You’re considered a MIPS eligible clinician (i.e. required to report) and will receive a payment adjustment when:
- You’re an eligible clinician type AND
- You enrolled in Medicare before January 1, 2022 AND
- You’re not identified as a QP AND
- You exceed the low-volume threshold (exceeding all 3 low-volume elements as shown below)
To exceed the low-volume threshold for the 2022 performance year, you must:
- Bill more than $90,000 for Part B covered professional services under the Physician Fee Schedule (PFS), and
- Provide services to more than 200 Medicare Part B patients, and
- Furnish more than 200 covered professional services to Part B Medicare Patients.
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.)
- Your performance across the MIPS performance categories, each with a specific weight, will result in a MIPS final score of 0 to 100 points.
- Your MIPS final score will determine whether you receive a negative, neutral, or positive MIPS payment adjustment.
- Your MIPS payment adjustment is based on your performance during the 2022 performance year and applied to payments for covered professional services beginning on January 1, 2024
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 APM Performance Pathway (APP) is a streamlined reporting framework available beginning with the 2021 performance year for MIPS eligible clinicians who participate in a MIPS APM. The APP is designed to reduce reporting burden, create new scoring opportunities for participants in MIPS APMs, and encourage participation in APMs.
- MIPS Value Pathways (MVPs) are subsets of measures and activities, established through rulemaking that can be used to meet MIPS reporting requirements beginning with the 2023 performance year. The MVP framework aims to align and connect measures and activities across the quality, cost, and improvement activities performance categories of MIPS for different specialties or conditions. In addition, MVPs incorporate a foundational layer that leverages Promoting Interoperability measures and a set of administrative claims-based quality measures that focus on population health/public health priorities.
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
- Check your initial MIPS eligibility
- Determine how you will participate
- Individual
- Group
- Virtual Group
- APM Entity
- Determine your reporting framework
- Traditional MIPS
- APM Performance Pathways (APP)
- Performance (Throughout 2022)
- Traditional MIPS - Select and Perform Your Measures and Activities
- Quality
- Promoting Interoperability
- Improvement Activities
- Cost
- APM Performance Pathways (APP) - Perform Your Measures and Activities
- Quality
- Promoting Interoperability
- Improvement Activities
- Verify Your Eligibility again (late 2022)
- Submit Your Data (early 2023)
- Review Your Performance Feedback (mid-2023)
- Note the application of payment adjustments (throughout 2024)
- Preview your data for public reporting (late 2023 or early 2024)
