Download – FAQs on MIPS

10 FAQs About the Merit-based Incentive Payment System (MIPS) – Updated for 2019

By SA Ignite

In this FAQ we attempt to explain in one narrative the key aspects of MIPS, as updated for the 2019 performance year, both for those new to the program as well as those with previous experience and familiarity with the 2018 MIPS rules. The FAQs are optimally read in sequential order but also sufficiently standalone to enable skipping to the topic of greatest interest. Our team has referenced, reproduced and curated key excerpts from original CMS source documents, such as Federal Register regulatory rules and CMS fact sheets to enable readers to quickly and easily explore a topic in greater depth based on the source-of-truth CMS document.

On November 1, 2018, CMS released revisions to payment policies under the Medicare Part B physician fee schedule for the Quality Payment Program (QPP) for calendar year 2019. In accordance with one of the most bipartisan and significant legislative changes to Medicare in a generation, the Medicare Access and CHIP Re-authorization Act of 2015 (MACRA) repeals the legacy Medicare Part B Sustainable Growth Rate (SGR) reimbursement formula and replaces it with the QPP, a new value-based reimbursement system impacting Part B payments to clinicians nationally. The QPP rule is updated at least once per year and consists of two major tracks:

  • The Merit-based Payment System (MIPS)
  • Alternative Payment Models (Advanced APMs)

This paper includes information from the CMS rules and updated with 2019 information with 10 FAQs answered.

  1. What is MIPS?
  2. What are the financial and reputational impacts of MIPS?
  3. Who is subject to MIPS?
  4. What determines a clinician’s MIPS score?
  5. How is the Quality performance category scored?
  6. How is the Cost performance category scored?
  7. How are the Promoting Interoperability (PI) and Improvement Activities (IA) performance categories scored?
  8. What are MIPS data submission and audit requirements?
  9. How is MIPS different in 2019 versus 2018, and how will it further change in 2020?
  10. How does an organization sustainably succeed on the MIPS path?

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