2016-05-11 02:24:01 UTC

What is MIPS?

April 27, 2016

The majority of eligible clinicians will initially participate in the MIPS track, which closely reflects existing CMS quality programs.


Eligible clinicians who choose to participate in Merit-based Incentive Payment Systems (MIPS) will see many requirements similar to those currently being applied by CMS, but there are also many differences that will impact the rates that Medicare pays. 

It is important to start making decisions now, because the services you provide in 2017 will impact your Medicare reimbursement in 2019.

Financial Impact

  • MIPS works on a two-year cycle. Participants will eventually be subject to reimbursement adjustments — positive or negative — of up to 9 percent beginning in 2022 (for services provided in 2020). However, there is a transition period during which the maximum adjustment is:
    • 4 percent in 2019, for services in 2017.
    • 5 percent in 2020, for services in 2018.
    • 7 percent in 2021, for services in 2019.  
  • CMS anticipates awarding $833 million in incentive payments during 2019, but these will be offset by $833 million in payment reductions in the same year. 
    • Of these amounts, GIs will receive $34 million worth of incentives, but will also be subject to negative adjustments totaling $16 million.
  • Qualifying physicians can earn a portion of $500 million that CMS has allocated for exceptional MIPS performers.
  • Among GI clinicians (includes some non-physician staff such as NPs and PAs), 1,849 will see no impact from MIPS, because they qualify for exclusion based on APM participation, the low-volume threshold or status as a new Medicare provider.
  • Solo practitioners and small practices (across all specialties and primary care) will be disproportionately impacted by the MIPS program, with only 22 percent receiving positive payment adjustments.

Key Dates

  • April 16, 2015: MACRA legislation authorizing MIPS signed into law.
  • April 27, 2016: CMS releases proposed rules implementing MIPS.
  • June 27, 2016: Deadline for public to comment on MIPS before it becomes final.
  • Fall 2016: Final rules implementing MIPS will be released.
  • Jan. 1, 2017: First performance year for MIPS begins.
  • Jan. 1, 2019: MIPS payment adjustments take effect.


Updated May 11, 2016