
  • Have enrolled in Medicare before 2019
  • Not be a Qualifying Alternative Payment Model Participant (QP)
  • Exceed the Performance Year 2019 low-volume threshold
    • As an individual when reporting individually, or
    • At the group level by being in a practice that exceeds the low-volume threshold when reporting as a group or virtual group, or
    • As a MIPS APM participant that exceeds the low-volume threshold at the entity level

It is used to tie payments to quality and cost-efficient care, drive improvement in care processes and health outcomes, increase the use of healthcare information, and reduce the cost of care.

MIPS is based on allowed charges for covered professional services under the Medicare Physician Fee Schedule (PFS) and the number of Medicare Part B patients who are furnished covered professional services under the Medicare Physician Fee Schedule. Performance is measured through the data clinicians report in four areas - Quality, Improvement Activities, Promoting Interoperability (formerly Advancing Care Information), and Cost.

The MIPS Performance Year begins on January 1 and ends on December 31 each year. Program participants must report data collected during one calendar year by March 31 of the following calendar year. To learn more about the program and to check your participation status, please visit https://qpp.cms.gov/login.

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