MIPS

The requirements for MIPS participation change based on the scheduled implementation of the program as established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and by annual rule-making published by CMS.

Traditional MIPS requirements for the 2024 performance year are based on the Calendar Year 2024 Updates to the Physician Fee Schedule final rule.

For the 2024 performance year, the most significant change is the increased length of the Promoting Interoperability performance period from 90 days to 180 days. There were no changes to eligibility requirements, performance category weighting, or payment adjustments. The performance periods for the Quality, Cost, and Improvement Activities categories remain unchanged.

MIPS eligible clinicians are: Physicians, Osteopathic Practitioners, Chiropractors, Physician Assistants, Nurse Practitioners, Clinical Nurse Specialists, Certified Registered Nurse Anesthetists, Physical Therapists, Occupational Therapists, Clinical Psychologists, Qualified Speech-Language Pathologists, Qualified Audiologists, Registered Dietitian or Nutrition professionals, Clinical Social Workers, and Certified Nurse Midwives. Eligible clinicians must also exceed the Low-Volume Threshold as an individual or as part of a group.

In 2024, the Low-Volume Threshold applies to clinicians who:

• Bill $90,000 or less in Medicare Part B allowed charges

  Or

• Provide care for 200 or fewer Medicare Part B patients

  Or

• Provide 200 or fewer covered professional services to Medicare Part B patients

Still not sure if you qualify? Email the QPP Helpdesk at QPP@cms.hhs.gov. The QPP Participation Status Tool can also help you review your eligibility status throughout the year.

CMS measures EC performance through data submitted in four categories. These performance categories are weighted to comprise the MIPS composite score.

• Quality: measures the quality of care delivered, based on measures related to healthcare quality and outcomes of patient care. Quality accounts for 30% of the MIPS composite score.

• Cost: cost of care provided, calculated by CMS based on the EC’s Medicare administrative claims data. Cost accounts for 30% of the MIPS composite score.

• Promoting Interoperability (PI): promotes the use of certified EHR technology for improved patient engagement and electronic exchange of information. PI accounts for 25% of the MIPS composite score.

• Improvement Activities (IA): promotes innovation and ongoing improvement to clinical activities, with a focus on areas such as coordination of care, population management, and beneficiary engagement. IA accounts for 15% of the MIPS composite score.

The final MIPS composite score determines whether the EC will receive a positive, negative, or neutral payment adjustment. To avoid a negative payment adjustment, an EC must have a minimum score of 75 points (out of 100).

ECs can earn a positive payment adjustment on their Medicare Part B reimbursements based on MIPS performance in 2024. ECs who choose not to participate or who do not meet the minimum performance thresholds will receive a negative payment adjustment of up to -9%.

• Data for the Quality and Cost categories must be reported for the full calendar year.
  • CMS uses Medicare administrative claims data to calculate Cost measure performance which means ECs do not have to submit any data for this performance category.
• Data for Promoting Interoperability must be reported for a minimum continuous 180-day period.
• Data for Improvement Activities must be reported for a minimum continuous 90-day period.

The submission period to report MIPS data for the 2024 performance year will begin January 2025.

Visit the CMS Quality Payment Programs website or contact CMS's QPP Helpdesk by calling 1-866-288-8292 or emailing QPP@cms.hhs.gov

MIPS Promoting Interoperability

Quality Measures