The Merit-Based Incentive Payment System (MIPS) replaced the Physician Quality Reporting System (PQRS) on January 1, 2017. It is one of two quality payment options implemented by the Centers for Medicare & Medicaid Services (CMS). The second payment option is the Advanced Alternative Payment Model (AAPM). The goal of the MIPS program is to improve patient care and satisfaction, reduce costs, and increase communication between providers. Eligible MIPS clinicians are identified through their services billed under the Medicare Physician Fee Schedule (MPFS) for traditional Medicare Part B beneficiaries. Data are collected to determine performance in four areas: (1) Quality, (2) Improvement Activities, (3) Promoting Interoperability, and (4) Cost. Audiologists who are mandated MIPS reporters must currently only report under the Quality and Improvement Activities categories. For 2024, CMS plans to require audiologists to report under the Promoting Interoperability category. More details will become available in future rulemaking.
Learn more about MIPS on the CMS website.
Eligibility Standards and Conditions
As a result of program exclusions and low-volume thresholds, a large majority of audiologists are not currently required to participate under MIPS. MIPS applies only to those clinicians in outpatient non-facility settings—that is, those not associated with a hospital medical center. In addition, clinicians must meet ALL of the following criteria in order to be required to participate:
- bill $90,000 or more to the Medicare program
- treat 200 or more distinct Medicare beneficiaries
- provide 200 or more distinct procedures
Clinicians meeting one or two of the criteria may opt into the program to compete for payment adjustments. Others who do not meet any of the criteria may voluntarily report in order to gain experience. Required participants who choose not to report or who do not report successfully, will be subject to the maximum payment reduction of -9 percent. Remember, there is a gap in performance and payment years. For example, the 2023 performance year will impact the 2025 payment year.