MIPS (Merit-Based Incentive Payment System)

WHAT IS MIPS

MIPS (Merit-Based Incentive Payment System), established in the first year of the Quality Payment Program, is the original reporting option available to MIPS eligible clinicians for collecting and reporting data to MIPS. Your performance is measured across 4 areas – quality, improvement activities, Promoting Interoperability, and cost.

HOW IT WORKS

You submit the quality and Promoting Interoperability measures and improvement activities that you collect/perform during the performance year. QPP-CMS collects and calculates cost measures for you. The 4 performance categories are scored and make up your MIPS final score. Your final score determines the payment adjustment applied to your Medicare Part B claims.

MIPS CATEGORIES

QUALITY

This performance category assesses the quality of the care you deliver, based on performance measures created by CMS, as well as medical professional groups, specialty societies and interested parties. You pick the quality measures that best fit your practice.

Weightage: 30%

PROMOTING INTEROPERABILITY

This performance category promotes patient engagement and the electronic exchange of health information using certified electronic health record technology (CEHRT). You report a defined set of Promoting Interoperability objectives and measures.

Weightage: 25%

IMPROVEMENT ACTIVITIES

This performance category assesses how you improve your care processes, enhance patient engagement in care, and increase access to care. You choose the activities appropriate to your practice.

Weightage: 15%

COST

This performance category assesses the cost of the patient care you provide. We calculate cost measures, based on your Medicare claims; to determine the cost of the care you provide to certain patients.

Weightage: 30%

MIPS REPORTING & PAYMENT ADJUSTMENT PROCESS

The MIPS performance year begins on January 1 and ends on December 31 each year. If you’re eligible for MIPS, you must report data collected during the calendar year by March 31 of the following calendar year. Payment adjustments, based on the data you submit for services provided, are applied to Medicare Part B claims during January 1 to December 31 of the year following data submission. For example, if you collect data between January 1 and December 31, 2024 (i.e., the performance year), you must report your data by March 31, 2025, and you'll receive a MIPS payment adjustment between January 1 and December 31, 2026 (i.e., the payment year)

SDRCM PROCESS & SOLUTION FOR MIPS

  • REVIEW MIPS REQUIREMENTS

    1. Check MIPS Eligibility (Participation Status)

    2. Review Reporting Factors

    3. Choose Participation option(s)

    4. Understand Reporting Options available based on your eligibility

CHOOSE MEASURES & ACTIVITIES FOR REPORTING

Explore each MIPS performance category step by step, gaining insight into the key factors influencing category scores and your overall MIPS performance.

Identify the optimal combination of measures and collection types for reporting and determine whether to report individually or as a group to maximize your MIPS score and payment adjustments.

SET ALERTS FOR CONSISTENT DATA COLLECTION & REPORTING

Use CDS (Clinical Decision Support) and/or DSI (Decision Support Interventions) module features for appropriate and seamless data collection throughout the year.

SET PERFORMANCE INDICATORS & HIGHLIGHT GAPS FOR IMPROVEMENT

View Quarterly Reports to identify your performance score. Highlight non-compliant patients along with reasons of non-compliance. Explain the actions required to comply with those patients and improve performance score.

MIPS DATA SUBMISSION

Select the submission method and submit your MIPS data to QPP-CMS seamlessly using EHR or Registry methods to ensure compliance with MIPS requirements while optimizing your score and payment incentives.