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MIPS (2018)

Last Updated: Nov 16, 2018 03:48PM PST

#What is MACRA?
#MIPS vs Advanced APMs
#Who can Participate?
#MIPS Performance Categories
#Reporting Period
#Clinical Quality Measure Webinar PPTs

IMPORTANT: Elation has created a cheat sheet that will help you with meeting the criteria for the different Clinical Quality Measures (CQMs). We encourage you to check the attachments section for more information.

What is MACRA?

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repeals the Medicare Sustainable Growth Rate and replaces it with a new program known as the Quality Payment Program (QPP).
Beginning on January 1st, 2017, qualified providers will participate in one of two tracks, either Advanced Alternative Payment Models (Advanced APMs) or the Merit-based Incentive Payment Program (MIPS).


MIPS vs Advanced APMs

Mips is the standard track that applies to most physicians, and is based directly on the traditional Medicare Fee-for-Service schedule. 


Advanced APMs
Advanced APMs are unique payment programs that replace or heavily augment how providers are paid. A few examples are CPC+ and Medicare Shared Savings Program Track 2

  • Payment Track for ~95% of Physicians.
  • Replaces Meaningful Use (MU), PQRS, and Value Based Payment Modifier (VM)
  • Adjustments to Medicare payments based on performance, varying by program year:
    • 2019: +/- 4%
    • 2020: +/- 5%
    • 2021: +/- 7%
    • 2022: +/- 9%
  • Additional incentive from $500 Million pool to provide positive adjustments to
  • Payment Track for ~5% of Physicians.
  • Exempt from MIPS Incentives and Penalties
  • 5% annual payment bonus between 2019 and 2024
  • Multiple payment structures.


Who can Participate?

Clinicians are included if they are an eligible clinician type and meet the low volume threshold, which is based on allowed charges for covered professional services under the Medicare Physician Fee Schedule (PFS) and the number of Medicare Part B patients who are furnished covered professional services under the Medicare Physician Fee Schedule.
  • Practice is excluded if provider or provider's group has ≤$90,000 in Part B allowed charges or ≤200 Part B beneficiaries.
  • QPP Participation Tool to identify eligibility (NPI needed to search) 

MIPS Performance Categories

There continues to be four performance categories in 2018; Clinical Quality Measures, Cost, Improvement Activities and Advancing Care Information. The weighted score (in %) from each category will be added together to give you a final MIPS score. The final MIPS score is compared to the MIPS performance threshold to determine if you receive a partial, neutral or negative payment adjustment in 2020.

To avoid the 5% penalty, physicians must earn at least 15 points via 1 of the following:
  1. Full participation in the Improvement Activities category, such as submitting one high-weighted activity or two medium-weighted activities for small practices, or two high-weighted activities, four medium-weighted activities, or a combination of both medium- and high-weighted activities;
  2. The Advancing Care Information (ACI) category base score and one quality measure meeting the measure threshold, or data completeness, but not benchmarks
  3. ACI base score and one medium-weighted improvement activity
  4. Six quality measures meeting data completeness, but not measure benchmarks
  5. If providers report a particular measure, but do not meet the benchmarks or submission thresholds, they will automatically receive a score of 3 points for that measure if they are in a small practice, and 1 point if they are in a larger practice.
Important: We have attached the benchmarks for all the different measures for you to reference. Please check the attachments for more information.

Reporting Period

Clinical Quality Measure Webinar PPTs

Session 1: Diabetes Related Measures
Session 2: Cancer, Cognitive, Falls Related Measures
Session 3: Hypertension and BMI Related Measures
Session 4: Immunization Related Measures
Session 5: FAQs and Troubleshooting Tips
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