• MIPS Manual 2017—Financial Impact: Your 2017 MIPS Final Score Will Impact Your 2019 Medicare Reimbursement

    Written By: Rebecca Hancock, Flora Lum, MD, Chris McDonagh, Cherie McNett, Jessica Peterson, MD, MPH, and Sue Vicchrilli, COT, OCS

    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.)

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    Next: The Payment Adjustment Factor: Bonuses Will Be Budget Neutral

    Note: Meeting regulatory requirements is a complicated process involving continually changing rules and the application of judgment to factual situations. The Academy does not guarantee or warrant that regulators and public or private payers will agree with the Academy’s information or recommendations. The Academy shall not be liable to you or any other party to any extent whatsoever for errors in, or omissions from, any such information provided by the Academy, its employees, agents, or representatives.

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