Getting Ready for MIPS – What You Need To Know


The first performance year for the Merit-Based Incentive Payment System (MIPS), as required by Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), is January 1, 2017. Being prepared is crucial, in order to earn up to 12 percent more on your Medicare Part B payments and avoid penalties. The system is designed to steer the healthcare industry toward reimbursements that are more value- and quality-based, and successful enrollment will determine the payment adjustments for 2019 and after.

What is MIPS?

Beginning in January of 2017, Eligible Providers (EPs) for Medicare Part B will be evaluated annually, and will be given a cumulative score. Medicare reimbursement adjustments will then be increased or reduced based on this score.

Medicare Part D

  • 10 percent (average of attributable measures) – Resource use
  • 15 percent (60 possible points) – Clinical practice improvement
  • 25 percent (100 possible points) – MU of certified EHR technology
  • 50 percent (80-90 possible points) – Quality (VBMP/PQRS)

***It is important to note that a physician’s points will be made public on the CMS Physician Compare website – making it vital to try to achieve the highest points possible.

Why prepare now for MIPS?

Once MIPS goes into effect, penalties will be issued for lack of compliance, even during the time prior to the release. In 2019, the range of positive or negative payment adjustments is -3.5 to -4.5 percent; in 2020, that number will expand to –5 percent and eventually settle at -9 percent by 2020.

Making Use of Certified EHR Technology

Electronic Health Record (EHR) technology can help to fulfill Meaningful Use and PQRS requirements with a greater deal of accuracy. In addition to supplying real-time summaries of quality measure progress, EHR technology can be used to generate authentication documentation that reduces administrative work in meeting program goals.

Once in effect, the current EHR Incentive Program and pay-for-performance program measures will be combined and streamlined via MIPS, creating one program from the following:

  • Meaningful Use (MU),
  • Physician Quality Reporting System (PQRS),
  • Value-based Payment Modifier (VM)

Meeting the existing program performance and quality measures sooner rather than later helps your practice to be more apt to be prepared for higher payment bonuses once MIPS is in effect. Main Street Medical’s Consulting Services can help to ensure your practice is ready for MIPS. While MIPS is designed to improve upon the current system, the process itself will be cumbersome and complicated. Where are you in your preparation for MACRA MIPS – contact Main Street Medical today and let our expert team help prepare you for the transition.