MIPS Guide

Master MIPS data reporting requirements

The Merit-Based Incentive Payment System (MIPS) is one of two tracks in the CMS Quality Payment Program. You can use your NPI number to learn whether you’re required to participate in the program. MIPS consists of four weighted categories:

• Quality (50%)
• Advancing care information (25%)
• Improvement activities (15%)
• Cost (10%)

You can report for MIPS as an individual or as part of a group of two or more eligible clinicians. If you’re part of a small practice, you can join with other small practices to form a virtual group. Learn more about MIPS reporting.

Earning bonuses & penalties

The MIPS data you collect and report for 2018 will impact your 2020 Medicare reimbursement fee schedule. Here’s how it works:

• To avoid a 5% penalty in 2020, you’ll need to score at least 15 points based on your 2018 data.
• To earn a bonus of up to 5% in 2020, you’ll need to score between 15 and 100 points on 2018 data.
• The very highest performers—those who earn between 70 and 100 points—will receive an additional Exceptional Performance bonus in 2020 from CMS.

Important deadlines

• Jan. 1, 2018: Start collecting data for MIPS Quality and Cost categories. You need 365 days of data for these categories.
• Between Jan. 1 and Oct. 2, 2018: Start collecting data for Advancing Care Information and Improvement Activities categories. For these measures, you need at least 90 days’ worth of data.
• March 31, 2019: Deadline to submit all 2018 MIPS data.

Looking ahead

Each year, the bonus or penalty you stand to earn based on MIPS data increases:

• 2019: +/-4% based on 2017 data
• 2020: +/-5% based on 2018 data
• 2021: +/-7% based on 2019 data
• 2022 and beyond: +/-9% based on data from 2020 and beyond

Getting help

AOA members can contact the AOA for free, personalized assistance with MIPS and the Quality Payment Program. Physicians can also contact CMS at (866) 288-8292 or qpp@cms.hhs.gov.