Merit-based Incentive Payment System (MIPS) Alternative Payment Model (APM)

MACRA Basics

Merit-based Incentive Payment System (MIPS) Alternative Payment Models (APMs), or MIPS APMs

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Get the Making Sense of MACRA: Supplements Bundle to learn the basics of QPP. This downloadable resource features information about the law and reporting requirements for the MIPS track.


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Learn how to Pick Your Pace, select and report quality measures, and more, with Making Sense of MACRA: MIPS Playbook, a step-by-step, downloadable guide.


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The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was passed and signed into law in April of 2015. MACRA introduces two new payment tracks for physicians and aims to transition Medicare from volume-based to value-based payment models. Under MACRA, eligible clinicians (ECs) will participate in either the Merit-based Incentive Payment System (MIPS) or an Advanced Alternative Payment Model (AAPM). MIPS and AAPMs are collectively referred to as the Quality Payment Program (QPP). The initial performance period begins in 2017.

Eligible clinicians in certain APMs and those who do not meet the payment threshold or the patient threshold to receive the annual AAPM 5% lump-sum bonus payment fall into a subset of APMs called “MIPS APMs.” Clinicians in MIPS APMs are scored using the APM Scoring Standard, which was established to reduce the reporting burden on participants by eliminating the need to report to both the APM and MIPS.

MIPS APM Overview

MIPS APMs are Medicare APMs that meet certain criteria.

MIPS APMs include APMs that do not meet the criteria (e.g., taking on financial risk) to become an AAPM.

Primary care MIPS APMs include:

  • Medicare Shared Savings Program (MSSP) Track 1
  • MSSP Track 2
  • MSSP Track 3
  • Comprehensive Primary Care Plus (CPC+) initiative
  • Next Generation Accountable Care Organization (NGACO)
  • Vermont Medicare ACO initiative (as part of the Vermont All-Payer Accountable Care Organization [ACO] Model)

Most AAPMs are also considered MIPS APMs. Eligible clinicians in AAPM entities that do not meet either the patient threshold or payment threshold to be qualifying participants can opt to participate in MIPS and will be scored using the APM Scoring Standard.

Using the APM Scoring Standard, one final score for the APM entity is calculated and applied to all ECs within the APM entity.

ECs in MIPS APMs are not eligible for the annual AAPM 5% lump-sum bonus payment. However, they may qualify for positive MIPS payment adjustments and exceptional performance adjustments, based on the APM entity’s final score.

The following is the APM Scoring Standard for MSSP Tracks 1-3 and NGACO:

MIPS Performance Category

Reporting Requirement

Performance Category Weight

MIPS Performance Category

:

Quality

Reporting Requirement

:

CMS will use data submitted to the CMS Web Interface on behalf of participating MIPS APM eligible clinicians to assess the quality category.

Performance Category Weight

:

50%

MIPS Performance Category

:

Cost

Reporting Requirement

:

CMS will not assess MIPS APM eligible clinicians on cost.

Performance Category Weight

:

0%

MIPS Performance Category

:

Improvement Activities

Reporting Requirement

:

CMS will assign a score based on the requirements of the MIPS APM compared to the improvement activities requirements.

Performance Category Weight

:

20%

MIPS Performance Category

:

Advancing Care Information

Reporting Requirement

:

All TINs in the MIPS APM will need to submit data for the ACI category.

Performance Category Weight

:

30%

ACI = Advancing Care Information; CMS = Centers for Medicare & Medicaid Services; TINs = Tax Identification Numbers

The following is the APM Scoring Standard for all other MIPS APMs (e.g., CPC+):

MIPS Performance Category

Reporting Requirement

Performance Category Weight

MIPS Performance Category

:

Quality

Reporting Requirement

:

CMS will not assess MIPS APM eligible clinicians on quality in the first performance period. Eligible clinicians will submit data to CMS as required by the MIPS APM.

Performance Category Weight

:

0%

MIPS Performance Category

:

Cost

Reporting Requirement

:

CMS will not assess MIPS APM eligible clinicians on cost.

Performance Category Weight

:

0%

MIPS Performance Category

:

Improvement Activities

Reporting Requirement

:

CMS will assign a score based on the requirements of the MIPS APM compared to the improvement activities requirements.

Performance Category Weight

:

25%

MIPS Performance Category

:

Advancing Care Information

Reporting Requirement

:

All MIPS APM eligible clinicians will need to submit data either as an individual or as part of a group for the ACI category.

Performance Category Weight

:

75%

ACI = Advancing Care Information; CMS = Centers for Medicare & Medicaid Services