Merit-Based Incentive Program (MIPS)

Your MIPS scores determines your Medicare payment…and your public reputation

Health care costs consume a significant amount of our nation’s resources.  In the United States, one source of inefficiency is a legacy payment system that rewards medical inputs rather than outcomes, has high administrative costs, and lacks focus on disease prevention.

HHS and CMS have introduced innovative payment and service delivery models that can reduce program expenditures for Medicare while improving or preserving beneficiary health and quality of care.  To achieve the goal of transforming Medicare fee-for-service to quality or values, they have revamped their programs and payment structure, including introducing the Merit-based Incentive Payment System (MIPS).

The Merit-based Incentive Payment System (MIPS) is a competitive program that merged Meaningful Use and PQRS to streamline multiple value-based programs. With MIPS, healthcare providers receive a single annual score determined by the following four categories:

  • Promoting interoperability (PI, formerly MU)
  • Quality (formerly PQRS/VBM)
  • Improvement Activities
  • Cost

Each of the categories has its own measures, scoring, and weighting to make up the category score, which then are aggregated to determine a MIPS final score.

The Bottom Line

It’s important to note that MIPS ranks clinicians against each other to determine who qualifies for incentives. Your final score will determine positive, neutral, or negative adjustments to your annual Medicare reimbursement.

The first MIPS performance year began on January 1, 2017, with the results affecting clinicians’ 2019 Medicare reimbursement. In subsequent years, penalties and incentives have continued to increase and eligibility requirements to become more challenging.

In addition, MIPS scores are publicly reported by the government via the Physician Compare website and will be made freely available to third-party sites like Consumer Reports, Amino, Yelp, and Angie’s List. That means that your score may not only affect your reimbursement, but also your reputation.

With so much on the line, it is critical to have a partner you can trust to help you optimize your score, revenue, and reputation.

We have extensive expertise in population health solutions with decades of experience in healthcare measures and quality improvement.

We offer a suite of solutions that can help you maximize Medicare reimbursements and avoid the negative penalties from the new Merit-Based Incentive Payment System (MIPS). Our solutions minimize workload and administrative burden, while helping you improve your MIPS Composite Performance Score. Depending on your readiness, our solutions can improve your scores in any one or all of the four MIPS categories: Quality, Improvement Activities, Promoting Interoperability, and Cost.

  • Boost all four MIPS category scores: Directly impact your Quality, Improvement Activities, Promoting Interoperability, and Costs with the SPH solution set.
  • Ongoing monitoring for improved score: Continually track your progress with our guided analytics and intuitive dashboards so you can make targeted improvements before submissions.
  • MIPS submissions: We can submit group or individual level performance data for all three MIPS categories.
  • Expert guidance: We work closely with our clients on measure selection, performance optimization, and understanding necessary data elements for success.
  • Multi-payer quality improvement: Display measure performance across Medicare and non-Medicare patients to support all payer quality improvement initiatives. Custom measure build available.

Timeline for Upcoming MIPS Value-based Potential Maximum Incentives


Each year, CMS will set a new performance threshold (PT) number of points to avoid a negative payment adjustment. Each additional point above the PT earns higher incentives, and each point the final score is below the PT incurs proportional penalties. Therefore, every point translates directly into higher or lower reimbursement.


Ensure you capture every MIPS point to boost your composite score.

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