MACRA/MIPS Participation



Education – webinars, videos available on the CMS website:

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Quality-Payment-Program-training-videos.html



Who Qualifies: You are eligible to participate in the MIPS track of the Quality Payment Program if you bill more than $90,000 to Medicare Part B, and provide care to more than 200 Medicare patients per year and you are a:

Physician – Physician Assistant – Nurse Practitioner – Clinical Nurse Specialist – Certified Registered Nurse Anesthetist

If you are eligible and choose to not participate in the program, you will receive the maximum amount of penalty!

You can use the Participation Status Look-up tool on qpp.cms.gov which was updated with 2018 eligibility information in the second quarter of 2018.



If your first year participating in Medicare is 2018 – then you are not required to participate in the Quality Payment Program in 2018.

Starting in 2018, MIPS eligible clinicians may participate in MIPS individually, as a group, or as a Virtual Group. Performance data is due March 31, 2019. Payment adjustments go into effect January 1, 2020.








Quality Payment Program Year 2: MIPS Highlights:

In the Quality Payment Program Year 2, here’s how we’ve adopted 2018 policies to further reduce your burden and give you more ways to participate successfully. We are keeping many of our transition year policies and making some minor changes including:

  1. Raising the performance threshold to 15 points in Year 2 (from 3 points in the transition year).
  2. Allowing the use of 2014 Edition and/or 2015 Certified Electronic Health Record Technology (CEHRT) in Year 2, and giving you a bonus for using only 2015 CEHRT.
  3. Getting up to 5 bonus points on your final score for treatment of complex patients.
  4. Automatically weighting the Quality, Promoting Interopability, and Improvement Activities performance categories at 0% of the final score for clinicians impacted by hurricanes Irma, Harvey and Maria and other natural disasters.
  5. Adding 5 bonus points to the final scores of small practices
  6. For more information click here: https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/QPP-Year-2-Final-Rule-Fact-Sheet.pdf

Quality Payment Program Year 2: APM Highlights

  1. Better Coordination and Promoting Alignment
  2. Increasing APM Participation
  3. Reducing complexity
  4. For Further information click here: https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/QPP-Year-2-Final-Rule-Fact-Sheet.pdf

Practices that have submitted PQRS in the past can access their Quality and Resource Use Reports (QRURs) to see where they stand on quality measures as well as cost measures compared to their colleagues since 50% of their scoring will be the Quality category and 10% will be their Cost category. Some cloud-based EHRs provide benchmarking services and if previous submissions were through qualified clinical data registries you can check your measures there.

There are four (4) categories for comparative performance - Quality – 50%; Promoting Interopability (PI) – 25%; Improvement Activities (CPIA) – 15% - the Resource (Cost) - 10%.

Quality – 50%

Promoting Interopability (PI) – 25% (formerly ACI)

  • Pick between two measure sets:
    • Advancing Care Information Objectives and Measures
      • Submission via Technology certified to the 2015 Edition or
      • A combination of technologies certified to the 2015 Editions that support these measures
    • 2018 Advancing Care Information Transition Objectives and Measures
      • Submission via Technology certified to the 2015 Edition or
      • Technology certified to the 2014 Edition or
      • A combination of technologies certified to the 2014 and 2015 Edition
    • Bonus of 10% if you use Advancing Care Information Objectives and Measures using 2015 CEHRT only
  • Base Scoring
    • The 5 base score Advancing Care Information measures are:
      • Security Risk Analysis
      • E-Prescribing
      • Provide Patient Access
      • Send a Summary of Care*
      • Request/Accept Summary of Care*
    • The 4 base score 2018 Advancing Care Information transition measures are:
      • Security Risk Analysis
      • E-Prescribing*
      • Provide Patient Access
      • Health Information Exchange*

*The 2018 Quality Payment Program final rule with comment period added exclusions for the ePrescribing and Health Information Exchange measures beginning with the 2017 performance period. If you qualify for these exclusions, you can still receive the base score if you:

Improvement Activities – 15%

  • Required performance report is at least a continuous 90-day period in 2018, up to and including the full calendar year (January 1, 2018 through December 31, 2018)
  • You’ll be able to pick from 100+ activities, separated into 9 subcategories
  • MIPS Improvement activity list click here: https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/2018-Resources.html
  • Individuals, Groups or Virtual groups with more than 15 clinicians that aren’t in a rural area or HPSA:
    • Maximum score - 40 points
      • 2 high-weighted activities (any subcategory) - Worth 20 points each
      • 1 high-weighted activity and 2 medium-weighted activities (any subcategory) - worth 20 points for high and 10 points for medium weights
      • 4 medium-weighted activities (any subcategory) - worth 10 points for each
  • Groups or Virtual groups with 15 or fewer clinicians, non-patient facing clinicians, and/or clinicians located in a rural area or HPSA
    • Maximum score - 40 points
      • 1 high-weighted activity (any subcategory) - worth 40 points
      • 2 medium-weighted activities (any subcategory) - worth 20 points each
  • Credit for Certified Patient-Centered Medical Home Participants, APM Participants, and MIPS APM Participants
  • Additional information click here: https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Improvement-Activities-Performance-Category-fact-sheet.pdf

Cost – 10%