Merit-Based Incentive Payment System

MIPS is here. The effects are real. And it’s not exactly simple. We know your time is valuable, so let us do the hard part for you. We’ve studied the ins-and-outs and summarized it here and throughout our site. Read through our breakdown and take action (if needed) to protect your bottom-line. And feel free to contact us directly for more assistance. We’re here to help.


According to the CMS,

MIPS was designed 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.


The U.S. healthcare system has begun the transition to a new clinician reimbursement model based on quality of care, rather than quantity of treatment. And Medicare is spearheading the rollout.

What does that mean for you?

It means that certain medical providers, who treat a designated amount of Medicare patients per year, must begin participating in the new system or they will receive reimbursement penalties.

Who must participate?

For 2020 and 2021, MIPS eligible clinicians include (same as 2019): Physicians, Physician Assistants, Nurse Practitioners, Clinical Nurse Specialists, Certified Registered Nurse Anesthetists, Clinical Psychologists, Occupational Therapists, Qualified Speech-Language Pathologists, Qualified Audiologists, and Registered Dieticians & Nutritionists. Those clinicians must participate in MIPS if they 1) bill $90,000 or more in Medicare Part B allowed charges, 2) see more than 200 Part B-enrolled Medicare beneficiaries, AND 3) provide 200 or more covered professional services to Part B patients. Those who fail to participate, will receive financial reimbursement penalties.

Participating in MIPS

Eligible providers who participate in MIPS receive financial bonuses. The CMS evaluates clinicians and decides on a positive payment adjustment between 0 and 7 percent (range depends on the performance year) to be added onto the clinician’s pay. The CMS evaluates clinicians by looking at 4 aspects of their performance.


Click on the buttons below any of the Performance Categories to learn more about a respective category and view its available Measures/Activities.


Click on the buttons below any of the Performance Categories to learn more about a respective category and view its available Measures/Activities.

MIPS 2020 & 2021 Performance Categories

How the CMS Judges your Care & Determines your Payment Adjustment


replaced PQRS

2020: 55% • 2021: 40%

The ‘Quality’ performance category replaces the Physician Quality Reporting System (PQRS). It covers the quality of the care you deliver, based on performance measures created by CMS, as well as medical professional and stakeholder groups. You pick the six measures of performance that best fit your practice.

Promoting Interoperability

replaced Meaningful Use

2020: 30% • 2021: 25%

The ‘Promoting Interoperability’ (PI & aka Advancing Care Information) performance category replaced the Medicare EHR Incentive Program for EPs, commonly known as Meaningful Use. It is achieved by proactively sharing information with other clinicians or the patient in a comprehensive manner. This may include: sharing test results, visit summaries, and therapeutic plans with the patient and other facilities to coordinate care.

Improvement Activities

new category

2020: 15% • 2021: 15%

‘Improvement Activities’ is a new performance category that includes an inventory of activities that assess how you improve your care processes, enhance patient engagement in care, and increase access to care. The inventory allows you choose the activities appropriate to your practice from categories such as, enhancing care coordination, patient and clinician shared decision-making, and expansion of practice access.


replaced the Value-based Payment Modifier

2020: 0% • 2021: 20%

The ‘Cost’ performance category replaces the Value-Based Modifier (VBM). The cost of the care you provide will be calculated by CMS based on your Medicare claims. MIPS uses cost measures to gauge the total cost of care during the year or during a hospital stay. As of 2018, this performance category counts towards your MIPS final score.

MIPS Participation Options

Individuals, Groups, & Virtual Groups
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Individual Clinicians

If you report MIPS data in as an individual, your payment adjustment will be based only on your performance. An individual is defined as a single NPI tied to a single TIN.

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Clinician Groups

If you report MIPS data with a group, your payment adjustment is based on the group’s performance. A group is defined as a set of clinicians – identified by their National Provider Identifier (NPI) – sharing a common Taxpayer Identification Number (TIN), no matter the specialty or practice site.

Virtual Groups

A Virtual Group is a combination of two or more Taxpayer Identification Numbers (TINs) made up of solo practitioners and groups of 10 or fewer eligible clinicians who come together “virtually” (no matter specialty or location) to participate in MIPS for a performance period of a year.

Contact us today to receive more information or speak with a Valletta billing expert.



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