The Merit Based Incentive Payment System (MIPS) was established under Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. MIPS is designed to provide incentives for providers for certain quality measures, improvement activities, and the use of EMRs that meet certain standards. MIPS scoring for physical therapists, occupational therapists and qualified speech therapists is based on:
Read Jerry Henderson's blog for the updates from July 2018 about FLR and MIPS.
MIPS is one of two tracks in the Quality Payment Program, which was developed to help improve Medicare by helping care givers focus on care quality making patients healthier. It repeals:
Get up to speed on MIPS. Discover helpful guides, tools, articles and more in our MIPS Resource Center for PT and OT.
CMS wants to increase the focus on quality and value-based care. MIPS is one of the programs designed to help achieve this.
“MIPS” eligible clinicians like physical therapists, occupational therapists and speech-language pathologists who participate in Medicare Part B.
Therapists earn a payment adjustment based on evidence-based and practice-specific quality data. Therapists show they provided high quality, efficient care supported by technology by sending in information in the following categories.
MIPS is comprised of four Performance Categories that make up a composite performance score (CPS) of a possible 100 points. Only two performance categories apply to physical therapists, occupational therapists and qualified speech therapists at this time. These are the quality and improvement activities categories. Therapists can submit their individual score or a score for their entire group.
A therapist’s MIPS performance score will factor in performance in two weighted performance categories. The scale is based on a 0-100 point scale:
The payment-adjustment year is two years after the data-collection year. That means that when a therapist reports in 2019, the adjustment will be made to payments in 2021.
Under MIPS therapists with composite scores below the performance threshold will be subject to MIPS penalties on a sliding scale, with maximum penalties of up to 7% in 2021, and 9% in 2022 and beyond.
The information provided herein is intended to be general in nature. It is not offered as legal or insurance related advice, and is not a complete description, or meant, or intended, to replace or be interpreted as specific, of Medicare requirements. Although every effort has been made to ensure the content herein is correct, we assume no responsibility for its accuracy. Contact Department of Health & Human Services (DHHS) Centers for Medicare and Medicaid (CMS) Services for more information.
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