The 4 Scoring Thresholds of MIPS

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2017 is the year for clinicians to transfer to the new MIPS program, and CMS has done its best to make the transition as smooth as possible – especially for those who are just starting to participate in MIPS. For those clinicians who don’t participate at all, a score of zero will be assigned; but even just modest participation can result in a score above the 3-point positive payment threshold, reaching the neutral payment adjustment.

What Are the MIPS Thresholds?

For those who may not be clear on how MIPS is structured, the following may be of help:

  •      0 Points – Clinicians who don’t participate in MIPS at all will receive zero points and a negative payment adjustment of 4%.
  •      3 Points – Even minimal participation in MIPS, often known as the “test pace” option, earns clinicians three points. This qualifies them for a neutral payment adjustment.
  •      4-69 Points – Clinicians will begin to see modest payment adjustments in this range. Positive adjustments are assigned on a linear sliding scale, and higher scores will move clinicians closer to the 4% maximum positive adjustment.
  •      70-100 Points – Clinicians in this group are eligible for the exceptional performance bonus, which uses additional funds to increase positive payment adjustments for those in the top tier.

How Does the Sliding Scale Work?

Several factors will be taken into account when determining the sliding scale for payment adjustments. These factors will include things like available money retained in negative payment adjustments and participating clinicians’ scores.

For scores in the 4-100 range, CMS will apply an adjustment factor that accounts for these considerations. For those who score in the 70-100 range, additional funds can be used toward a minimum 0.5% performance bonus, going as high as 10%.

Want to Learn More About MIPS?

Learn more about how to increase your MIPS score, and contact us when you’re ready to let us handle your practice’s billing and coding. We’d love to help you out!