MIPS Financial Impact

Starting in 2017 reporting year i.e. 2019 payment year, the potential impact of the MIPS scoring system to clinician reimbursement will be significant. There are two ways MIPS will financially impact Medicare Part B providers:

  • Inflationary Adjustment – a 0.05% increase in payments from 2016 through 2019
  • Performance Adjustment – a negative or positive adjustment based on performance

The adjustment tiers are detailed below:

Negative Adjustments

Clinicians whose composite performance score falls between 0 and 25% of the threshold (for example, if the performance threshold is 60, then scores between 0 and 15) will receive the maximum possible negative payment adjustment for the year. Clinicians with composite performance scores closer to the threshold will receive proportionally smaller negative payment adjustments. The negative adjustments will be capped at 4% in 2019, 5% in 2020, 7% in 2021, and 9% in 2022 and beyond.

Zero Adjustments

Clinicians who submit at least one quality measure can avoid the MIPS payment adjustment.

Positive Adjustments

Clinicians whose composite performance scores are above the threshold will receive positive payment adjustment. These adjustments can be up to 4 percent in 2019 and grow over time to a maximum of 9 percent in 2022 and beyond. If the number of physicians attaining high composite scores is low, these incentives can be increased by a factor of up to 3. On the other hand, if the number of physicians attaining high score is high, then these incentives can be scaled down to ensure budget neutrality.

A special additional incentive payment funded with $500 million per year is applied for the top 75 percent of physicians above the performance threshold, ensuring that even if all physicians meet the MIPS threshold, there will still be funds for positive updates. Medicare will be able to reward over-achievers more than the under-achievers because the MIPS program is designed to be budget neutral.

Performance Year

Payment Year

% Payment Adjustment

+% Payment Adjustment

2017

2019

-4% penalty

+4% * X incentive

2018

2020

-5% penalty

+5% * X incentive

2019

2021

-7% penalty

+7% * X incentive

2020

2022

-9% penalty

+9% * X incentive

Note: The “X” incentive factor is a function of physician peer performance and incentives funds availability

To learn how TriumpHealth can help you successfully comply with MIPS requirements and maximize incentives, contact us!