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 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) provide care to more than 200 Part B-enrolled Medicare beneficiaries. Those who fail to participate, will receive financial reimbursement penalties in 2020.

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 each clinician’s quality of care and decides on a payment adjustment of between 1 and 5 percent to be added onto the clinician’s pay. The CMS evaluates quality of care by looking at 4 aspects of a clinician’s performance.

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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