WHAT IS MIPS?

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.

Basically,

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 2018, MIPS eligible clinicians include: Physicians, Physician Assistants, Nurse Practitioners, Clinical Nurse Specialists, & Certified Registered Nurse Anesthetists. Those clinicians must participate in MIPS if they 1) bill $90,000 or more in Medicare Part B allowed charges, AND 2) see more than 200 Part B-enrolled Medicare beneficiaries. Those who fail to participate, will receive financial reimbursement penalties in 2020.

For 2019, MIPS eligible clinicians include: All clinicians eligible under the 2018 rule, plus 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 in 2021.

For a breakdown of all the major rule changes for MIPS 2019 (versus 2018), click the button below:

For more detailed information about MIPS 2018, including specifics about eligibility, exemptions, and how to participate, click the button below:

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.

MIPS Participation Options

Individuals, Groups, & Virtual Groups