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MIPS

Quality Performance Category
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Summary of the Quality Performance Category
  • Select 6 measures to report
  • 1 outcome or high-priority measure
  • Select from individual measures or a specialty measure set
  • Population measures automatically calculated
MIPS Composite

The Quality Performance category is closely related to the Physician Quality Reporting System (PQRS). The 2016 PQRS requirements have been relaxed [now requiring 6 measures to be reported as opposed to 9] and the measures list has been updated with additional measures available.

CMS has removed the previously available Measures Group option where physicians could report on 20 patients via a registry, at least 50% of which were Part B beneficiaries. Providers must report on 50% of all patients, if reporting via registry or EHR, or 50% of all Medicare Part B patients if reporting via claims.

Key Changes from PQRS

For PQRS, eligible groups or clinicians had to report 50% of all eligible instances (using only Medicare Part B patient encounters) for individual measure reporting, or 20 unique patients for measure group reporting. For MIPS, measure groups are no longer an option, and 50% of patients from ALL payers must be reported on (80% for individual clinicians reporting via claims).

For PQRS, eligible groups or clinicians using individual measures had to report 9 measures covering 3 National Quality Strategy (NQS) domains, including one cross-cutting measure. For MIPS, the requirement is only 6 measures. As a part of those 6 measures, clinicians or groups will report one cross-cutting measure and one outcome based measure. If there is no applicable outcome measure, than a high priority measure may be used instead. There is also no NQS domain requirement under MIPS.

For PQRS in 2016, reporting successfully only achieved penalty avoidance. For MIPS, the ability to gain an incentive returns and is greater than it ever was under PQRS. Highly performing groups or clinicians can earn up to a 32% incentive for having an exceptional MIPS Composite Score.

For PQRS in 2016, groups of over 100 had to perform Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. For MIPS, there is an option to perform CAHPS surveys, but it is no longer required.

  • Submission
  • Scoring

An organization may choose to submit measure data to CMS as an individual or as a group through any the options below.

Method Individual Submisson Group Submission
Qualified Registry MIPS Quality MIPS Quality
QCDR MIPS Quality MIPS Quality
EHR MIPS Quality MIPS Quality
Claims MIPS Quality MIPS Quality
CMS Web Interface MIPS Quality MIPS Quality
CAHPS for MIPS Survey MIPS Quality MIPS Quality
Find out which submission option is best for you? Talk to a Consultant
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