Why Participate in the Merit-based Incentive Payment System (MIPS)?

CMS recently announced that participation status letters will be mailed in May to those clinicians who are eligible to participate in the Merit-based Incentive Payment System (MIPS.)

Starting in late April through May, clinicians’ Medicare Administrative Contractor will be sending letters including MIPS participation status of each clinician associated with the Taxpayer Identification Number (TIN) used for Medicare Part B claims. Clinicians can now also check eligibility on the CMS’ website at qpp.cms.gov by entering their NPI number:






Who Is Eligible to Participate in MIPS?

As mentioned in our previous post, clinicians are eligible if:

  • They bill more than $30,000 in allowable Medicare Part B charger per year; and
  • Provide services to more than 100 Medicare Part B beneficiaries per year.

Eligible clinicians include:

  • Physicians
  • Physician Assistants
  • Nurse Practitioners
  • Clinical Nurse Specialists
  • Certified Registered Nurse Anesthetists


Why Participate in MIPS?

CMS is allowing eligible clinicians to pick their own pace, when it comes to adopting MIPS. In 2017, providers have a few options:

As noted, clinicians have the option of not participating, or reporting, at least, on one measure to avoid a negative adjustment. Obviously, the best way to maximize positive adjustment is to submit a full year of data on all the MIPS performance category. Although, it is important to note that adjustments are based on performance shown by data submitted , not by amount of data. So, submitting a full year of data does not automatically mean you’ll receive the highest bonus.

Some clinicians may argue that Wellness exams and Chronic Care Management can offset any potential negative impact, if a provider were to choose not to participate in MIPS. However, there several reasons why, even if Wellness exams and CCM payments compensates for a Medicare payment penalty, eligible providers should participate in MIPS in 2017:

  1. Incentives could reach up to 37% of Medicare Part B payments by the fourth year of the program. Considering the changes and adjustments providers must make to prepare for MIPS, it is important that those who plan on maximizing Medicare payments start preparing now by using 2017 as a test year. Building competencies and fostering a culture of engagement that is needed to succeed in a value-based system takes time, and are not developed overnight.
  2. Penalty will grow to 9% by 2022. On the other hand, by using 2017 as a test year, providers will be able to see which areas need to improve, in order to avoid a negative payment adjustment from Medicare.
  3. Starting in 2018, CMS plans to publish provider-specific quality data in order to help patients looking for a doctor. Providers not participating in MIPS will not be included in this database. Knowing that patients are relying on online reviews more than ever, it makes sense that providers take advantage of this trend by participating in MIPS and provider-specific databases.

How are you preparing for MACRA and the Quality Payment Program? We can help!

Vicki Perry, Managing Partner at APM Plus. Vicki.Perry@shcare.net


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