MIPS is a program introduced by the Centers for Medicare & Medicaid Services (CMS) that adjusts Medicare payments to eligible healthcare providers based on performance in four categories: Quality, Cost, Improvement Activities, and Promoting Interoperability.
This category evaluates healthcare providers based on their performance on various quality measures related to patient care, outcomes, and processes.
The Cost category assesses healthcare providers based on the cost of care provided to Medicare beneficiaries. It evaluates both the total cost of care and the use of healthcare resources.
This category measures healthcare providers’ participation in activities that improve clinical practice, patient engagement, care coordination, and patient safety.
Formerly known as the Advancing Care Information category, it assesses healthcare providers’ use of certified electronic health record (EHR) technology to improve the quality and coordination of patient care.
Healthcare providers who are eligible to participate in MIPS include physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, and groups that include such professionals.
The minimum composite performance score required to avoid a negative payment adjustment under MIPS. The threshold is determined annually by CMS.
A score calculated based on performance in each MIPS category (Quality, Cost, Improvement Activities, Promoting Interoperability). The CPS determines the payment adjustment received by a healthcare provider.
The positive or negative adjustment applied to Medicare payments based on a healthcare provider’s performance in MIPS. The adjustment is applied two years after the performance year.
MIPS APMs are specific types of alternative payment models that are eligible for participation in MIPS. They offer incentives for healthcare providers to participate in innovative payment models that focus on quality and value-based care.