The Merit-based Incentive Payment System, or MIPS, is one tough cookie. It’s complicated and downright frustrating at times—but it’s something that rehab therapists need to be familiar with. If you’ve been looking for a no-nonsense, easy-to-follow MIPS explainer, then you’ve come to the right place! Just play the video to understand the basics behind this latest government program. 

If you’ve finished the video and want a followup (or a recap) of the more complicated info we discussed, keep on scrolling. We provided that very information below! And if you want to learn even more about MIPS, check out our MIPS quality measures download.

Low-Volume Threshold

In 2019, rehab therapists are only required to report for MIPS if (between October 1, 2017, and September 30, 2018, and October 1, 2018, and September 30, 2019) they:

  • Billed Medicare for more than $90,000 in Part B allowed charges;
  • Provided care to more than 200 Medicare Part B beneficiaries; and
  • Provided more than 200 covered professional services under the Physician Fee Schedule.

If therapists do not meet all three of these criteria during both determination periods, then they’re not required to participate in MIPS. If therapists meet one or two of the low-volume threshold requirements, then they can opt in, but do not have to. Similarly, if therapists meet all three requirements during only one of the determination periods, they can opt in to the program, but do not have to participate.

QPP Participation Lookup

The easiest way to check your participation status is to use the QPP’s official participation lookup, which can be found here

Payment

Your MIPS score determines the payment adjustment you see on all Medicare Part B claims two years in the future. So, the score you earn in 2019 will affect your 2021 claims. Depending on your overall performance, you can earn up to a positive (and down to a negative) 7% reimbursement adjustment in 2019. If you excel in the program, you’ll receive an exceptional performance bonus—ranging from an additional 0.5% to 10% reimbursement—that stacks on top of your base adjustment. 

Payment History

MIPS is a budget-neutral program, which means that every positive base adjustment comes out of the penalty of a poorly-performing provider. So far, there haven’t been very many poorly-performing providers. Click here to see a chart from CMS that shows the division of performance from the first year of the program. Spoiler: A large majority of participants performed very, very well—which meant that the absolute highest positive adjustment capped out at 1.88%.

Don’t forget: The exceptional performance bonus (i.e., the additional 0.5% to 10% adjustment) is divvied up from a flat $500 million pool. That same chart indicates that 71% of MIPS participants earned the exceptional performance bonus in 2017, which meant that the bonus was split between hundreds of thousands of participating providers. 


Remember, this is just the tip of the MIPS iceberg! If you want to learn about some common MIPS-related lies or thumb through the dozens of questions other providers have had about the program, check out some of our other MIPS content, or drop a question below. We’re always happy to help!