Merit-Based Incentive Payment System (MIPS)

What is MIPS?

MIPS is part of the CMS Quality Payment Program (QPP) and allows providers to receive monetary incentives for practices improving patient care. Provider eligibility for MIPS can be determined on the QPP participation status page.

MIPS Scoring

MIPS overall scoring is a combination of sub-scores across four categories. Each of the categories is weighted, with some contributing more to the final score than others. QPP adjusts the weighting of each category annually. Category weighting is also determined by the specific MIPS pathway that you choose to report. Click here to learn more about participation options.

The following sections review the scoring and weighting for Traditional MIPS. Refer to QPP for detailed information on alternative pathways, including APM Performance Pathway (APP) and MIPS Value Pathway (MVP).

Quality

This category contributes to 40% of the final MIPS score for the 2021 performance year and focuses on achieving a high quality of patient care. Scores in the quality category are based on ratios of patient populations that relate to a specific measure. Measures are reported through the CMS MIPS portal.

Providers and practices reporting to MIPS are required to submit data for a minimum of six different measures, out of a wide variety available. Measures are available through the following different types of collections:

• Electronic Clinical Quality Measures (eCQMs)

• MIPS Clinical Quality Measures (CQMs)

• Qualified Clinical Data Registry (QCDR) Measures

• Medicare Part B claims measures

• CMS Web Interface measures

• Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS Survey

Click here to learn more about the MIPS Quality category.

Our Quality Measures Report offers 8 different eCQMs. The data can be generated and downloaded as a QRDA-III file to submit through the CMS MIPS portal.

Promoting Interoperability (PI)

This category contributes to 25% of the final MIPS score for the 2021 performance year. Promoting Interoperability focuses on the availability of electronic health information (EHI) for providers, patients, caregivers, and public health programs.

Measures for this category are the same for all providers and practices reporting to MIPS. Requirements are met through a mixture of patient population data and attesting yes or no to measures.

Click here to learn more about the MIPS Promoting Interoperability category.

Our MIPS Promoting Interoperability Report allows providers and practices to report population data and attestations. The report can be downloaded as a .csv or .pdf file to submit through the CMS MIPS portal.

Improvement Activities

This category contributes to 15% of the final MIPS score for the 2021 performance year. Improvement Activities are focused on efforts achieved through internal policies and procedures at the practice. These are changes that the provider or practice attests yes or no to, directly through the CMS MIPS portal.

There are over 100 available activities for your practice to implement. Activities are classified as Medium-weighted or High-weighted. You must attest to a combination of activities in order to meet the requirements for this category. QPP recommends attesting to one of the following combinations:

• Two high-weighted activities

• One high-weighted and two medium-weighted activities

• Four medium-weighted activities

Click here to learn more about the MIPS Improvement Activities category.

Cost

This category contributes to 20% of the final MIPS score for the 2021 performance year. Cost focuses on providing reasonable pricing to patients. CMS calculates this measure automatically, based on Medicare claims that you submit. No additional reporting is required.