CMS Launches New Online MIPS Tool

The Centers for Medicare and Medicaid Services (CMS) wants to help healthcare providers to determine whether they must take part in the Merit-Based Incentive Payment Program – better known as MIPS.

The new Medicare reimbursement program is central to the Quality Payment Program, which intends to shift reimbursement away from the volume of services provided to a system that rewards providers for providing quality care to patients.

CMS recently released an online tool that allows clinicians to better determine if they have to participate in the program.

Generally speaking, clinicians should participate in MIPS in the 2017 transition year if they bill more than $30,000 in Medicare Part B allowed charges a year and provide care for more than 100 Part B-enrolled Medicare beneficiaries a year. There are some exemptions, including those providers who are new to Medicare or who participate in Advanced Alternative Payment Models (APM) and who receive a specified amount of revenue from those arrangements.

An APM is a payment approach that allows for additional incentive payments to provide high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population. APMs reward some providers with a lump-sum incentive payment for quality improvement and costs savings.

MIPS was created to replace the Physician Quality Reporting System, the Value Modifier Program, and the Medicare electronic health records Incentive Program for eligible clinicians. It will provide yearly updates to physicians starting in 2019, based on performance in four categories: quality, resource use, clinical practice improvement activities and meaningful use of an electronic health record (EHR) system.

Organizations that are not exempt, but that choose not to participate in MIPS, will receive a negative 4 percent payment adjustment.

CMS recently announced that Medicare administrative contractors (MACs) would alert providers about their MIPS status. If you have not yet received a letter, expect one by the end of this month.

The Health Law Offices of Anthony C. Vitale can assist physicians with navigating the various CMS shared savings models to maximize revenue opportunities in these times of diminishing reimbursements. If you have any questions or concerns, contact us at 305 358-4500 or email us at

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