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Merit-based Incentive Payment System

The Merit-based Incentive Payment System is one of two payment tracks offered by the Centers for Medicare and Medicaid Services. Currently, it is the largest value-based care payment program, and a consolidation of three previous programs – Medicare Electronic Health Records (EHR) Incentive Program for Eligible Clinicians, Physician Quality Reporting System (PQRS) and Value-Based Payment Modifier (VBM)

Clinicians are required to report MIPS data in four categories – Quality, Improvement Activities, Advancing Care information and Cost. Each category carries its own weight and maximum allowable point values. The unified scoring system accounts for exceptional performance, exemptions, evaluation at the individual or group level, special circumstances and non-patient-facing MIPS eligible physicians.

The MIPS performance threshold and payment adjustments have increased since the start of the program and are only expected to continue to increase. In 2018, providers could receive a negative or positive adjustment in 2020 of five percent depending on performance. This adjustment follows the provider, wherever they are in practice, two years after the performance year.

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