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MIPS Participation Guide for 2018

By: Cal LaGroue


The purpose of this post is to walk you everything you need to know in order to successfully participate in MIPS for the 2018 performance year. Whether you’re relatively fluent in MIPS or a complete beginner, we hope you’ll leave with a general understanding of the MIPS system and what’s required of you.

If you’re completely new to MIPS, check out the following links before reading the remainder of this article.

  1. Our MIPS Page: Contains a general explanation of MIPS, along with information about who must participate in 2018, the evaluation criteria (Performance Categories), and Reporting Options for providers
  2. MIPS 2018 Overview and Assistance: A blog post containing information about MIPS 2018 eligibility, exemptions, and logistics


The following information is provided in part by Mingle Analytics, a valued partner of Valletta and a leading expert on Value-Based Care.


Quick Review


Does MIPS apply to me?

For the first two performance years of MIPS, an Eligible Clinician (previously known as an Eligible Provider in the retired PQRS program) is defined by CMS as a Physician, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, or Certified Registered Nurse Anesthetist.

Clinicians are exempt in 2018 if any of the following apply to them:

  • Qualifying participant in an advanced APM
  • Treat ≤ 200 Medicare patients OR have
    ≤ $90,000 in Medicare Part B allowable charges
  • First year provider in Medicare Part B PFS


What’s at Stake?

2018 is the second year of MIPS — providers and practices have the potential to lose up to 5% of their Medicare reimbursements in 2020 based on their 2018 MIPS Final Score. Since 2018 is another transition year, it’s easy to participate and avoid a penalty for most MIPS eligible clinicians.


Submitting your Data

With MIPS, the Registry method is more convenient and effective than ever. CMS allows Quality, Advancing Care Information, and Improvement Activities to be submitted through a single vendor with a common deadline of March 31.


The Changes to MIPS for 2018



The bar got a little higher for avoiding penalty. CMS now requires 15 points instead of just 3. The exceptional performance bonus threshold remains at 70 points.


Full Year Performance Period

The Quality and Cost performance categories now require a full year of data. Advancing Care Information and Improvement Activities require a minimum of 90-days.


Small Practices & Eligibility

The MIPS low-volume exclusion for MIPS has been increased to ≤ $90,000 in Medicare Part B Allowable charges or ≤ 200 individual Medicare patients.



The data completeness criteria increases from a minimum of 50% of eligible patients for each measure and 90-days of data, to 60% of eligible patients and a full year of data.



The cost performance category for 2018
will include: “Total per capita costs for all attributed beneficiaries” and “Medicare Spending per Beneficiary.” CMS calculates the cost score from claims data. No additional data needs to be submitted.


Participating in MIPS

So you’ve discovered you’re eligible for MIPS? What do you do now?


Quality Measures

Review the list of MIPS Quality Measures that relate best to the services you render and may want to report on for this performance year.

Once you decide which measures you’d like to report on, verify you are capturing the correct elements for each quality measure in your clinical documentation. Be sure to check the specifications for any changes to the measures.

Quality Measures List & Elements


Improvement Activities

Review the list of 2018 Improvement Activities; what activities will your practice implement for 2018?

Improvement Activities List & Elements


Advancing Care Information (aka Promoting Interoperability)

Are you following the required information sharing requirements in regards to your patients and colleagues? If you use an EHR, are all the modules for the base score measures functional and are you able to capture data with them as needed for reporting?

Advancing Care Information List & Elements



The Cost performance category is calculated by CMS based on claims data submitted throughout the year. There is no data submission requirement.



The above information should give you a pretty solid idea of how to participate in MIPS for the 2018 performance year. However, there is plenty more you can do to better ensure that you will avoid reimbursement penalties and receive the highest possible financial bonuses.

For more information, contact The Valletta Group today and learn more about how we can optimize your billing and best prepare you for MIPS and the transition to Value-Based Care. With help from our partner, Mingle Analytics, you’ll be in the best possible position. Clients of Valletta have the option to receive Mingle’s valuable services at a discounted rate and with much less effort on their part.

About the Author: Cal LaGroue

Cal has over a decade of experience in the Revenue Cycle Management industry. He serves as Board Secretary for the Healthcare Business Management Association (HBMA), the leading organization for Revenue Cycle Management professionals. He's also accredited by the HBMA as a Certified Healthcare Business Management Executive (CHBME).

Full Bio

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