Quality Payment Program: Key Information about MIPS

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable Growth Rate formula, which threatened physicians with significant payment cuts.  It also replaces Meaningful Use and Physician Quality Reporting System with the Quality Payment Program (QPP).

The Quality Payment Program has two tracks you can choose:

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

We will focus on MIPS since it’s designed for a wider audience.  This program became effective with services on or after January 1, 2017.  Medicare Part B providers billing more than $30,000 per year AND providing care for more than 100 Medicare patients will need to participate in MIPS, or face a negative 4 percent payment adjustment on 2019 services.

When you participate in MIPS, you have three options: (1) submit some data and receive a neutral or small payment adjustment, (2) report for a 90-day period and receive a small positive payment adjustment, or (3) fully participate starting January 1, 2017 and receive a modest positive payment adjustment.  You earn a payment adjustment by sending in information in the following categories: Quality (replaces PQRS), Improvement Activities, Advancing Care Information (replaces Meaningful Use), and Cost (replaces the Value-Based Modifier).  For 2017, the Cost category will not be used to determine your payment adjustment, but will start being used in 2018 payment adjustment calculations.

If you don’t have a 2014 Certified EHR you can still participate and report on the Quality and Improvement Activities categories.  You just won’t be able to fully participate

In order to get started, CMS suggests you follow these steps:

  1. Ensure your Electronic Health Record is certified by the Office of the National Coordinator (ONC) for Health Information
  2. Determine if you want to use a qualified clinical data registry or other registry to submit your quality data
  3. Figure out which measures and activities fit best with your practice
  4. Decide whether to report as a group or individual

Quality-based reimbursement is here to stay.  In order to participate in MIPS, the minimum requirement is to do one of the following:

  • Report 1 quality measure to CMS on 1 Medicare patient
  • Attest to 1 improvement activity performed consistently during any 90 days in 2017
  • Attest to the 4 measures that make up the Base Score of the Advancing Care Information (ACI) category – these are from the Modified Stage 2 Meaningful Use measures and you must meet the threshold of 1 patient or answer Yes for each measure during any 90 days

If you are able participate more fully, it is highly recommended as it will help set you up for future success with the program.  Also you may qualify for a better adjustment on your 2019 payments.

CMS has created various tools and resources to assist you with a successful transition to the Quality Payment Program.  The site is


Packages & Pricing | Electronic Health Records | MACRA/MIPS | Physician Billing Services