MIPS Reporting

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) rule was finalized on October 14, 2016 replacing the Sustainable Growth Rate by the new Quality Payment Program (Medicare Payment Reform).

Full rule and an executive summary can be found at the new CMS page: The Quality Payment Program page at www.qpp.cms.gov/education

The Quality Payment Program has two paths: Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs)


1.    Quality (formerly PQRS program): 50% – report up to 6 quality measures, include at least one outcome measures, for full calendar year. See the 2018 AAAAI QCDR Measures List.
2.    Promoting Interoperability (formerly known as Advancing Care Information, or Meaningful Use)”:  25% - meet the five required measures for a minimum of 90 days. See the CMS ACI Measures List.
3.    Clinical practice improvement activities – (new performance category):15% – For groups less than 15 providers, fulfill two medium-weighted  improvement activities or one high improvement activity for a minimum of 90 consecutive days.  For groups with 15 or more providers, fulfill any of the following:  4 medium-weighted improvement activities; or 1 high-weighted and 2 medium-weighted activities; or 2 high-weighted activities for a minimum of 90 consecutive days. See the CMS Improvement Activities List.
4.    Resource Use (based on claims data): 10 % - For 2018, MIPS uses cost measures that cover the total cost of care during the year or during a hospital stay. We plan to use episode-based measures in the future. The Cost performance category uses your Medicare claims data to collect Medicare payment information for the care you gave to beneficiaries during a specific period of time. Because we use Medicare claims data, we’ll calculate the Cost performance category score and you don’t have to submit any data. For the 2017 transition year, the Cost performance category didn’t count toward your total MIPS score. In year 2, it does count for 10% of your total MIPS score.  We finalized a weight of 10% for the 2018 MIPS performance period to help you get ready for a higher weighting in the future. The 10% cost weight will help you have an easier transition to the 30% cost weight MACRA requires starting with the 2019 MIPS performance period.  Please click here for more details.

CMS has put together a helpful fact sheet explaining and providing examples of each MIPS performance category scoring calculation. Each category has its own scoring rules that counts toward the overall MIPS score. Two simple tips to obtain a better score: (1) report on measures that are most relative to the services you provide (not the easiest to report); and (2) take advantage of the additional bonus or credit points, because it DOES make a difference. Reporting on additional improvement activities and public health measures, using a CERHT edition 2015, and submitting data for more than 90 days will help you boost your MIPS score AND be considered for a positive payment adjustment! Access the CMS Registry/QCDR Scoring Explainer sheet here.

Learn more about MIPS categories criteria and check your participation status. See the MIPS Measures for Allergists.

Who will participate in MIPS (Eligible Clinician or EC)?
For year 1 and 2 (performance year 2017 and 2018 / payment adjustment year 2019 and 2020)

  • Physicians (MD, DO, DDS)
  • Physician Assistant (PA) -> do not report to Advanced Care Information/MU
  • Nurse Practitioner (NP) -> do not report to Advanced Care Information/MU
  • Certified Nurse Specialist (CNS)
  • Certified Registered Nurse Anesthetics (CNRA)

For year 3+ onward (performance 2019 onward / payment adjustment year 2021 onward)
All of the above PLUS:

  • Physical and Occupational Therapist
  • Speech language Pathologist and audiologist
  • Nurse Midwife
  • Clinical social Worker and Clinical Psychologist
  • Dietitian and Nutritionist

Who will NOT participate in MIPS?

  • Providers billing Medicare Part B for the first time or first year participation
  • Providers below low patient volume threshold = bill less than $90,000 to Medicare, and provide care to less than 200 Medicare patients per year
  • Qualified Professionals (QPs) participating in an Advanced APM
  • Hospital and Facilities


APMs must meet the following requirements:

  1.  Use of a certified EHR technology
  2.  Receive payment based on quality measure (comparable to those used by the quality performance category of MIPS)
  3.  Bear “more than nominal financial risk” in other words defined as the lesser of 8% of total Medicare revenues or 3% of total Medicare expenditures (through 2020).

All Advanced APMs will be exempt from MIPS reporting requirements and qualify for the 5% bonus payment to those fulfilling all qualifications. In other words, If you receive 25% of Medicare covered professional services or see 20% of your Medicare patients through an Advanced APM in 2018, then you earn a 5% Medicare incentive payment in 2020.

These models are considered Advanced APMs in Performance Year 2018:

CMS Comprehensive List of APMs
APM look-up tool The 2018 MIPS Participation Status Tool now includes Performance Year 2018 APM Participation and Predictive Qualifying APM Participant (QP) status.
Advanced APM Resource Guide

Get started and learn more about the Quality Payment Program and review the educational resources including Fact Sheets, downloads and webinars at https://qpp.cms.gov/about/resource-library.

More details can be found here at the CMS APM Page

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