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.

2022 MIPS Performance Year

In Performance Year 2022, the performance threshold to receive a positive payment adjustment is 75 points. Individuals and groups scoring below 75 points will receive a negative payment adjustment in 2024. Those practices scoring exactly 75 points will receive a neutral adjustment. Those scoring above 75 points will receive a positive payment adjustment with those scoring 89 points or above earning an "exceptional bonus." 

2022 Performance Category Weighting are:

2021 MIPS Performance Year

In Performance Year 2021, the performance threshold to receive a positive payment adjustment is 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 performance year 2023, MVPs are not available for reporting in 2021 or 2022. 

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 (this may affect your total points used to determine your 2022 payment adjustment).

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 learn more about how to receive an extreme and uncontrollable circumstance reporting exemption via the CMS Quality Payment Program (QPP) website.