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. Learn more about MIPS on the CMS website.
As a result of setting exclusions and low-volume thresholds, a large majority of audiologists will be excluded for 2020 and until CMS changes the thresholds. 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 in to 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 will be subject to the maximum payment reduction for the 2021 payment year of –7% related to the 2019 reporting year.