The MIPS timeline includes four important milestones.
- January 1, 2019: Performance period begins and runs through the calendar year.
- March 31, 2020: The deadline for submitting data to CMS.
- Summer 2020: You’ll receive your final MIPS score and payment adjustment information.
- January 1, 2021: CMS will start prospectively applying your payment adjustment to each claim.
Four MIPS performance categories will determine your final score.
Clinicians and practices will report across four reporting categories for a final MIPS score of 100 possible points.
- Quality Performance: Clinicians will report on six quality of care measures, either as individuals or as groups.
- Cost: This category measures the total cost of care. It’s calculated by CMS based on claims data.
- Improvement Activities: Clinicians choose a combination of high- and medium-weighted activities.
- Promoting Interoperability: Clinicians must report on base-score measures to receive credit.
Clinicians who are not enrolled in an ACO will be scored across all four of the MIPS reporting categories.
- Quality: Accounts for 45% of your overall MIPS score. You’ll need to report on at least six quality measures for a full calendar year. At least one of them must be an outcome measure or a high-priority measure. You may also choose to report a specific specialty measure set identified by CMS.
- Cost: Accounts for 15% of your overall score. It’s based on the calendar year’s administrative claims, so you don’t need to submit any cost data. CMS will analyze your claims and give you a score based on the full calendar year. Measures include Medicare spending per beneficiary and total per capita cost.
- Improvement Activities: Accounts for 15% of your score. You must report for a minimum of 90 days and select a combination of medium-weight activities or high-weighted activities.
- Promoting Interoperability: Accounts for 25% of your score. You must meet the base measures and report for a minimum of 90 days.
Clinicians who are enrolled in an ACO will be scored across three MIPS categories.
- Quality: Accounts for 50% of your overall MIPS score. Your quality performance score will be based on the quality measures that your ACO reports with its GPRO submission.
- Improvement Activities: Accounts for 20% of your overall score and will be automatically assigned to you based on the ACO. No additional reporting is necessary.
- Promoting Interoperability: Accounts for 30% of your overall score. You’ll need to report on it at the practice or individual level. The data is aggregated and weighted to get a single ACO score that applies to all eligible clinicians in the ACO.
Promoting Interoperability is a key category.
To report this category, your practice must use 2015 Edition Certified EHR Technology (CEHRT).
This category is split into four different objectives. You must score at least 100 points to get full credit for the category:
- e-Prescribing: 10 points (with10 additional bonus points available)
- Health Information Exchange: 40 points
- Provider-to-Patient Exchange: 40 points
- Public Health and Clinical Data Exchange: 10 points
Your final score will determine your payment adjustment.
Your MIPS final score will be compared to the MIPS performance threshold to determine whether you’ll receive a neutral, negative or positive payment adjustment.
- If you score fewer than 30 points in the MIPS program: You’ll receive a negative payment adjustment.
- If you score 30 points: You’ll get a neutral payment. No negative or positive payment adjustment will be applied to your Medicare reimbursements.
- If you score 30 – 74 points: You’ll earn a positive payment adjustment.
- If you score 75 points or higher: You’ll earn a positive payment adjustment and a bonus adjustment.
All payment adjustments will be prospectively applied to each claim beginning January 1, 2021.
For more information about MIPS
Contact the New Jersey Innovation Institute at 973-642-4055 or firstname.lastname@example.org.