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MIPS 2017 update is over. All the eligible participants who took part in MIPS 2017, whether individuals or groups now await results and the payment adjustments due in 2019. Whoever was unable to participate in 2017 can start attempting measures in MIPS 2018 while reporting data to CMS through a MIPS Registry.

Let us look at the most prominent changes made in MIPS 2018. The Quality Payment Program’s track of MIPS in 2018 adds new clauses to the value-based reimbursement system in the form of measures and weight classifications. It will help us in learning about the program’s salient features as well as becoming aware of the new additions.

MIPS 2018 performance benchmark is raised from 3 to 15

From a total score of 100, now the eligible clinicians must have a score above 15 to avoid negative payment adjustments in 2020. To achieve this target, the eligible professionals will be reporting at least 6 quality measures and a clinical cluster or fulfilling the requirements of improvement activity category.

The Quality category carries 50% weight

The Quality category’s value is down by 10% making it 50% for MIPS 2018.

To achieve a safe final score, the participants should attest to and report a total 6 quality measures to the CMS. In those 6 measures, one must be an Outcome Measure or a High-Priority Measure, in case you can’t find a suitable Outcome Measure. However, if you choose to submit data via CMS web interface (eligible for groups of 25 or more clinicians), you will have to report 14 measures.

Outcome Measures are those measures that relate to the health of the patients after a possible treatment or intervention. For example, the number of patients who passed away after the surgery.

The other types of measures include reporting against procedures, arrangements, effectiveness and patient involvement/experiences.

Be prepared to score in the Cost category

The big change in MIPS 2018 is the addition of a new category, cost! Now clinicians will be judged against the cost category as well. It holds 10% weight in the MIPS final score. Performing well in this category means a better composite performance score (CPS). It will impact the total score and may be the only measure standing between you and the bonus payments. The two most important measures evaluated under this category are –

  • Medicare Spending Per Beneficiary (MSPB)
  • Total Per Capita cost per recognized beneficiary

Cost category works through medical billing claims analysis as there are no data submissions required for it. To have a higher score in cost category, clinicians:

  • Must see the patients in the hospitals
  • Must have a background in at least 35 cases for MSPB
  • Must have at least 20 cases for Total Per Capita
  • Must provide a multiplicity of Medicare Part B services to a beneficiary

The idea behind this performance category is to see how much cost on an average incurs in the treatment of the patients.

The Rise of the Virtual Groups

In 2018, we see the inclusion of virtual groups as a new method of participation in MIPS. There are a total of four ways to take part in MIPS 2018. They can take part in as:

  • Individuals
  • Groups
  • APM entity in a MIPS APM
  • Virtual groups

A virtual group combines two or more TINs (Tax Identification Numbers) associated with one or more individual practitioners or one or more groups comprising of 10 or fewer eligible professionals.

Quality reporting period extends from 90 days to a whole year

Remember to complete and report those 6 measures including an outcome measure or a high-priority measure for the entire year. If you haven’t started reporting until now, there is no time left. You must start reporting MIPS data instantly. We invite you to choose P3Care for better reporting and adherence to the rules and regulations laid down by CMS. The quality category holds 50% weight in the total score, thus, a crucial factor in the achievement of bonus payments.

Data completeness

This element is emphasized in 2018. In the current performance year, all the quality methods should report 60% data completeness instead of 50%.

Using Certified EHR Technology of 2015

To make the data more authentic and up-to-date, CMS will prefer reports initiating from the 2015 Edition of the Certified EHR Technology (CEHRT). A 10% bonus for Advancing Care Information (ACI) category will be a reward for those eligible clinicians using the most recent EHR system.

You have to report for quality performance category for the entire year and the rest of the three performance categories; you only need to report for 90 days.


Be mindful of the deadlines in 2018. To conclude it, we have MIPS 2018 with quality category holding 50% importance, Advancing Care Information with its 25% invaluable share, Improvement Activities (IA) carrying 15% weight and finally the cost category holding 10% value in the final score.


The MIPS 2018 will help the healthcare providers realign themselves to ensure compliance, enabling them to keep taking advantage of the incentive payments.

CMS gave an update on 2nd November 2017, sharing MIPS 2018 updates applicable to the QPP (Quality Payment Program).

A Background to the MIPS 2018 Updates

We all know that there is a shift in the US healthcare industry towards quality healthcare. These new updates reflect the refinement of the policies for QPP while taking into consideration the US healthcare industry’s transformation concerning infrastructure, technology, clinical practices, and physician support practices.

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Copyright by P3 Care Healthcare Solution 2018. All rights reserved.

Copyright by P3 Care Healthcare Solution 2018. All rights reserved.

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