This content was excerpted from EyeNet’s MIPS Manual 2017.
Can you afford to ignore the Merit-Based Incentive Payment System (MIPS)? The program, which launched this year, has significant ramifications for reimbursement
Here’s how CMS will determine whether you get a bonus or a penalty.
First, CMS calculates your 2017 final score, which for most physicians can range from 0 to 100 points. It is a composite score that will be based on your scores in 3 performance categories, which will usually be weighted as follows.
- Your quality score contributes up to 60 points to your final score.
- Your advancing care information (ACI) score contributes up to 25 points.
- Your improvement activities score contributes up to 15 points.
Second, CMS checks whether your 2017 final score exceeds, meets, or falls below the 3-point performance threshold. This will determine whether your 2019 payment adjustment factor is positive, neutral, or negative (see “The Payment Adjustment Factor: Bonuses Will Be Budget Neutral”).
Third, CMS sees how you stack up against the 70-point additional performance threshold. If you score 70 or more points, you will get a 2019 additional payment adjustment factor, which is also known as the exceptional performance bonus. See, “The Additional Payment Adjustment Factor (Tap Into a $500M-Bonus Pool.)”
Next: The Payment Adjustment Factor: Bonuses Will Be Budget Neutral
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