2019 MIPS Reporting Options
Eligible clinicians and groups will be able to report 4 categories in the Merit-Based Incentive Payment System (MIPS): Quality, Promoting Interoperability, Improvement Activities, and Cost. Performance scores from the categories are combined into a Final MIPS Score to determine a payment adjustment for the MIPS eligible clinicians or group during the 2021 payment year.
Downward payment adjustment of -7%
Downward payment adjustment of greater than -7% and less than 0%
Neutral payment adjustment
A final score of 30 or more will avoid the penalty and potentially be eligible for an upward payment adjustment
Earning 75 points or more will earn a 7% upward payment adjustment and possibly an exceptional performance bonus
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2019 MIPS Reporting Timeline
Individual vs. Group Reporting
Report as an individual
Eligibility is based on >$90,000 in Medicare Part B allowable charges AND >200 Medicare Part B patients AND >200 covered professional services during the designated CMS determination period per NPI/TIN combination.
An individual is defined as a single clinician, identified by a single National Provider Identifier (NPI) number tied to a single Tax Identification Number (TIN).
If you report as an individual, your payment adjustment is based upon your MIPS Final Score for the performance year.
Report with a group
Eligibility is based on >$90,000 in Medicare Part B allowable charges AND >200 Medicare Part B patients AND >200 covered professional services the designated CMS determination period by Tax Id Number.
A group is defined as a single Taxpayer Identification Number (TIN) with 2 or more eligible clinicians (including at least one MIPS eligible clinician), as identified by their National Provider Identifiers (NPI).
Eligibility is based upon the TIN, each individual clinician included in the TIN regardless of MIPS eligibility will have to report under the group. The TIN will receive a payment adjustment based on the group’s MIPS Final Score for the performance year.