The Merit-based Incentive Payment System (MIPS)

Eligible Clinicians (ECs) and groups participating in the Merit-based Incentive Payment System (MIPS) will earn up to 100 points based upon their performances in four performance categories. Non-participation in MIPS when an individual or group is required to participate may result in those ECs and groups receiving a -9% payment adjustment on their Medicare Part B payments.

In Performance Year 2021, the performance threshold to receive a positive payment adjustment has been increased to 60 points. Individuals and groups scoring below 60 points will receive a negative payment adjustment. Those practices scoring exactly 60 points will receive a neutral adjustment.

2021 Performance Category Weighting are:

ECs and their practices should check their participation status to see if they must report MIPS to avoid a negative adjustment. The participation status will also indicate whether the EC or group has a Special Status designation. Some MIPS eligible clinicians (ECs) and groups may have alternate component weightings or reduced MIPS category requirements based on Special Status designations.

Although CMS has proposed MIPS Value Pathways (MVPs) in future performance years, MVPs are not available for reporting in 2021. 

CMS has allowed individual eligible clinicians and their groups to apply for a hardship exemption for MIPS reporting years 2020 and 2021 because of the COVID-19 pandemic. In 2020, CMS has made a decision not to calculate the MIPS Cost performance category for any individual or group who submitted MIPS data. If the pandemic prevents you or your group from collecting 2021 MIPS performance period data for an extended period of time, or impacts your performance on cost measures, you can submit an extreme and uncontrollable circumstances application via the CMS Quality Payment Program (QPP) website.