With the MACRA initiative of QPP, effective since January 1, 2017, there is a big relief to the providers where they do not have to enroll in the QPP. However, the desired can do so through CAHPS (Consumer Assessment of Healthcare Providers and Systems) for MIPS survey measures, the deadline being June 30 every year.

What Providers receive for MIPS?

For merit-based incentive payment system (MIPS) the providers receive any one of the following:

  • Neutral payment adjustment, which would neither increase nor decrease Medicare payments.
  • Positive payment adjustment with the receipt of additional incentives
  • Negative payment adjustment as a penalty of up to 4% of practice collection


Provider eligibility for MIPS?

MIPS applies to physical therapists, occupational therapists, clinical psychologists, and social workers. MIPS incorporates either Medicare EHR incentive program or Meaningful Use, or value-based payment modifier or physician quality reporting system (PQRS). CMS estimates around 500,000 providers for 2020, and for AAMPs (Advanced Alternative Payment Models) is +5% for 2019-2024 and estimates around 205,000 providers to become QP for the payment year 2021.

How to Submit MIPS Data?

Administrative claims, qualified registry, CMS web interface or CAHPS can be one of the ways to submit the data. One of the ECs from the CMS approved list must be chosen while using the qualified registries or QCDR as the mode of submission to ensure the entity selected has met CMS submission standards and criteria.

The Key areas of Quality Payment Program

Relevant quantification of small and rural practices and comforting the clinicians in MIPS are the key aspects of the QPP. QPP offers updating MIPS thus encouraging interoperability category as well as measured adjustments.

Eligibility and Qualification for advanced APM

The eligibility for advanced APMs calls for at least reaching the verge of Medicare payments or patients to be qualifying APM participant or partial qualifying APM participant. However, the providers in the first year registered in the Medicare program are not considered as MIPS-eligible clinicians until subsequent year.

The use of CEHRT is a must by at least 75% of eligible providers in each APM entity for the qualification as advanced APM for year 3; whereas for year 1 and 2 at least 50% of eligible providers in each APM entity must use CEHRT.

Eligible Provider Requirements

Multiple submission types for measures and activities are allowed to the eligible providers for 2019 performance year. CMS uses the highest score.

Hospital value-based purchasing (VBP) score should be chosen by the facility based providers for 2019 performance year rather than MIPS reporting. Preference should also be given to quality and cost performance categories or hospital VBP score converted to MIPS score. It also extends to the providers rendering 75% or more of their services to inpatient hospital or emergency room or outpatient hospital.