MIPS Categories - A Summary
Mary Beth Black,
MBA, MHA, CPC, CEMC, CPMA
The Merit-Based Incentive Payment System (MIPS) is the model by which most practices will be paid under MACRA. This model is composed of four (4) performance categories, each of which has a weight assigned by CMS. In 2017, these categories and weights are as follows:
- Quality (replaces PQRS) – 60%
- Advancing Care Information (replaces Meaningful Use) – 25%
- Improvement Activities (new category) – 15%
- Cost (replaces Value Based Modifier – Calculated by CMS) – 0%
In order to fully satisfy each category and obtain the highest benefit, your practice will need to report on a full year of data. Below is a summary of each category and its reporting requirements, as well as a link to the measures in each category.
The Quality Category replaces PQRS. Under this category, you will need to choose six (6) quality measures, including one (1) outcome/high quality measure, and one (1) cross-cutting measure, such as medication reconciliation. You may choose from the general measures set or a specialty measures set. Once you review the measures, you will note that there are a number that apply to all specialties. The list of measures may be found at: https://qpp.cms.gov/measures/quality.
Advancing Care Information Category
This category takes the place of Meaningful Use. In order to obtain full credit for 2017, you will need to report on five (5) electronic health record (EHR) use-related measures. If you have been successful in your Meaningful Use reporting, you should be successful here. In this category, you will report key measures of interoperability and information exchange. Your practice will be rewarded on the measures that matter most. You may find the list of measures and identify your EHR edition at: https://qpp.cms.gov/measures/aci. There are two (2) options for reporting which will depend on your EHR version.
Improvement Activities (IA) Category
In order to attain the full 15%, you will need to verify that, for a minimum of ninety (90) days during 2017, your practice completed four (4) Improvement Activities that you determined to be the most important. You will submit your verifications through whichever means you have chosen for submitting your Quality and Advancing Care categories. The IA measures can be found at: https://qpp.cms.gov/measures/ia.
In 2017, this category has no weight, but that will change in the future. CMS will calculate this category based on claims and availability of sufficient volume. Clinicians do not need to report anything.
There are various methods of reporting. If you choose to report through your EHR, work closely with your vendor to ensure that your chosen measures are available and easily reported. Many practices prefer to report through registries, such as MIPSWizard or MIPSPro, among others, which may be more accurate and easier to use.
If you have questions, please feel free to contact Mary Beth Black at: 770-951-8427 or firstname.lastname@example.org.