You’re considered a MIPS eligible clinician (i.e. required to report) and will receive a payment adjustment when:
To exceed the low-volume threshold for the 2022 performance year, you must:
Check your preliminary eligibility status based on analysis of data from the first segment of the MIPS Determination Period by entering your National Provider Identifier (NPI) in the QPP Participation Status Tool .
MIPS determination period includes two, 12-month segments for the 2022 performance period. The first 12-month segment is from October 1, 2020 to September 30, 202. The second 12-month segment is from October 1, 2021 to September 30, 2022.
Quality measures should be reported for 12-month calendar year performance period. Cost category should be reported for 12-month calendar year performance period. Promoting Interoperability and Improvement activities measures should be reported for continuous 90 days minimum performance period.
The MIPS is based on the FFS model with a direct tie to quality performance. You earn a payment adjustment based on evidence-based and practice-specific quality data. You show you provided high quality, efficient care supported by technology by sending in information in the following categories.
You generally have to submit data for the quality, improvement activities, and Promoting Interoperability performance categories. (We collect and calculate data for the cost performance category for you.)
Under the traditional MIPS, participants select from 200 quality measures and over 100 improvement activities, in addition to reporting the complete Promoting Interoperability measure set. We collect and calculate data for the cost performance category for you.
In addition to traditional MIPS, 2 other MIPS reporting frameworks, designed to reduce reporting burden, will be available to MIPS eligible clinicians.
The MIPS performance categories have different “weights,” and the scores from each of the categories are added together to give you a MIPS Final Score. Traditional MIPS performance category weights are dependent on the level for which you participate in MIPS.
For example, MIPS eligible clinicians that participate in traditional MIPS as an APM Entity have different performance category weights than clinicians who participate in traditional MIPS as an individual, group, or virtual group.
Final Score = (Quality Score*Quality Weight) + (PI Score*PI Weight) + (IA Score*IA Weight) + (Cost Score*Cost Weight)*100
|FINAL SCORE||PAYMENT ADJUSTMENT|
|89.00 – 100.00 points||Positive Adjustment and Eligible for Performance Incentive|
|75.01 - 88.99 points||Positive Adjustment and NOT Eligible for Performance Incentive|
|75.00 points||Neutral Payment Adjustment|
|0 – 74.99 points||Negative payment adjustment (up to -9%)|
2022 performance year will be the last year that CMS will provide an additional MIPS incentive for exceptional performance.
If you’re an eligible clinician, you should