What is the Merit-Based Incentive Payment System?

As part of its commitment to improving healthcare quality and value, the Centers for Medicare and Medicaid Services (CMS) implemented the Merit-based Incentive Payment System (MIPS). MIPS originated as a part of the Medicare Access and CHIP Reauthorization Act (MACRA) in 2015. The creation of this system was intended to establish a value-based healthcare arrangement aimed at encouraging eligible clinicians to deliver high-quality care, achieve better patient outcomes, and be rewarded for doing so via improved reimbursements. This program was first offered to qualifying providers, like Medical Doctors and Doctors of Osteopathic Medicine in 2017. It was later expanded to include allied healthcare professionals (PTs, OTs, SLPs) in 2019.

MIPS Performance Categories

Eligible Medicare Part B clinicians and organizations collect and report data to MIPS annually in four “performance categories”. This data is collected on all qualifying patients, inclusive of non-Medicare beneficiaries.

MIPS Performance Category Weighting

Allied healthcare professionals are only scored on the Quality and Improvement Activities categories, while physicians are scored on all four performance categories.

Depending on the specialty of the participating clinician, or the structure of the organization, the relevant performance categories are assigned differing weights to calculate a MIPS score.

MIPS Scoring

Using the data reported in each required category, MIPS calculates a score on a 100-point performance scale, coined the Composite Performance Score (CPS). The CPS directly impacts Medicare reimbursements, with higher scores resulting in payment incentives, and lower scores potentially leading to payment penalties. 

It is important to note that MIPS is a “budget-neutral program”, meaning the positive payment adjustments of one organization are paid for by the negative adjustments of other organizations. Patient-reported outcome measures like Limber supports offer the best opportunity to maximize your MIPS score. Throughout time, process measures (BMI, med list, falls screening) have been “topped out”, meaning you cannot achieve a score over 7 out of the available 10 points. This is done in an effort to encourage providers to utilize “high priority” outcomes, such as patient-reported outcome measures.

Bottom Line

MIPS reporting and scoring plays a significant role in Medicare reimbursement and the drive towards delivering high-quality healthcare. By understanding the four performance categories and selecting appropriate measures and activities, clinicians and organizations can maximize their MIPS score, positively impact patient care, and be financially rewarded for doing so. Healthcare providers should stay informed about the latest MIPS reporting requirements and leverage available resources to succeed in this value-based reporting program. The organization’s MIPS score directly impacts Medicare reimbursement rates.