MIPS (Merit-based Incentive Payment System)

The Merit-based Incentive Payment System (MIPS) is a new medical reimbursement framework that consolidates different parts of three existing payment programs that sunset Dec. 31, 2018:

  • Physician Quality Reporting System (PQRS)
  • Value-based Payment Modifier (VBM)
  • Medicare Electronic Health Record (EHR) Incentive Program

To increase innovation, a fourth element, Improvement Activities (IA), has been added to MIPS, which offers its providers the flexibility to choose the most relevant and significant activities to demonstrate quality improvement in their practice.

To monitor the performance of the providers, few matrices have been set apart. Instead of quantity being the core of reimbursements, the emphasis will now fall on performance categories:

  • Quality (replaces PQRS and parts of VM)
  • Cost (replaces VM in 2018)
  • Advancing Caring information (replaces EHR meaningful use)
  • Improvement Activities

Based on your actions in 2017, your payment for Medicare services in 2019 can range from a negative 4% payment reduction to an increased payment adjustment as high as 22%.