MIPS Score and Exemption

mips score

The Merit-based Incentive Payment System (MIPS) is one of two pathways in MACRA’s Quality Payment Program. Most anesthesia providers will be eligible for MIPS participation and will have their MIPS score calculated, as MIPS applies to all Medicare Part B physicians, physician assistants, nurse practitioners, and certified registered nurse anesthetists.

Here, we’ll talk more about MIPS, who is exempt from it, and how your score will be calculated.

What Is MIPS?

At the moment, Medicare uses a combination of programs to measure quality and cost for clinicians. These programs include the Value-based Modifier (VM), the Physician Quality Reporting System (PQRS), and Meaningful Use. Basically, MIPS is a way to streamline all of these programs into one new system.

There are four components to MIPS:

  •      Quality
  •      Advancing Care Information (formerly known as Meaningful Use)
  •      Clinical Practice Improvement Activities
  •      Cost (or resource use)

How Is My MIPS Score Calculated?

Providers will be scored in each of the four categories above. These individual scores will then be weighted and combined to form one composite score. Each category’s weight changes over time, but initially, quality composes a whopping 50% of the score, while cost is a mere 10%. By year 3, each of these numbers shifts to 30%.

All providers’ scores will be compiled and evaluated, and then a threshold will be established. Providers whose score falls below the threshold will be penalized, while those who score above the threshold will be rewarded. CMS will calculate this threshold by considering data from the previous two years, which means the threshold will likely change every so often.

Am I Exempt from MIPS?

CMS estimates that 15,000 anesthesiologists may end up being exempt from MIPS. If you’re curious as to whether or not you’re one of those 15,000, here are the criteria that determine possible exemption. If any of the following apply to you, you may be exempt from MIPS:

  •      You are newly enrolled in Medicare.
  •      You have less than or equal to $10,000 in Medicare charges and fewer or equal to 100 Medicare patients.
  •      You participate in an APM (Alternative Payment Model).

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